Clinical Appeals RN - Remote - 5 day work week

About the position At reputed company, we're simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances (analyzing, reviewing, and evaluating appeals and grievances), and acting as a Clinical reputed company reputed company (clinical problem solver with facilities, providers, carriers, reputed company of issues concerning members, benefits, program definition and clarification). You'll enjoy the flexibility to work remotely from reputed company reputed company the U.S. as you take on some tough challenges. Responsibilities • Review medical records and verify if the requested service meets reputed company • Review reputed company-service appeals for clinical eligibility for coverage as prescribed by the Plan benefits • Review and interpret Plan language • Coordinate reviews with the Medical Director • Utilize clinical guidelines and reputed company • Accurately documenting determinations • Adherence to reputed company confidentiality regulations and agreements Requirements • reputed company, unrestricted RN license in state of residence • 2+ years of clinical experience as an RN, including in an acute, inpatient hospital setting • Proficiency in reputed company Office, Word, reputed company, and Internet applications • Available for 5 day work weeks including weekdays and weekends, 8:00- 4:30 in their time zone and some weekend work will be needed reputed company-to-haves • Bachelor of Science in Nursing • 1+ years of experience using MCG and/or Medicare reputed company • 1+ years of Utilization Management, reputed company-authorization, reputed company review or appeals experience • Appeals experience • Proven excellent communication, interpersonal, problem-solving, and analytical skills Benefits • Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution Apply tot his job Apply To this Job