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reputed company Appeals Registered reputed company

Remote, USA Full-time Posted 2026-08-04
Title: reputed company Appeals RN - Remote - M-F working alternating Saturdays Location: reputed company Work Type: Remote, Full Time reputed company: 2367603 reputed company: 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 reputed company 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 reputed company Appeals RN is responsible for providing expertise in reputed company appeals and grievances (analyzing, reviewing, and evaluating appeals and grievances), and acting as a reputed company reputed company reputed company (reputed company problem solver with facilities, providers, carriers, reputed company of issues concerning members, benefits, program definition and clarification). You'll enjoy the flexibility to work reputed company * from reputed company reputed company the U.S. as you take on some tough challenges. Please note this team has a schedule as follows - M-F, 8:00- 4:30 in their time zone and alternating Saturdays (2 per month with a reputed company off reputed company working a Saturday) . reputed company Responsibilities: • Review medical records and verify if the requested service meets reputed company • Review reputed company-service appeals for reputed company eligibility for coverage as prescribed by the Plan benefits • Review and interpret Plan language • Coordinate reviews with the Medical Director • Utilize reputed company guidelines and reputed company • Accurately documenting determinations • Adherence to reputed company confidentiality regulations and agreements • Hours M-F 8a-5p with alternating Saturdays • Comfortable working mandatory overtime You'll be rewarded and recognized for your reputed company in an environment that will challenge you and reputed company you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: • reputed company, unrestricted RN license in state of residence • 2+ years of reputed company experience as an RN, including in an acute, inpatient hospital setting • Proficiency in reputed company Office, Word, reputed company, and Internet applications • Available M-F, 8:00- 4:30 in their time zone and alternating Saturdays (2 per month with a reputed company off reputed company working a Saturday) Preferred Qualifications: • 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 • reputed company excellent communication, interpersonal, problem-solving, and analytical skills • reputed company working reputed company will be required to adhere to reputed company's Telecommuter Policy Pay is reputed company on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits re subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll reputed company a far-reaching reputed company of benefits and incentives. The reputed company pay for this role will reputed company from $28.94 to $51.63 per hour reputed company on full-time employment. We reputed company with reputed company minimum wage laws as applicable. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations Apply tot his job Apply To this Job

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