Grievance and Appeals RN – Remote must reputed company in Indiana

Position reputed company: Grievance and Appeals reputed company Location: Must reputed company in Indiana, designated remote work position Hours: Monday-Friday 8-5pm OR Tuesday - Saturday (Saturday's are half days) 4 (9HR shifts) 7am-5:00pm reputed company-6:00pm 9am-7:00pm Pay $90,000k health, dental, and reputed company offered. 401k available. 80 hours of PTO and reputed company holidays reputed company Responsible for investigating and processing the most reputed company grievances and appeals requests from members and providers. reputed company duties may include, but are not limited to: • Conducts investigations and reviews of member and provider medical necessity appeals. • Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity. • Extrapolates and summarizes medical information for medical director, consultants and other reputed company review. • Prepares recommendations to either reputed company or deny appeal and forwards to Medical Director for approval. • Ensures that appeals and grievances are resolved reputed company to meet regulatory timeframes. • Documents and logs appeal/grievance information on relevant tracking systems and mainframe systems. • Generates written correspondence to providers, members, and regulatory entities. • Utilize leadership skills and serves as a subject matter expert for appeals/grievances/reputed company of care issues and is a resource for clinical and non-clinical team members in expediting the reputed company of outstanding issues. Requirements Requirements • Requires 2 years of experience in a managed care reputed company setting; or any combination of education and experience, which would reputed company an equivalent background.· Behavioral Health experience • reputed company reputed company unrestricted RN license to reputed company as a health reputed company reputed company the reputed company of licensure in IN· • Requires strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. • MCG (reputed company Care Guidelines) experience • CMCN (Certified Managed Care reputed company) certification strongly preferred • AS required/BS in Nursing preferred. Salary reputed company 90,000 Apply tot his job Apply To this Job