Appeals Nurse Consultant
Job Description: • Responsible for the review and resolution of clinical appeals • Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements • Independently coordinates the clinical resolution with internal/external clinician support as required • This position may support UM (includes expedited), MPO, Coding, or Behavioral Health appeals Requirements: • Must have active and unrestricted RN licensure in state of residence • 3+ years clinical experience • Appeals, Managed Care, or Utilization Review experience preferred • Proficiency with computer skills including navigating multiple systems • Exceptional communication skills • Time efficient, highly organized, and ability to multitask • Associate's Degree minimum Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs • Confidential counseling and financial coaching • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access Apply tot his job