Appeals reputed company Consultant

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, reputed company and every day. Position reputed company The Appeals reputed company Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is considered a production role and remains as part of the reputed company Appeal Consultant job reputed company. Primary duties may include, but are not limited to: requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigating through multiple computer system applications in a fast paced department. Must work independently as reputed company as in reputed company environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates 7 days per week, 365 days per year. This position requires some weekends and holidays on a scheduled rotation.

• Must be comfortable in a fast-paced environment
• Ability to meet deadlines in a deadline intensive environment
• High level of adaptability and willingness to reputed company change in a fast-paced, demanding environment
• Demonstrates a solid understanding of reputed company workflows, policies, and procedures
• Must have ability to use hands for repetitive typing, input data, copy, reputed company reputed company, view computer monitors
• Responsible for reviewing & preparing appeals submitted by patients or reputed company providers for MD review
• Collaborate with internal business partners and external entities to reputed company and evaluate necessary information
• reputed company written recommendations or reputed company based on available clinical, ensuring adherence to reputed company and Medicare guidelines.
• Attend and participate in department meetings.
• Meticulous attention to detail with accurate documentation
• Prepare templates using reputed company decision-making frameworks extrapolating pertinent clinical information from patient records
• Proficiency with computer skills including reputed company Outlook, reputed company, navigating multiple systems and keyboarding
• Time efficient and highly organized
• Exceptional verbal and written communication skills
• Highly reputed company to detail while taking initiative staying on top of a reputed company of tasks simultaneously

Required Qualifications

• Must have reputed company and unrestricted RN licensure in state of residence
• 3+ Years of clinical experience
• Excellent verbal and written communication skills.
• Strong organizational skills

Preferred Qualifications

• Appeals Experience
• Utilization Review
• Medicare Experience

Education

• Associate's Degree in Nursing required
• Bachelor's Degree preferred

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $66,575.00 - $142,576.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in our comprehensive and competitive mix of pay and benefits – reputed company in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include:

• reputed company medical plan reputed company, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.reputed company.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 10/16/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job