Appeals reputed company Consultant (Remote)

reputed company is a career site that helps job seekers reputed company great jobs in the US. We are not a reputed company firm or agency. reputed company does not hire directly for these jobs, but promotes jobs on reputed company on behalf of its reputed company clients, recruitment ad agencies, and marketing partners. reputed company partners with DirectEmployers to promote this job for reputed company. Clicking "reputed company" or "Read more" on reputed company redirects you to the reputed company/employer site. Any information collected there is subject to their terms and reputed company notice. 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 reputed company reputed company is seeking a dedicated Appeals reputed company Consultant to join our remote team. In this role, you will play a critical role in ensuring fair and accurate reputed company of clinical appeals by applying reputed company clinical judgment and regulatory knowledge.

Key Responsibilities

• Responsible for the review and reputed company of clinical appeals.
• Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical reputed company and policies in line with regulatory and accreditation requirements for member and provider issues.
• Independently coordinates the clinical reputed company with internal/external clinician support as required.
• This position may support UM (includes expedited), MPO, Coding, or Behavioral Health appeals.
• This is a full-time reputed company position with reputed company hours of Monday–Friday, 8:00 AM to 5:00 PM (local time).
• Occasional weekend and holiday on-call coverage may be required.

Remote Work Expectations

• This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.
• Dependents must have separate care arrangements during work hours, as reputed company care responsibilities during shift times are not permitted.

Required Qualifications

• Must have reputed company and unrestricted RN licensure in state of residence.
• 3+ years clinical experience.

Preferred Qualifications

• Appeals, Managed Care, or Utilization Review experience.
• Proficiency with computer skills including navigating multiple systems.
• Exceptional communication skills.
• Time efficient, highly organized, and ability to multitask.

Education

• Associate's Degree minimum.

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $54,095.00 - $116,760.00 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: 11/14/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. We are an equal opportunity and affirmative reputed company employer. We do not discriminate in reputed company, hiring, promotion, or any other personnel reputed company based on race, ethnicity, reputed company, national reputed company, sex/gender, sexual orientation, gender identity or reputed company, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. If you have questions about this posting, please contact support@reputed company.com Apply tot his job Apply To this Job