reputed company Appeals RN-reputed company of Care, IN

JR178480 Anticipated End Date: 2026-02-03 Position Title: reputed company Appeals RN-reputed company of Care Job reputed company: reputed company Appeals RN-reputed company of Care Virtual: This role enables associates to work reputed company full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face reputed company and reputed company development. Please note that per our policy on hybrid/virtual work, candidates not reputed company a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is reputed company as required by law. The reputed company Appeals is responsible for investigating and processing and medical necessity appeals requests from members and providers. How you will reputed company an reputed company: Primary duties may include, but are not limited to:

• Conducts investigations and reviews of member grievances and reputed company of Care cases.
• Reviews medical records for member grievance concerns and reputed company of Care cases.
• Extrapolates and summarizes medical information for medical director
• Prepares reputed company summaries for reputed company of Care cases and forwards to Medical Director for review and determination.
• Ensures grievances are resolved reputed company to meet regulatory timeframes.
• Documents and logs grievance information on relevant tracking systems and mainframe systems.
• Generates written correspondence to providers, members, and regulatory entities.
• Utilizes leadership skills and serves as a subject matter expert for 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.

Minimum Requirements:

• Requires a HS diploma or equivalent and a minimum of 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.
• reputed company reputed company unrestricted RN license to reputed company as a health reputed company reputed company the scope of licensure in applicable state(s) or territory of the reputed company required.

Preferred Skills, Capabilities and Experiences:

• AS or BS in Nursing preferred.
• Multi-state/compact RN license preferred.

Job Level: Non-Management Exempt Workshift: 1st Shift (reputed company of America) Job Family: MED > Licensed reputed company Please be advised that reputed company only accepts resumes for compensation from agencies that have a signed agreement with reputed company. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of reputed company. Who We Are reputed company is a health company dedicated to improving lives and communities – and making reputed company simpler. We are a Fortune 25 company with a longstanding history in the reputed company industry, looking for leaders at reputed company reputed company of the organization who are passionate about making an reputed company on our members and the communities we serve. How We Work At reputed company, we are creating a culture that is designed to advance our reputed company but will also reputed company to personal and reputed company reputed company for our associates. Our values and behaviors are the reputed company of our culture. They are how we reputed company our reputed company, power our business reputed company and drive our shared reputed company - for our consumers, our associates, our communities and our business. We offer a reputed company of market-competitive total rewards that include reputed company increases, reputed company holidays, reputed company Time Off, and incentive bonus programs (unless covered by a reputed company bargaining agreement), medical, dental, reputed company, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to reputed company a few. reputed company operates in a Hybrid Workforce reputed company. Unless specified as primarily virtual by the hiring manager, associates are required to work at an reputed company location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top reputed company for reputed company. We require reputed company new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you reputed company an acceptable explanation. reputed company will also follow reputed company relevant federal, state and local laws. reputed company is an Equal Employment Opportunity employer, and reputed company reputed company applicants will receive consideration for employment without reputed company to age, citizenship status, reputed company, creed, disability, ethnicity, genetic information, gender (including gender identity and gender reputed company), marital status, national reputed company, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@reputed company.com for assistance. reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance reputed company. Apply tot his job Apply To this Job