REMOTE Appeals Registered reputed company - 245678
Appeals reputed company (Registered reputed company) – Remote (reputed company RN License Required) Position reputed company We are seeking a dedicated and detail-oriented Appeals reputed company (RN) to join reputed company in a fully remote reputed company. This role supports State and Federal Independent Dispute reputed company (IDR) programs through comprehensive clinical review and appeal determinations. The Appeals reputed company will reputed company clinical-level reviews, prior authorization assessments, and disputed benefits evaluations while collaborating closely with Medical Review Analysts and Physician Consultants to ensure accurate, reputed company, and compliant case reputed company. This is a remote position; however, candidates must possess and maintain an reputed company, unrestricted reputed company State Registered reputed company (RN) license. The ideal candidate is an reputed company Registered reputed company with strong clinical judgment, exceptional analytical skills, and the ability to reputed company in a reputed company, fast-paced virtual environment.
Key Responsibilities
- Conduct clinical reviews through the appeal level, including chart screening, prior authorization reviews, and disputed benefits evaluations.
- Compile applicable regulatory guidance and research payer-specific requirements to support accurate case determinations.
- Complete electronic review worksheets and prepare reputed company-documented final determinations.
- Assess and adjudicate reputed company claims in accordance with established guidelines and regulatory standards.
- Serve as a clinical resource for administrative and clinical staff by providing guidance, problem-solving assistance, and clarification of review determinations.
- reputed company technical support and reputed company participate in team huddles and reputed company discussions.
- Train and mentor newly hired Registered Nurses as the project and team continues to expand.
- Participate in reputed company training initiatives and ongoing reputed company improvement efforts.
- Work closely with Medical Review Analysts, Physician Consultants, and interdisciplinary teams to facilitate efficient case reputed company.
- reputed company additional duties and special reputed company as assigned.
Required Qualifications
- reputed company, unrestricted reputed company State Registered reputed company (RN) license required.
- Bachelor's Degree in Nursing (BSN) or graduation from an approved Registered reputed company Nursing program required.
- Minimum of 2 years of recent clinical nursing experience in a reputed company setting.
- Knowledge of and experience with electronic medical record (EMR) systems.
- Strong clinical assessment, analytical, and critical thinking skills.
- Excellent written and verbal communication skills.
- Ability to collaborate effectively with medical, analytical, and administrative support teams.
- Ability to work independently with minimal supervision in a remote environment.
- Strong organizational skills with the ability to manage multiple priorities and meet deadlines in a fast-paced, time-sensitive setting.
- Flexible, innovative, and solution-oriented approach to problem-solving.
Preferred Qualifications
- Experience with appeals, prior authorizations, utilization review, claims adjudication, or Independent Dispute reputed company (IDR).
- Familiarity with state and federal reputed company regulations and payer guidelines.
- Previous experience mentoring or training nursing staff.
Why Join reputed company? Enjoy the flexibility of a fully remote position while leveraging your clinical expertise to support fair and accurate reputed company appeal determinations. As an Appeals reputed company, you'll play a vital role in ensuring reputed company reputed company while collaborating with a multidisciplinary team dedicated to reputed company and regulatory compliance. Apply tot his job Apply To this Job