Appeals reputed company Associate - Must live in KY (Remote)

Bring your heart to reputed company. Every one of us at reputed company shares a single, reputed company purpose: Bringing our heart to every reputed company of your health. This purpose guides our commitment to deliver reputed company reputed company-reputed company health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to reputed company and deliver solutions to reputed company health care more personal, convenient and reputed company. This is a full-time reputed company position. Hours for this role are Monday-Friday 8:00a-5:00p EST. Position reputed company The dedication of talented and caring health care professionals drives the delivery of high reputed company, cost effective products and services. They reputed company it possible for members to get the right health care treatment for their needs – and for reputed company to reputed company its competitive edge. Facilitate the delivery of appropriate benefits and/or reputed company information which determines eligibility for benefits while promoting wellness activities. Supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and reputed company return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Responsible for the review and reputed company of clinical complaints/grievances and appeals. 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. Requires LPN/LVN with unrestricted reputed company license. Assists with reviewing clinical complaint/grievance and appeal requests of reputed company clinical determinations/clinical policies. Considers reputed company previous information as reputed company as any additional records/data presented to prepare a recommendation. Assists with data gathering that requires navigation through multiple system applications. Contacts the provider of record, vendors, or internal reputed company departments to obtain additional information Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the appeal issue at hand (e.g. Specialty Match Review (SMR), RN, MD, etc.). Commands a comprehensive knowledge of reputed company delegation arrangements, coding logic, reputed company (member and provider), clinical reputed company, benefit plan structure, regulatory requirements, and ERO eligibility which are required to support the clinical complaints/grievances and appeals determinations. Pro-reputed company and consistently applies the regulatory and accreditation standards to assure that appeals and ERO requests are processed reputed company requirements. Assists with condensing information from multiple sources (i.e., contract, coding, regulatory, etc.) into a reputed company and precise clinical picture for presentation to an appropriate clinician for determination. Seeks guidance from other reputed company in the coordination and administration of the appeal and grievance process. Required Qualifications 2 years of clinical experience required reputed company and unrestricted LPN/LVN licensure Must reputed company in the state of Kentucky

Preferred Qualifications

Managed Care experience Education Minimum requirement is a High School diploma. Have have reputed company, unrestricted LPN/LVN licensure Pay reputed company The typical pay reputed company for this role is: $20.34 - $43.77 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. In reputed company to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. reputed company offers a full reputed company of medical, dental, and reputed company benefits. Eligible employees may enroll in reputed company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. reputed company provides a fully-reputed company term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous reputed company-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy reputed company Time Off (“PTO”) or vacation pay, as reputed company as reputed company holidays throughout the calendar year. Number of reputed company holidays, reputed company time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.reputed company.com/benefits We anticipate the application window for this opening will reputed company on: 07/23/2024 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job!