Appeals Nurse Jobs

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Job Title:G&A Appeals Nurse

Location:Remote – OH

Duration:6+ Months (Contract to Hire)

:

Walk me through the day to day responsibilities of this the role and a description of the project (Outside of Workday JD):

Perform appeal review for medical necessity, complete appeal cases (making determination, documenting outcome, sending out letter, and closing out appeal in system).

Behavior and accountability and ability to pivot when new priorities come up

Describe the performance expectations/metrics for this individual and their team:

10 to 15 appeals a day after training. Not letting any items in work queues go over compliance Turn Around Time.

What previous job titles or background work will in this role?

Utilization review nurse, appeal review nurse and direct patient care experience.

Required Skills/Experience:

1.

Experience with Utilization Review/Management--2 yrs

1.

Direct patient care experience

2.

Reviews relevant information within denied authorization/prior authorization case to ensure a complete case summary is provided to the Medical Director for review of the appeal case.

2.

Longevity at positions

3.

Review medical code data and records to determine whether a denial is warranted.

Utilizing multiple appeals/claims systems to conduct medical reviews.

3.

Writing appeal or authorization outcome letters.

Education Requirement:

LPN Minimum

Education Preferred:

RN-Not required

Software Skills Required:

Comfortable with Microsoft office programs and utilizing systems to input medical criteria.