Nurse Appeals Jobs

• Job Family: Medical and Clinical
• Req #: JR81982
• Type: Full time
• Date Posted:Jul 18, 2023

Location:

• National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
• VA, NORFOLK

Description
Location: Remote-This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
Schedule: Working schedule is from 7:30am to 4:30pm on Eastern time zone or Central time zone.
Primary Duties May Include, But Are Not Limited To
The Nurse Appeals is responsible for investigating and processing quality of care issues, clinical grievances, and critical incidents from members, providers, and internal staff.

• Ensures that Quality of care reviews and clinical grievances are resolved timely to meet regulatory timeframes.
• Utilize leadership skills and serves as a subject matter expert for critical incidents/grievances/quality of care issues and is a resource for clinical and non-clinical team members in expediting the resolution of outstanding issues.
• Documents and logs grievance information and quality of care investigations on relevant tracking systems and mainframe systems.
• Conducts investigations and reviews of member grievances and potential quality of care issues.
• Reviews medical records for potential quality of care issues.
• Generates written correspondence to providers, members, and regulatory entities.
• Extrapolates and summarizes medical information for medical director.
• Resolving member clinical grievances (complaints).

Qualifications -

• Current active unrestricted RN license to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required.
• 2 years of experience in a managed care healthcare setting; or any combination of education and experience, which would provide an equivalent background.

Preferred Requirements

• For URAC accredited areas the following applies: Requires strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• AS or BS in Nursing preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $69,872 to $114,336.
Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY.
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, 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 [email protected] for assistance.
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• EEO Policy Statement
• Pay Transparency
• Know Your Rights
• Privacy Notice for California Residents

Elevance Health, Inc. is anE-verify Employer (https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)
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