Register
Recruit Create CV

Clinical Appeals Registered Nurse – Telecommute Jobs in Ohio

Registered Nurse (Rn) - Appeals & Grievances
By CareOregon At , Portland, 97204, Or $87,140 - $105,435 a year
Knowledge of utilization management practice principles and industry standard criteria
Knowledge, skills and abilities required
Maintain confidentiality of all discussions, records, and other data in connection with quality management activities according to professional standards
Knowledge of Oregon Health Plan benefit package including rules and regulations that pertain to health plan operations
Knowledge of Medicare A and B benefits and regulations that relate to Medicare Advantage plans
Physical Skills and Abilities Required
Nurse Appeals Jobs
By Elevance Health At Columbus, OH, United States
Preferred Capabilities, Skills And Experiences
Location: Remote – OH, VA, NY, FL
Job Family: Medical and Clinical
Conducts investigations and reviews of member and provider medical necessity appeals.
Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.
Extrapolates and summarizes medical information for medical director, consultants and other external review.
Registered Nurse (Telehealth Clinical Technician)
By US Veterans Health Administration At , Lorain, Oh $76,502 - $140,628 a year
Provides patient and family health education with a focus on self- management, prevention, and wellness, based on the patient's goals.
Providing patient and family health education with a focus on self-management, prevention, and wellness, based on the patient's goals.
If you are relying on your education to meet qualification requirements:
Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required.
VA offers a comprehensive total rewards package: VA Nurse Total Rewards

Are you a Registered Nurse looking for a unique opportunity to use your clinical expertise from the comfort of your own home? We are looking for a Clinical Appeals Registered Nurse to join our team and help us provide quality care to our patients. As a Clinical Appeals Registered Nurse, you will be responsible for reviewing appeals and making decisions based on clinical criteria. If you are looking for an exciting and rewarding career, this is the perfect opportunity for you!

Overview:

A Clinical Appeals Registered Nurse – Telecommute is a professional nurse who works remotely to review and process appeals for medical claims. The nurse is responsible for reviewing medical records, determining the validity of the appeal, and making a recommendation to the insurance company. The nurse must be knowledgeable in medical coding, billing, and appeals processes.

Detailed Job Description:

The Clinical Appeals Registered Nurse – Telecommute is responsible for reviewing medical records and claims to determine the validity of appeals. The nurse must be able to interpret medical records, understand medical coding and billing, and be familiar with the appeals process. The nurse must be able to make recommendations to the insurance company regarding the appeal. The nurse must also be able to communicate effectively with the insurance company and the patient.

What is Clinical Appeals Registered Nurse – Telecommute Job Skills Required?

• Knowledge of medical coding and billing
• Knowledge of the appeals process
• Ability to interpret medical records
• Ability to communicate effectively with insurance companies and patients
• Ability to make recommendations to insurance companies
• Ability to work independently

What is Clinical Appeals Registered Nurse – Telecommute Job Qualifications?

• Registered Nurse (RN) license
• Bachelor’s degree in Nursing
• 3+ years of experience in medical coding and billing
• Experience in the appeals process
• Excellent communication and interpersonal skills

What is Clinical Appeals Registered Nurse – Telecommute Job Knowledge?

• Knowledge of medical coding and billing
• Knowledge of the appeals process
• Knowledge of medical terminology
• Knowledge of medical records

What is Clinical Appeals Registered Nurse – Telecommute Job Experience?

• 3+ years of experience in medical coding and billing
• Experience in the appeals process
• Experience working with insurance companies

What is Clinical Appeals Registered Nurse – Telecommute Job Responsibilities?

• Review medical records and claims to determine the validity of appeals
• Interpret medical records
• Communicate effectively with insurance companies and patients
• Make recommendations to insurance companies
• Work independently and meet deadlines