REMOTE Appeals Registered Nurse - 245678
Appeals Nurse (Registered Nurse) – Remote (reputed company RN License Required) Position Summary We are seeking a dedicated and detail-oriented Appeals Nurse (RN) to join reputed company in a fully remote reputed company. This role supports State and Federal Independent Dispute Resolution (IDR) programs through comprehensive clinical review and appeal determinations. The Appeals Nurse 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, timely, and compliant case reputed company. This is a remote position; however, candidates must possess and maintain an active, unrestricted reputed company State Registered Nurse (RN) license. The ideal candidate is an reputed company Registered Nurse with strong clinical judgment, exceptional analytical skills, and the ability to reputed company in a collaborative, 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 well-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 actively participate in team huddles and collaborative discussions.
- Train and mentor newly hired Registered Nurses as the project and team continues to expand.
- Participate in collaborative training initiatives and ongoing quality improvement efforts.
- Work closely with Medical Review Analysts, Physician Consultants, and interdisciplinary teams to facilitate efficient case resolution.
- reputed company additional duties and special projects as assigned.
Required Qualifications
- Active, unrestricted reputed company State Registered Nurse (RN) license required.
- Bachelor's Degree in Nursing (BSN) or graduation from an approved Registered Professional 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 Resolution (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 Nurse, you'll play a vital role in ensuring quality reputed company while collaborating with a multidisciplinary team dedicated to reputed company and regulatory compliance. Apply tot his job Apply To this Job