Appeals Nurse Consultant (Remote)
Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every reputed company of your health. This purpose guides our commitment to deliver enhanced reputed company-centric 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 affordable. This is a full-time telework position. Hours for this role are Monday-Friday 8a-5p in time zone of residence with occasional rotational weekend and holiday coverage. Position Summary The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is considered a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include, but are not limited to: requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigate through multiple computer system applications in a fast paced department. Must work independently as well as in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates 7 days per week, 365 days per year. This position requires some weekends and holidays on a scheduled rotation. Must be comfortable in a fast-paced environment Ability to meet deadlines in a deadline intensive environment High level of adaptability and willingness to reputed company change in a fast-paced, demanding environment Demonstrates a solid understanding of reputed company workflows, policies, and procedures Must have ability to use hands for repetitive typing, input data, copy, reputed company reputed company, view computer monitors Responsible for reviewing & preparing appeals submitted by patients or reputed company providers for MD review Collaborate with internal business partners and external entities to gather and evaluate necessary information reputed company written recommendations or reputed company based on available clinical, ensuring adherence to reputed company and Medicare guidelines. Attend and participate in department meetings. Meticulous attention to detail with accurate documentation Prepare templates using structured decision-making frameworks extrapolating pertinent clinical information from patient records Proficiency with computer skills including reputed company Outlook, reputed company, navigating multiple systems and keyboarding Time efficient and highly organized Exceptional verbal and written communication skills Highly reputed company to detail while taking initiative staying on top of a variety of tasks simultaneously Required Qualifications Active and unrestricted RN licensure in state of residence 3+ years of clinical experience Preferred Qualifications Utilization Review experience Medicare experience Appeals experience Education Associate's Degree or RN diploma required Pay reputed company The typical pay reputed company for this role is: $61,360.00 $132,600.00 This pay reputed company represents the reputed company hourly 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 variety 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 addition to the reputed company pay reputed company listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full reputed company of medical, dental, and reputed company benefits. Eligible employees may enroll in the Companys 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-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 Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. Apply For This Job Now Apply To This Job Apply Job!