Appeals Review Nurse
Posted Updated
Position Summary:
- Reviews clinical information provided by the facility and providers to evaluate the medical necessity and clinical appropriateness of requested services for a member
- Collects information concerning eligibility, provider status, benefit coverage, coordination of benefits and subrogation necessary to reach prospective, concurrent and retrospective decisions in the appeals process
- Produces approval and denial letters on behalf of the Medical Director for submission to member, provider or hospital
Hours for this Position: Monday-Friday 8:00-5:00
Advantages of this Opportunity:
- Competitive salary, negotiable based on relevant experience
- Benefits offered, Medical, Dental, and Vision
- Fun and positive work environment
What We Look For:
- LVN/LPN
- Experience in acute care facility
- Experience managing patients in an inpatient environment
- Knowledge of MS applications
Are you an experienced LVN or LPN with claims and appeals experience looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!
Interested in hearing more about this great opportunity? Please click on the apply button for immediate consideration.