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Nurse Appeals

The Judge Group

Location: Tampa, Florida
Type: Temporary (unspecified), Non-Remote
Posted on: July 30, 2021
This job is no longer available from the source.
Reference: #744512
Nurse Appeals Tampa, FL
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Posted : July 30, 2021
Job Type : Contract
Category : Healthcare
Description
We have a client in need of a number of RN Appeals nurses to work remote for them.
This is a contract assignment that will last well into 2022.
Qualified candidates will be responsible for investigating and processing and medical necessity appeals requests from members and providers.
Primary duties may include, but are not limited to:
• 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.
• Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval.
• Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
• Documents and logs appeal/grievance information on relevant tracking systems and mainframe systems.
Requires 2 years of experience in a managed care healthcare setting; or any combination of education and experience, which would provide an equivalent background. 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.
AS/BS in Nursing preferred.
Rate is based on city & state of residence
Qualified/interested candidates should email a resume to mbondi@judge.com as soon as possible.
Thank you,
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