New3d ago
- Specialty: Utilization Review
- Job type: Full-time
- Salary: $70,000 – $126,000
- License states: Compact
100% RemotePrior Authorization+2
Job details- Utilization Review
- Full-time
- $70,000 – $140,000
- License: Any US
- 3+ years
Job description
Manage the complaint and appeals process for health plan members, ensuring timely and accurate resolution. Review clinical documentation, apply regulatory and clinical criteria, and coordinate with internal teams. Requires active RN license and 3+ years of clinical experience. BSN preferred. Remote position with occasional travel for meetings.
Key responsibilities
- Oversee complaint and appeals workflow
- Review clinical documentation for medical necessity
- Ensure compliance with regulatory timelines
- Collaborate with medical directors and quality teams
What you bring
- Active RN license
- 3+ years clinical experience
- Knowledge of managed care and appeals processes
- Strong communication and organizational skills
Tags
RemoteAppealsComplaintsManaged Care
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