New2d ago
- Specialty: Utilization Review
- Job type: Full-time
- Salary: $70,000 – $100,000
- License states: Compact
100% RemoteCompact RN+2
Job details- Utilization Review
- Full-time
- $75,000 – $95,000
- License: Compact
- 3+ years
Job description
The Appeals Nurse Consultant reviews member and non-par provider appeals for medical necessity and contractual benefits. This is a weekend shift role (Fri-Mon or Sat-Tue) with a 4x10 schedule. Responsibilities include conducting clinical reviews, applying medical policy and criteria, documenting decisions, and communicating with providers and members. Requires active RN license (compact preferred), 3+ years clinical experience, and knowledge of managed care. Salary range $75,000-$95,000.
Key responsibilities
- Review member and non-par provider appeals for medical necessity and contractual benefits
- Apply medical policy and clinical criteria to determine coverage
- Document review decisions in the system
- Communicate with providers and members regarding appeal outcomes
What you bring
- Active RN license (compact preferred)
- 3+ years clinical experience
- Knowledge of managed care and appeals process
- Strong clinical judgment and communication skills
Tags
Weekend shiftAppealsUtilization ReviewRemote
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- Specialty: Utilization Review
- Job type: Full-time
- Salary: $70,000 – $100,000
- License states: Compact
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- Specialty: Utilization Review
- Job type: Full-time
- Salary: $45,000 – $65,000
- License states: Compact
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