Appeals Review Nurse

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.