Appeals Nurse- (Remote)
NEW REMOTE APPEALS Nurse for a contract at an insurance company in Maryland!
UM/Appeals RN Qualifications...
? MD or Compact RN
? 2 years of appeals and denials experience
? Managed care experience
? InterQual criteria experience a must
Job Description:
? 13 weeks, M-F, 8 hour days up to 40 hours or Part time working 20 hours per week, REMOTE, No weekends or Holidays
? Responsible for the day to day management of health confined plan members in acute care and/or rehabilitative facilities. The Utilization Nurse (UN) actively monitors the appropriateness of care received by plan members in a variety of settings, acute hospital, sub-acute hospital, and acute rehabilitation facility. The Utilization Nurse applies member benefit and medical criteria to determine authorization of services in coordination with the Medical Directors. The Utilization Nurse proactively initiates discharge planning for of members, including identification of post-discharge needs and coordination of post discharge referrals/services. The UN communicates verbally and in writing authorization and/or denial of covered services with providers, facilities and members. The UN is a member of administrative and clinical teams in the area of assignment. Clinical knowledge is maintained and updated and UN must maintain acceptable documentation and quality standards.
? Skills: Excellent verbal and written communication skills to effectively interact and work correctively with enrollees, Physicians facility staff and management staff. Work requires excellent interpersonal skills and attitude to effectively project a positive image of our Managed Care Program. Computer skills working with a variety of applications and online systems. Knowledge of Enterprise and utilizing various criteria sets i.e. InterQual. Ability to negotiate and resolve conflicts with external customers.
? *Must be able to go into the office for equipment (Hanover, MD)
Contact information below:
Kayla Walsh- 410-825-6186 #2
rsirecruit.com
Key Words: Utilization review Nurse, Registered nurse, Remote, InterQual, managed care, insurance, Appeals and Denials
Job Type: Full-time
Pay: Up to $44.00 per hour
Weekly schedule:
? Monday to Friday
Experience:
? Interqual: 1 year (Required)
? Appeals and Denials: 2 years (Required)
? Utilization Review: 2 years (Preferred)
License/Certification:
? MD or Compact RN License (Required)
Location:
? Hanover, MD (Required)
Work Location: Remote
Similar Remote Jobs
Appeals Nurse- (Remote)
Posted on: 16-07-2024 19:04
Delta Airlines Remote Customer Service Representative - Apply Now
Posted on: 16-07-2024 19:04
Researcher | YouTube News Channel
Posted on: 16-07-2024 19:04
Java Full Stack Developer (Fully Remote)
Posted on: 16-07-2024 19:04
CostCo At Home Careers - Data Entry Remote Jobs (Part-Time)
Posted on: 16-07-2024 19:04
(No Experience/ Entry Level) Data Entry Specialist - REMOTE WORK
Posted on: 16-07-2024 19:04
Customer Service Rep (REMOTE)
Posted on: 16-07-2024 19:04
Online Call Center Associate
Posted on: 16-07-2024 19:04
User Experience Athlete ( Night shift, Remote)
Posted on: 16-07-2024 19:04
Online Remote Google Job
Posted on: 16-07-2024 19:04
Delta Work At Home Jobs $27/Hour ? DPS
Posted on: 27-08-2024 00:00
Senior Engineering Manager - HR Systems & People Technology (REMOTE)
Posted on: 11-09-2024 00:00
Victim Services Specialist - Southern Colorado
Posted on: 31-01-2025 09:59
Administrative Business Partner
Posted on: 25-10-2024 07:23
Flex Jobs Data Entry
Posted on: 16-07-2024 18:39
Category Director - Remote
Posted on: 24-09-2024 00:00
Human Resources Coach
Posted on: 22-10-2024 05:24
Part-time Faculty, Philosophy -- Remote | WFH
Posted on: 16-07-2024 19:05
UnitedHealth Group Enrollment Specialist ? National Remote in Tampa, Florida
Posted on: 31-01-2025 10:00
Construction Manager, AMZL Pacific Northwest Region
Posted on: 07-12-2024 04:21