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Appeals Nurse - Chesterfield

Company: HealthCare Support
Location: Chesterfield
Posted on: January 9, 2019

Job Description:

Are you an experienced Appeals Nurse 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! Daily Responsibilities as an Appeals Nurse: Facilitate medical necessity appeals and denials including disposition of denials notification letters, review of clinical information to determine if medical necessity criteria are met.
Review clinical data to determine claim payment based on company policies and National Committee for Quality Assurance (NCQA) guidelines, including overturning denied claims, upholding the denials and submitting cases to the Medical Director for review Prepare case review for the Medical Director in cases where criteria are not met based on the additional clinical information received Generate appropriate appeal resolution communication to the member and provider in accordance with company policies and NCQA guidelines.
Create system authorization events for overturned denial decisions Requirements for this Appeals Nurse Position: LPN with 3+ years of clinical nursing experience and strong UM experience or RN with 2+ years of experience Hours for this Appeals Nurse Position: Monday-Friday 8:00am-5:00pm Advantages of this Appeals Nurse Opportunity: Competitive salary, negotiable based on relevant experience Benefits offered, Medical, Dental, and Vision Fun and positive work environment Interested in being Considered?

Keywords: HealthCare Support, Chesterfield , Appeals Nurse - Chesterfield, Healthcare , Chesterfield, Missouri

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