Remote Appeals & Claims UR Nurse

May 9, 2024

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Job Description

Summary Description:
As an Appeals & Claims UR Nurse, you will be responsible for investigating and reviewing clinical appeals and post-claim cases, utilizing your clinical expertise to assess the medical appropriateness of healthcare services. This remote position involves collaborating with medical providers and internal teams to ensure high standards of healthcare delivery

Location: Remote position open to residents of various states including Arizona.
Compensation and Benefits:
– Base pay ranges from $35 to $45.94 per hour
– Eligible for employee benefits
– Monthly vacation accrual of up to 10 days per year
Why you should apply for this position today:
– Join a dynamic team committed to maintaining high standards of healthcare delivery
– Opportunity to work remotely
Skills:
– Clinical expertise
– Strong communication skills
– Ability to assess medical appropriateness of healthcare services based on established criteria
– Collaboration with medical providers and internal teams
– Adherence to clinical guidelines and regulations
Responsibilities:
– Conduct medical necessity reviews and level of care assessments
– Gather essential information to evaluate members’ clinical conditions
– Maintain decision-making service level agreements
– Ensure compliance with laws and regulations
– Perform other assigned duties as needed

Qualifications:
– Active, unrestricted RN licensure in specified states or compact multistate RN license
– Associate Degree in Nursing or equivalent
– Ability to obtain additional state licenses as required
– At least 1 year of utilization review experience in managed care setting
– 2+ years of clinical experience, including 1 year in acute care setting

Similar Occupations / Job Titles that would be a great fit for this role:
– Utilization Review Nurse
– Clinical Appeals Nurse
– Medical Review Specialist

Education Requirements:
– Associate Degree in Nursing
– Graduate of Accredited School of Nursing
– Diploma Program in Practical Nursing from an Accredited School of Nursing

Education Requirements Credential Category:
– RN licensure

Experience Requirements:
– 1 year of utilization review experience in managed care setting
– 2+ years of clinical experience, including 1 year in acute care setting

Why work in Tempe, AZ:
– Tempe is a vibrant city known for its great weather, outdoor activities, and cultural scene.
– The city offers a variety of dining options, shopping centers, and entertainment venues.
– Tempe is home to Arizona State University, providing opportunities for education and cultural events.
– The city has a diverse community and offers a range of housing options to suit different preferences

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