Appeals Nurse

HealthCare Support is actively seeking an Appeals Nurse for a remote opportunity with a top managed care company. Candidates in the Columbus, Ohio area are preferred.

Daily Responsibilities for Transitional Care Nurse:

• Perform appeal review for medical necessity, complete appeal cases (making determination, documenting outcome, sending out letter, and closing out appeal in system).
• Obtain access to systems and attend trainings on criteria for making utilization and appeal
• 10 to 15 appeals a day after training. Not letting any items in work queues go over compliance Turn Around Time.
• M-F, 8—5
• Right to Hire!
  
  
  

Required Qualifications for Transitional Care Nurse:

• Clear and active Ohio RN or LPN license
• Good job tenure – manager doesn't like jumpy candidates, wants them to stay long term
• LPN or RN with clear and active Ohio license
• 2 years of experience in appeals, denials or UR (prior auth, concurrent review, retrospective review) from MCO setting
• Experience reviewing relevant information within denied authorization case to ensure a complete case summary is provided to the Medical Director for review of the appeal case.
• Experience reviewing medical code data and records to determine whether a denial is warranted.
• Comfortable with Microsoft office programs and utilizing systems to input medical criteria.
• Graduate from accredited school of nursing
  
  
  

Benefits for Transitional Care Nurse:

• Immediate enrollment in Health Insurance
• Dental Insurance
• Life Insurance
• Employee Assistance Program (EAP)
• Access to Investment Accounts
• Career and educational tools within our Ingenovis ACT (Advocacy) Program
  
  
  

Pay Details: $30 – $37/hour

Interested in being considered?

If you are interested in applying to this position, please click Apply Now for immediate consideration.

For additional consideration, please email a copy of your resume to [email protected] with your phone number, the position title and location, and our recruiters will reach out.

Healthcare Support Staffing, LLC. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.