Clinical Appeals Nurse
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Job Location:
West Des Moines, IA - USA
Monthly Salary:
Not Disclosed
Posted on:
2 hours ago
Vacancies:
1 Vacancy
Job Summary
Position Title: Appeals Nurse
Location: Remote IA
Duration: 10 months (possibility to extend or convert to FTE)
Schedule: 8 am to 5pm CST no OT
Payrate - $35 to $36 an hour
Job Responsibilities:
- Review and process Iowa Medicaid Member Appeals
- Volume of appeals continues to increase and is at an all-time putting team at risk for liquidated damages if cases are not 100% resolved in 30 days.
- The team is fully remote and highly experienced. They collaborate effectively demonstrate strong accountability and consistently work well together to manage complex appeals.
- Member appeal requests are received and assigned by the team lead the appeals nurse is responsible for working the appeal start to finish.
- Outreach attempts are made to member/provider.
- A clinical review is completed and case sent to specialty review/MD.
- Appeals nurse will write determination letters and close the case.
- 30 calendar days to complete standard cases and 3 business days to acknowledge receipt of the case.
- This team handles all Iowa Medicaid appeals except behavioral health
Job Requirements:
Education: Associates
Licensure: LPN
Experience : at least 2 years nursing experience UM experience helpful
Additional qualities to look for: The ideal candidate will thrive in a fast paced environment with frequently changing workloads. This role requires strong prioritization organization and adaptability.
Skills:
- Customer service
- Time management
- Computer skills/ability to learn new systems
