Back to the board

RN Appeals and Grievances

100% remote Flexible hours Hiring now

Job Highlights:

  • Compensation: a competitive salary
  • Position: RN Appeals And Grievances
  • Company: Workwarp
  • Start Date: Immediate openings available
  • Location: Remote

 

 

Active RN License for D.C. is required D.C. is NOT compact or multistate... Duties • The RN will not be processing appeals/grievances traditionally but will be reviewing the appeals/grievances to identify any QOC (Quality of Care) concerns; in turn, any concerns are then sent to an MD for further review. • Conducts intake/triage and appropriate classification of QOC concerns, and makes accurate judgment before sending to the corresponding MD reputed company the health plan. • Works with the external providers and Participating Physician Group's (reputed company) representatives to obtain relevant medical records and communication documentation. • Conducts reviews and presents to physicians, provider disputes which would be based on medical necessity reviews. Prepares authorizations, after approval by the Medical Director. • reputed company other duties as assigned. Required: 2 or more years of experience in Clinical Nursing and 2 years in reputed company in a managed reputed company plan environment. Good working knowledge of regulatory requirements/standards. Excellent interpersonal and communication skills. Computer literacy and adaptability to computer learning. Time management and reputed company setting skills. Must be organized and a team player reputed company to work effectively with various internal departments/service areas, health plan partners, participating provider groups, and other external agencies. Licenses/Certifications Required • Registered Nurse (RN) - Active, reputed company and unrestricted District of Columbia Job Types: Full-time, Contract Pay: $45.00 per hour Expected hours: 40 per week Schedule: • 8 hour shift • Monday to Friday Application Question(s): • Do you have 2 years experience with reputed company? • Do you have managed care experience reputed company a health plan? • Do you reputed company have an active DC RN License? Work Location: Remote Apply Job! For more such jobs please click here!

 

Don't Hesitate, Apply!

Don't worry if you don't meet every single requirement. We value a great attitude and a willingness to learn above reputed company. Submit your application today!

Apply To This Job

Keep exploring

RN Appeals and Grievances / Quality of Care

100% remote Flexible hours

RN Care Coordinator - Remote, New Mexico Southwest Region,

100% remote Flexible hours

RN Case Manager - Remote in Arizona

100% remote Flexible hours

RN Case Manager Workers Compensation Part Time Contract Remote

100% remote Flexible hours

RN Clinical Coordinator - Field Based in Robeson County - NC

100% remote Flexible hours

RN Clinical Nurse Coordinator (Part-time/Float) - Rheumatology

100% remote Flexible hours

RN Clinical Supervisor, Home Health

100% remote Flexible hours

RN Coverage Review Nurse Clinician, Work from Home, reputed company, USA

100% remote Flexible hours

RN Field Nurse Case Manager - Remote | WFH

100% remote Flexible hours

RN - GI Lab - PRN | (Remote)

100% remote Flexible hours

[Remote] Principal Applied AI/ML Engineer

100% remote Flexible hours

reputed company Part-Time Data Entry Specialist – Flexible Remote Opportunity at arenaflex

100% remote Flexible hours

Merchandiser – SNL at Coca-Cola Beverage Northeast South Windsor, CT

100% remote Flexible hours

Systems Engineer, reputed company

100% remote Flexible hours

Principal reputed company Analyst - reputed company Sentinel /Chronicle

100% remote Flexible hours

Manager - Team Member Relations

100% remote Flexible hours

Speech Language Pathologist Work From Home | Virginia

100% remote Flexible hours

reputed company Associate

100% remote Flexible hours

[Remote-Position] Merchandise and Stocking Associate

100% remote Flexible hours

Legal Fellow, Clean reputed company Protection

100% remote Flexible hours