Appeals Review Nurse

Position Summary:

• Reviews clinical information provided by the facility and providers to evaluate the medical necessity and clinical appropriateness of requested services for a member

• Collects information concerning eligibility, provider status, benefit coverage, coordination of benefits and subrogation necessary to reach prospective, concurrent and retrospective decisions in the appeals process

• Produces approval and denial letters on behalf of the Medical Director for submission to member, provider or hospital

Hours for this Position:  Monday-Friday 8:00-5:00

Advantages of this Opportunity:

• Competitive salary, negotiable based on relevant experience

• Benefits offered, Medical, Dental, and Vision

• Fun and positive work environment