Appeals Nurse Consultant (Remote) – Work From Home Job

Join our dynamic team as an Appeals Nurse Consultant and make a difference in the lives of patients while enjoying the flexibility of working remotely from home. As an Appeals Nurse Consultant, you will be responsible for reviewing denied claims and appeals, analyzing medical records, and collaborating with healthcare providers to ensure proper documentation and justification for medical services rendered. You will utilize your clinical expertise to assess medical necessity, provide guidance on appeal strategies, and advocate for the best possible outcomes for patients.

What You Will Do:

• Review denied claims and appeals to determine medical necessity and appropriateness of care.
• Analyze medical records, treatment plans, and supporting documentation to evaluate the quality and completeness of information.
• Collaborate with healthcare providers, including physicians and specialists, to gather additional information and documentation as needed.
• Develop and execute appeal strategies to overturn denied claims and secure authorization for medical services.
• Provide clinical expertise and guidance to internal teams and external stakeholders on appeal processes and regulations.
• Maintain accurate documentation and communication regarding appeal activities and outcomes.

Requirements:

• Registered Nurse (RN) with a current, unrestricted license.
• Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.
• Strong understanding of medical terminology, healthcare billing, and insurance regulations.
• Experience with utilization management, case management, or appeals management is preferred.
• Excellent analytical and critical thinking skills with the ability to interpret complex medical information.
• Effective communication and negotiation skills with the ability to collaborate with multidisciplinary teams.
• Proficiency in Microsoft Office Suite and electronic medical records (EMR) systems.
• Reliable high-speed internet connection and a dedicated workspace to work remotely.

Opportunity Benefits:

• Remote work flexibility: Enjoy the convenience and comfort of working from home while making a meaningful impact on patient care.
• Competitive salary and benefits package: We offer a competitive compensation package, including health benefits, retirement plans, and paid time off.
• Professional development: Take advantage of opportunities for ongoing training and professional development to enhance your skills and advance your career.
• Collaborative work environment: Join a supportive and collaborative team dedicated to improving patient outcomes and ensuring quality healthcare delivery.
• Work-life balance: Maintain a healthy work-life balance with flexible scheduling options and remote work arrangements.

If you’re passionate about using your nursing expertise to advocate for patients and navigate the appeals process, we invite you to join our team as an Appeals Nurse Consultant and be a part of our mission to provide high-quality, patient-centered care. Apply today to make a difference from the comfort of your own home!