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Appeals Nurse - Wilmington - Alliance
Description
Appeals Nurse
The Appeals Nurse serves as a clinical resource for the Appeals Team ensuring timely customer-focused responses to pharmacy and physical health appeals.
This position requires strong analytical skills utilizing data analysis techniques integrating programmatic information into required data sets for interpretation.
We are seeking a qualified Registered Nurse who can assist in resolving member complaints related to Adverse Benefit Determinations enforcing compliance with state regulations tailoring our plan contract standards while acting as settlement authority during mediations at Office of Administrative Hearings (OAH). Strong communication skills verbal written graphic presentation essential interacting internal external stakeholders addressing quality assurance issues promptly reviewing regulatory timeframes accuracy appeal cases monthly peer reviews improving processes maintaining current guidelines requirements
Duties will also involve preparing presenting complex case summaries Medical Directors managing general functions identification strategies improvement practices enhancing team workflow efficiency proactive problem solving generating innovative practical recommendations supporting company-wide initiatives,
Leverage expertise knowledge healthcare environment assisting colleagues staff analyzing policies procedures revision editing according agency rules steps advocacy management statutory international environments.
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Utilization Review Specialist
Only for registered members Wilmington
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Utilization Review Specialist
Only for registered members Wilmington
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Surgery - Plastic Physician
DOCTORS CHOICE PLACEMENT SERVICES, INC.- Wilmington
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Utilization Review Specialist
Only for registered members Wilmington, NC
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Locum Certified Registered Nurse Anesthetist
LocumJobsOnline- Wilmington
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Locum Certified Registered Nurse Anesthetist
LocumJobsOnline- Wilmington
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Locum Certified Registered Nurse Anesthetist
LocumJobsOnline- Wilmington
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Travel Cath Lab Registered Nurse - 2,627 per week
Revolution Healthcare Services- Wilmington
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Travel Licensed Practical Nurse Long-Term Care Job
Only for registered members Hanover
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Associate Planner
Only for registered members Wilmington
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Utilization Review Specialist
Only for registered members Wilmington, NC
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Shift Lead Registered Veterinary Technician
Banfield- Murraysville
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Dean of Health Sciences
Only for registered members Bolivia, NC