Appeals Nurse - Remote

Overview

The Appeals Nurse 2 resolves clinical complaints and appeals, reviewing documentation and interpreting data to ensure compliance with regulatory and accreditation requirements.

In Short

• Resolve clinical complaints and appeals.
• Review medical documentation and coordinate clinical resolutions.
• Provide education on second level review processes.
• Maintain knowledge of TRICARE policies and procedures.
• Document and summarize investigation results.
• Work remotely with occasional travel for training.
• Full-time position with standard working hours.
• Competitive salary and benefits.
• Must be a U.S. citizen with an active RN license.
• 3 years of clinical RN experience required.

Requirements

• Active unrestricted RN license.
• 3 years of clinical RN experience.
• Appeals nursing and claims experience.
• Proficient in Microsoft Office.
• Knowledge of ICD-9 or ICD-10.
• Familiarity with TRICARE contracts.
• Bachelor's degree preferred.
• Utilization Review/Quality Management experience preferred.
• Ability to work independently and in ambiguous situations.
• Must be able to obtain government security clearance.

Benefits

• Comprehensive medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off and holidays.
• Short-term and long-term disability coverage.
• Life insurance and other opportunities.