Grievance and Appeals Nurse - Remote

Overview

The Grievance and Appeals Nurse is responsible for investigating and processing complex grievances and appeals requests from members and providers in a remote work setting.

In Short

• Remote position requiring residence in Indiana.
• Full-time hours: Monday to Friday, with some Saturdays.
• Conduct investigations and reviews of medical necessity appeals.
• Review medical records of denied services.
• Prepare recommendations for appeal resolutions.
• Ensure timely resolution of appeals and grievances.
• Document appeal/grievance information accurately.
• Generate written correspondence to stakeholders.
• Serve as a subject matter expert in appeals/grievances.
• Utilize strong communication and analytical skills.

Requirements

• 2 years of experience in a managed care healthcare setting.
• Current active RN license in Indiana.
• Strong communication and problem-solving skills.
• Experience with MCG guidelines preferred.
• CMCN certification is strongly preferred.
• AS required/BS in Nursing preferred.

Benefits

• Salary of $90,000 per year.
• Health, dental, and vision insurance offered.
• 401k plan available.
• 80 hours of PTO and paid holidays.