Investigate and process complex grievances and appeals requests from members and providers. Perform medical necessity reviews for inpatient, outpatient, ambulatory, and ancillary services. Prepare recommendations and generate written correspondence to providers, members, and regulatory entities. Qualifications: Unrestricted USRN mainland license with at least 2 years utilization management experience. Demonstrated clinical knowledge and experience relative to patient care and healthcare delivery processes. Strong problem-solving, facilitation, and analytical skills; appeals and grievance experience required. Remote position based in the Philippines with globally distributed teams. Flexible to work on business need support weekend transactions. BPM This company specializes in processing healthcare appeals and grievances for US members and providers. The organization operates with globally distributed teams, emphasizing clinical knowledge and regulatory compliance. #J-18808-Ljbffr
USRN - A&G (Fully Remote) in workfromhome at Unknown Company
- Typical pay
- $88,400–$135,200
For context, most registered nurses earn between $88,400–$135,200 a year according to Bureau of Labor Statistics wage data. What this particular role pays is set by the employer — check the description above.
This position is listed as full time and able to be worked remotely.