What are we looking for in our Remote Clinical Appeals Nurse?
PRIDE Health is seeking a Remote Clinical Appeals Nurse
This is a remote contract position with our client headquartered in Tennessee.
Our client is seeking a nurse with an acute inpatient care background, experienced with medical necessity reviews and InterQual + Milliman.
Location: Remote
License: RN or LPN Tennessee or Compact
Schedule: 8AM-5PM Monday thru Friday
Responsibilities:
- Compose, edit or otherwise support clinical evaluations for disputed claims.
- Working independently, they provide clinical insights for unresolved denials or escalated cases.
- Review and assess denial reconsideration documentation, payer denial documentation, medical records, and other relevant documents.
- Assist in preparing materials for legal support in disputes, contributing their expertise
- Demonstrate understanding of Medical Necessity software, such as InterQual and Milliman
Pay Rate Expectations: $30-$33 Hourly
Minimum 1+ years of case management experience
Strong Knowledge of Milliman + InterQual
2+ Years of Appeal and Denial Claims
Don’t Delay, apply today for this remote opportunity!
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Rate/Salary: $30-$33 Hourly