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Clinical Appeals Nurse (RN) in Dayton, OH at Alto Health Care Staffing

Date Posted: 2/6/2018

Job Snapshot

  • Employee Type:
  • Location:
    Dayton, OH
  • Job Type:
    Health Care
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Clinical Appeals Nurse (RN) needed for 3 month contract with possible extension. 

Duties required:

§  Responsible for the completion of clinical appeals and state hearings from all states

§  Review and complete all provider clinical appeals within required timeframes

§  Review and complete member clinical appeals within required timeframes

§  Review all information necessary to prepare State Hearing packets

§  Communicate with state agencies and internal departments to prepare for State Hearings

§  Attend assigned State Hearing and complete all required compliances

§  Complete required compliances for Administrative Hearing decisions

§  Apply Company Medical Policy and Milliman guidelines when processing clinical appeals

§  Issue notification letters to providers and members

§  Issue administrative denials appropriately

§  Refer denials based on medical necessity to medical director

§  Maintain hardcopy documentation, Facets documentation and appeals database documentation at 90-95% accuracy rates

Job Requirements


***You must be an RN to qualify for this position.***

*  Intermediate proficiency with Microsoft Office products and Facets

*  Strong written and oral communication skills

*  Ability to work independently and within a team environment

*  Critical listening and thinking skills

*  Proper grammar usage

*  Time management skills

*  Proper phone etiquette

*  Customer Service oriented