Clinical Appeals Nurse Analyst – RN

Johns Hopkins Health Plans; Washington (District of Columbia); In loco; USD 55.000 - 84.000; Tempo pieno

Descrizione del lavoro

Johns Hopkins Health Plans is seeking an RN to review and resolve clinical appeals across all lines of business. You will communicate determinations in line with regulatory requirements and act as a clinical resource for staff handling denials and coding-related appeals.

The role requires RN licensure in Maryland, a BSN preferred, and at least three years of acute care nursing experience, with payer experience strongly preferred. Familiarity with quality improvement initiatives is a plus.

Competenze

• RN license in Maryland is required.
• BSN preferred.
• Minimum three years of acute care nursing experience.
• Experience in health insurance payer environment preferred.
• Experience with quality improvement initiatives is a plus.

Mansioni

• Review and resolve clinical appeals submitted by providers and members across all lines of business.
• Communicate appeal determinations in accordance with regulatory requirements.
• Support non-clinical staff with administrative denials and coding-related appeals.
• Maintain accurate tracking of appeals through logs, databases, and reporting tools.

Conoscenze

Clinical appeals

Regulatory compliance

Health payer experience

Quality improvement collaboration

Formazione

BSN preferred

RN license in MD

Strumenti

Reporting tools

Descrizione del lavoro

Johns Hopkins Health Plans is seeking an RN to review and resolve clinical appeals across all lines of business. You will communicate determinations in line with regulatory requirements and act as a clinical resource for staff handling denials and coding-related appeals.

The role requires RN licensure in Maryland, a BSN preferred, and at least three years of acute care nursing experience, with payer experience strongly preferred. Familiarity with quality improvement initiatives is a plus.