Clinical Appeals RN - REMOTE - part time

Smart IT Frame LLC; Corvallis (OR); Remote; USD 10,000 - 60,000; Part time

Job summary

An innovative health care provider is seeking a Clinical Appeals RN to join their remote team. This role focuses on performing clinical appeal functions across various business lines, ensuring compliance with state and federal guidelines. Ideal candidates will have a strong clinical background with at least three years of recent experience, preferably in a managed care setting. The position starts as full-time during training and transitions to part-time, allowing flexibility while contributing to a mission-driven organization dedicated to building healthier communities. If you're passionate about making a difference in health care, this opportunity is perfect for you.

Qualifications

• 3+ years of recent clinical experience required.
• Experience in managed care setting preferred.

Responsibilities

• Perform clinical appeal functions for all lines of business.
• Ensure provider and member appeals are processed accurately.

Skills

Clinical Experience

Computer Applications

Case Management

Utilization Management

Job description

Clinical Appeals RN - REMOTE - part time

Job Summary/Purpose:

Performs clinical appeal functions for all lines of business. Ensures that provider and member appeals are processed and documented to meet state and federal guidelines for quality, accuracy, timeliness, and completeness.

Department Description:

Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

Note: During training, this role will need to be full-time and then part-time after training and nesting has been completed (10 hours per week).

This is a remote position.

Experience/Education/Qualifications:

• Three (3) years recent clinical experience required. Experience in a managed care setting preferred.
• Experience or training with computer applications required.
• Experience or training in case management and utilization management preferred.

Seniority Level: Mid-Senior level

Employment Type: Part-time

Job Function: Health Care Provider

Industries: Hospitals and Health Care