Nurse Appeals Specialist (Hybrid)

Elevance Health; Columbus, Northern (OH, KY); Hybrid; USD 39,000 - 74,000; Full time

Benefits offered by this job

Major medical insurance

HSA

Dental insurance

Vision insurance

Life insurance

Disability insurance

401k

Job summary

Elevance Health is seeking a qualified registered nurse to investigate and process medical necessity appeals from members and providers. This contract role requires an active RN license and at least 2 years of managed care experience, with URAC competencies preferred.

The position supports a hybrid workforce model and may involve state-specific market requirements. Ideal candidates will demonstrate strong written communication, analytical thinking, and the ability to collaborate with medical

Qualifications

• Requires HS diploma or equivalent and 2+ years in a managed care setting.
• Active RN license to practice (US) required; AS/BS in Nursing preferred.
• URAC competencies and strong communication, problem-solving, and analytical skills.

Responsibilities

• Investigates and processes medical necessity appeals for members and providers.
• Extrapolates and summarizes medical information for medical directors and consultants.
• Prepares recommendations to uphold or deny appeals for approval.
• Ensures timely resolution to meet regulatory timeframes; documents tracking.
• Generates correspondence to providers, members, and regulators.
• Acts as SME for appeals/grievances and quality-of-care issues.

Skills

RN license active

Clinical reviews

Managed care experience

Strong written communication

Education

HS diploma or equivalent

AS/BS in Nursing preferred

Active RN license in US

Job description

Elevance Health is seeking a qualified registered nurse to investigate and process medical necessity appeals from members and providers. This contract role requires an active RN license and at least 2 years of managed care experience, with URAC competencies preferred.

The position supports a hybrid workforce model and may involve state-specific market requirements. Ideal candidates will demonstrate strong written communication, analytical thinking, and the ability to collaborate with medical