Remote Appeals Nurse (LPN) – Denials & Case Review

IMCS Group; West Des Moines (IA); Hybrid; USD 60,000 - 80,000; Full time

Job summary

IMCS Group is seeking an experienced nurse for a 10-month contract role primarily focused on reviewing clinical data and managing member appeal requests in accordance with company policies. The position allows for remote work, preferably from Iowa, with possible on-site visits. Key responsibilities include preparing case reviews, generating appeal communications, maintaining the appeals process, and assisting with policy revisions. Candidates must have at least 2 years of nursing experience, with UM experience being beneficial.

Qualifications

• At least 2 years of nursing experience required; UM experience is helpful.

Responsibilities

• Review clinical data to determine claim payment based on policies.
• Prepare case reviews for the Medical Director.
• Generate appeal resolution communications in accordance with guidelines.
• Request additional information from providers to facilitate appeals.
• Gather and prepare case information for Administrative Law Hearings.
• Maintain appeals process within the prescribed timeframes.
• Assist the Medical Director with policy revisions to meet requirements.

Skills

Nursing experience

Understanding of UM

Job description

IMCS Group is seeking an experienced nurse for a 10-month contract role primarily focused on reviewing clinical data and managing member appeal requests in accordance with company policies. The position allows for remote work, preferably from Iowa, with possible on-site visits. Key responsibilities include preparing case reviews, generating appeal communications, maintaining the appeals process, and assisting with policy revisions. Candidates must have at least 2 years of nursing experience, with UM experience being beneficial.