Remote Behavioral Health Appeals Clinician

Hong Kong Study Skills Research Institute; Jefferson City (MO); On-site; USD 36,506 - 65,559; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Flexible work schedules

Job summary

Hong Kong Study Skills Research Institute seeks a Clinical Reviewer, fully remote, to perform clinical reviews and process appeals. Candidates should hold a nursing degree and possess 2–4 years of experience in relevant fields.

The role involves preparing case reviews and ensuring compliance with NCQA and regulatory standards, contributing to the efficiency of appeal responses. Benefits include competitive pay, health insurance, 401K, and flexible working options.

Qualifications

• Requires graduate from an accredited school of nursing.
• 2–4 years of related experience preferred.
• Knowledge of NCQA, Medicare and Medicaid regulations preferred.

Responsibilities

• Prepares case reviews for Medical Directors.
• Ensures timely review and processing of appeals.
• Communicates with members and providers regarding appeals.
• Generates appeals resolution communication.
• Improves clinical appeals processes.
• Complies with all policies and standards.

Skills

Knowledge of NCQA

Medicare knowledge

Medicaid knowledge

Utilization management processes

Education

Bachelor’s degree in nursing or related field

Job description

Hong Kong Study Skills Research Institute seeks a Clinical Reviewer, fully remote, to perform clinical reviews and process appeals. Candidates should hold a nursing degree and possess 2–4 years of experience in relevant fields.

The role involves preparing case reviews and ensuring compliance with NCQA and regulatory standards, contributing to the efficiency of appeal responses. Benefits include competitive pay, health insurance, 401K, and flexible working options.