Remote RN Appeals and Quality of Care Investigator

Elevance Health, Inc.; Indianapolis (IN); Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

Merit increases

Paid Time Off

401(k) with match

Wellness programs

Job summary

A healthcare company is seeking a Nurse Appeals specialist to investigate and process medical necessity appeals from members and providers. The role involves reviewing grievances, preparing summaries for Quality of Care cases, and ensuring timely resolution of grievances. Applicants need a high school diploma or equivalent with at least 2 years of experience in a managed care setting, along with a current RN license. This position offers a hybrid work model and a range of competitive benefits.

Qualifications

• Minimum of 2 years experience in managed care healthcare setting.
• Current active unrestricted RN license in applicable state.

Responsibilities

• Conduct investigations and reviews of member grievances.
• Review medical records for grievance concerns.
• Document grievance information on relevant tracking systems.

Skills

Investigation skills

Detail-oriented

Leadership skills

Education

HS diploma or equivalent

AS or BS in Nursing (preferred)

Job description

A healthcare company is seeking a Nurse Appeals specialist to investigate and process medical necessity appeals from members and providers. The role involves reviewing grievances, preparing summaries for Quality of Care cases, and ensuring timely resolution of grievances. Applicants need a high school diploma or equivalent with at least 2 years of experience in a managed care setting, along with a current RN license. This position offers a hybrid work model and a range of competitive benefits.