Remote RN: Appeals & Quality Review Specialist

HCSC Group; Richardson (TX); Remote; USD 70,000 - 126,000; Full time

Job summary

HCSC is seeking an experienced Registered Nurse to facilitate member and provider appeals and ensure processes meet guidelines and audit standards. You will partner with Medical Directors and Customer Service to drive quality care while managing workflow and inventory.

The role requires a valid RN license, at least 5 years of healthcare experience, and knowledge of managed care. This is a remote/work-from-home position with standard CST hours and occasional time shifts.

Qualifications

• RN with unrestricted license in state of operations.
• 5 years combine knowledge of healthcare processes.
• Knowledge of managed care processes.
• Organizational skills and ability to meet deadlines and manage multiple priorities.

Responsibilities

• Facilitate member and provider appeals; collaborate with Medical Directors and Customer Service to ensure guidelines are met.
• Adhere to accreditation and regulatory requirements to meet audit standards.
• Manage individual inventory through appropriate workflow.
• Communicate effectively with staff across organizational lines, members, and providers.

Skills

Communication

Organizational skills

Multitasking

Education

Registered Nurse license

Bachelor’s degree

Tools

Microsoft Word

Microsoft Access

Microsoft Excel

Job description

HCSC is seeking an experienced Registered Nurse to facilitate member and provider appeals and ensure processes meet guidelines and audit standards. You will partner with Medical Directors and Customer Service to drive quality care while managing workflow and inventory.

The role requires a valid RN license, at least 5 years of healthcare experience, and knowledge of managed care. This is a remote/work-from-home position with standard CST hours and occasional time shifts.