Remote RN: Clinical Quality & Appeals Reviewer

Enterprise HCM; Richardson (TX); Remote; USD 70,000 - 126,000; Full time

Job summary

HCSC is seeking a dedicated RN to facilitate member and provider appeals, coordinating with Medical Directors and Customer Service to ensure compliant processes while maintaining efficient workflow. The role requires strong communication and organizational abilities and a solid foundation in healthcare operations. This remote position supports the U.S.

market. Compensation ranges from $69,800 to $125,900 annually, with eligibility contingent on experience and location.

Qualifications

• RN license valid in the operating state.
• Minimum 5 years combined healthcare process experience.
• Knowledge of managed care processes.
• Strong organizational skills and ability to meet deadlines.
• Excellent verbal and written communication.

Responsibilities

• Facilitate member and provider appeals with established guidelines.
• Collaborate with Medical Directors and Customer Service to ensure audit-ready processes.
• Manage inventory workflow through appropriate procedures.

Skills

RN License

Healthcare Processes

Managed Care

Organization

Communication Skills

Word

Excel

Access

Education

Bachelor's degree

Job description

HCSC is seeking a dedicated RN to facilitate member and provider appeals, coordinating with Medical Directors and Customer Service to ensure compliant processes while maintaining efficient workflow. The role requires strong communication and organizational abilities and a solid foundation in healthcare operations. This remote position supports the U.S.

market. Compensation ranges from $69,800 to $125,900 annually, with eligibility contingent on experience and location.