Remote RN: Clinical Quality & Appeals Specialist

Health Care Service Corp.; Richardson (TX); Remoto; USD 70.000 - 126.000; Tempo pieno

Descrizione del lavoro

Health Care Service Corporation (HCSC) seeks a registered nurse to facilitate member and provider appeals, coordinating with Medical Directors and Customer Service to ensure compliant processes. The role requires adherence to accreditation and regulatory standards and managing inventory through established workflows.

The position is remote with work hours 9 AM–5:30 PM CST, offering a competitive pay range and a comprehensive rewards package. Sponsorship is not available.

Competenze

• Registered Nurse (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.
• Verbal and written communication skills to include interfacing with staff across organizational lines plus interfacing with members and providers.
• PC experience to include Microsoft Word, Access, and Excel.

Mansioni

• This position is responsible for facilitating member and provider appeals; working closely with Medical Directors and Customer Service to ensure appeal process meets established guidelines. Adhering to accreditation and regulatory requirements to meet audit standards. Managing individual inventory through appropriate workflow.

Conoscenze

Registered Nurse license (RN)

5 years healthcare processes

Managed care processes

Organizational skills

Verbal and written communication

Word, Access, Excel

Formazione

Bachelor’s degree

Strumenti

Microsoft Word

Access

Excel

Descrizione del lavoro

Health Care Service Corporation (HCSC) seeks a registered nurse to facilitate member and provider appeals, coordinating with Medical Directors and Customer Service to ensure compliant processes. The role requires adherence to accreditation and regulatory standards and managing inventory through established workflows.

The position is remote with work hours 9 AM–5:30 PM CST, offering a competitive pay range and a comprehensive rewards package. Sponsorship is not available.