Remote USRN: Appeals & Grievances Specialist

Bundesverband der Personalmanager e.V.; United States; A distancia; USD 70.000 - 95.000; Jornada completa

Descripción de la vacante

Bundesverband der Personalmanager e.V. seeks to fill a remote position overseeing utilization management and complex appeals processes for US members and providers. The role requires clinical expertise and regulatory awareness within a globally distributed team.

Candidates should have an unrestricted USRN license and a minimum of two years in utilization management, with strong analytical and communication skills to handle medical necessity reviews and written correspondence efficiently.

Formación

• Unrestricted USRN mainland license with at least 2 years utilization management experience.
• Demonstrated clinical knowledge and experience relative to patient care and healthcare delivery processes.
• Strong problem-solving, facilitation, and analytical skills; appeals and grievance experience required.

Responsabilidades

• Investigate and process complex grievances and appeals requests from members and providers.
• Perform medical necessity reviews for inpatient, outpatient, ambulatory, and ancillary services.
• Prepare recommendations and generate written correspondence to providers, members, and regulatory entities.

Conocimientos

Utilization management experience

Clinical knowledge

Problem-solving

Appeals and grievance experience

Descripción del empleo

Bundesverband der Personalmanager e.V. seeks to fill a remote position overseeing utilization management and complex appeals processes for US members and providers. The role requires clinical expertise and regulatory awareness within a globally distributed team.

Candidates should have an unrestricted USRN license and a minimum of two years in utilization management, with strong analytical and communication skills to handle medical necessity reviews and written correspondence efficiently.