RN Case Manager: Appeals & Denials Specialist

Healthcare Support Staffing; Sacramento (CA); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Fun and positive work environment

Job summary

A leading healthcare staffing firm is seeking a detail-oriented individual for managing medical necessity appeals and claims reviews. The role involves reviewing cases, preparing documentation for the Medical Director, and ensuring compliance with NCQA guidelines. Candidates should have strong computer skills, experience in utilization review or claims appeals, and effective written communication abilities. This position offers a positive work environment and competitive opportunities for career advancement.

Qualifications

• Proficient working on a computer.
• Experience with utilization review or claims appeals.
• Effective written communication skills.

Responsibilities

• Manage medical necessity appeals and denials.
• Review cases and determine appropriate actions.
• Prepare case reviews for the Medical Director.
• Generate communication regarding appeal resolutions.
• Gather information for Administrative Law Hearings.

Skills

Computer proficiency

Utilization review experience

Strong written communication

Job description

A leading healthcare staffing firm is seeking a detail-oriented individual for managing medical necessity appeals and claims reviews. The role involves reviewing cases, preparing documentation for the Medical Director, and ensuring compliance with NCQA guidelines. Candidates should have strong computer skills, experience in utilization review or claims appeals, and effective written communication abilities. This position offers a positive work environment and competitive opportunities for career advancement.