USRN - A&G (Fully Remote)

Bundesverband der Personalmanager e.V.; United States; Remote; USD 70,000 - 95,000; Full time

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Utilization management experience

Clinical knowledge

Problem-solving

Appeals and grievance experience

Job description

• 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.

Qualifications:

• 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.
• Remote position based in the Philippines with globally distributed teams.
• Flexible to work on business need support weekend transactions.

BPM

This company specializes in processing healthcare appeals and grievances for US members and providers. The organization operates with globally distributed teams, emphasizing clinical knowledge and regulatory compliance.