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Grievance and Appeals RN

Company: The Judge Group
Location: Remote
Posted on: May 13, 2022

Job Description:

Location: REMOTE
Description: The Judge Group is currently seeking a Grievance and Appeals RN for a fantastic healthcare facility in California! This will be 100% remote/work from home position!

This job will have the following responsibilities:
The Appeals and Grievances nurse perform accurate and timely clinical review of member-initiated appeals or appeals initiated by someone qualified to speak on behalf of the member.
The RN's perform first and second level appeal reviews for members utilizing Evidence of Coverage, evidenced based guidelines, policies, and nationally recognized clinical criteria.
The successful RN candidate will review both medical and pharmacy member appeals for benefits, medical necessity, coding accuracy and medical policy compliance

Qualifications & Requirements:CA RN License in good standing
Knowledge of provider billing, CPT codes, and regulations of Medicare, Medi-Cal, DHS, MRMIB, DMHC and NCQA
Knowledge of Medical policy and benefit reviews
Prior relevant experience.
Experience in Medicare and Medicaid (Must Have)
Managed care background preferred
Will train the right RN with Grievance and Appeals

If you or someone you might know would be interested to apply or would like more information, please send an updated resume or email to me at!

Thank You,
This job and many more are available through The Judge Group. Find us on the web at

Keywords: The Judge Group, Eugene , Grievance and Appeals RN, Healthcare , Remote, Oregon

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