Appeals Nurse Reviewer I

Appeals Nurse Reviewer I

• Validating appeal requests
• Manage Appeal requests that come via email, fax, mailed in letters, or live
• Opening and closing appeal requests following established appeal processes
• Outreach to providers with appeal process instructions
• Clinical review for the RBM and Surgical solution on a client specific basis
• Notifying providers and/or members of appeal decisions
• Maintain personal log all appeal requests assigned to ensure completion, as needed

• AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting
• Current unrestricted RN license in applicable state(s)
• Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO, and POS plans

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Life insurance
• Wellness programs
• Financial education resources

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler