RN Appeal Analyst - NJ Licensed - Sunnyvale California

Company: VirtualVocations
Location: Sunnyvale, California
Posted On: 11/08/2024

A company is looking for an Appeal Analyst RN to review Level 2 Commercial Appeals.



Key Responsibilities

Review and investigate reasons for UM denials and appeal requests
Present clinical information to a committee effectively
Maintain turnaround time by making sound clinical judgments quickly


Required Qualifications

Active Unrestricted RN License in NJ or Compact
Experience with health plan appeals is essential
Proficient in navigating UM policies and clinical guidelines
Knowledge of UM Pharmacy appeals is preferred
Technology savvy with experience in Care Radius, Outlook, Teams, and Microsoft Suite More...

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