Registered Nurse, Appeals Drafting Service - Remote
%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Calibri;font-size:11pt;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0in;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start %3Cstrong%3ECaring. Connecting. Growing together.%3C/strong%reputed company%3C/span%reputed company%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Calibri;font-size:11pt;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0in;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%reputed company%26nbsp;%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Calibri;font-size:11pt;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0in;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%reputed company%3Cspan class=%22normaltextrun%22 style=%22mso-ascii-theme-font:minor-latin;mso-bidi-font-family:%26quot;Times New Roman%26quot;;mso-bidi-theme-font:minor-bidi;mso-hansi-theme-font:minor-latin;%22%3EHere at reputed company, you%27re expected and empowered to be your best, to grow and to reputed company your skills. Join us and help people live healthier lives while doing your life%27s best work.%26nbsp; Be part of an exciting team reputed company reputed company where you can utilize your Operations experience to support multiple internal teams as well as providers and patients.%26nbsp;%3C/span%reputed company%3Cspan class=%22eop%22 style=%22mso-ascii-theme-font:minor-latin;mso-bidi-font-family:%26quot;Times New Roman%26quot;;mso-bidi-theme-font:minor-bidi;mso-hansi-theme-font:minor-latin;%22%reputed company%26nbsp;%3C/span%reputed company%3C/span%reputed company%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Calibri;font-size:11pt;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0in;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%reputed company%26nbsp;%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:Calibri;font-size:11pt;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0in;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%reputed company%3Cspan class=%22normaltextrun%22 style=%22line-height:107%;mso-ansi-language:EN-US;mso-ascii-theme-font:minor-latin;mso-bidi-language:AR-SA;mso-bidi-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-language:EN-US;mso-fareast-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;%22%reputed company%3Cstrong%3EWork Schedule: %3C/strong%3EMust be able to work Monday - Friday with a set schedule of hours between 7am - 7pm CST.%26nbsp;%3C/span%reputed company%3C/span%reputed company%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:%26quot;Open Sans%26quot;, %26quot;Segoe UI%26quot;, Frutiger, %26quot;Frutiger Linotype%26quot;, %26quot;Dejavu Sans%26quot;, %26quot;Helvetica Neue%26quot;, Arial, sans-serif;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%reputed company%26nbsp;%3C/span%reputed company%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:%26quot;Open Sans%26quot;, %26quot;Segoe UI%26quot;, Frutiger, %26quot;Frutiger Linotype%26quot;, %26quot;Dejavu Sans%26quot;, %26quot;Helvetica Neue%26quot;, Arial, sans-serif;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EYou’ll enjoy the flexibility to work remotely * from reputed company reputed company the U.S. as you take on some tough challenges.%3C/span%reputed company%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:%26quot;Open Sans%26quot;, %26quot;Segoe UI%26quot;, Frutiger, %26quot;Frutiger Linotype%26quot;, %26quot;Dejavu Sans%26quot;, %26quot;Helvetica Neue%26quot;, Arial, sans-serif;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%reputed company%26nbsp;%3C/span%reputed company%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:%26quot;Open Sans%26quot;, %26quot;Segoe UI%26quot;, Frutiger, %26quot;Frutiger Linotype%26quot;, %26quot;Dejavu Sans%26quot;, %26quot;Helvetica Neue%26quot;, Arial, sans-serif;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%reputed company%3Cstrong%3EPrimary Responsibilities:%3C/strong%reputed company%3C/span%reputed company%3C/p%reputed company%3Cp%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EThe Specialty Appeals Registered Nurse role fills an integral role in drafting and submitting appeals for specialty patients with acute and chronic disease states. In this role you will be preparing appeal letters for submission, obtaining support documents, following up on prior authorization outcomes, and addressing issues and handling concerns from other corresponding departments.%26nbsp;%3C/span%reputed company%3C/p%reputed company%3Cp%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EIn addition, the Registered Nurse would: %26nbsp;%26nbsp;%3C/span%reputed company%3C/p%reputed company%3Cul style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:%26quot;Open Sans%26quot;, %26quot;Segoe UI%26quot;, Frutiger, %26quot;Frutiger Linotype%26quot;, %26quot;Dejavu Sans%26quot;, %26quot;Helvetica Neue%26quot;, Arial, sans-serif;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:12px 0px;orphans:2;padding:revert;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3ECommunicate with providers, patients, and pharmacy staff to obtain necessary clinical documentation, prior authorizations, and appeal letters%3C/span%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EFacilitate appeals process between the patient, physician, and insurance company by requesting denial information and facilitates obtaining the denial letter from the insurance, patient or physician. %26nbsp;Composes clinical appeals letters based off of specific denial reason and patients clinical presentation. %26nbsp;Ensures reputed company clinical information and documentation are obtained prior to appeal submission%3C/span%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EAccessing multiple reputed company resources to reputed company PA, insurance and appeal status and benefits. Utilization of and proficiency in multiple internal processing systems for record keeping and tracking of letter determinations%3C/span%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EInterpret and utilize clinical documentation from providers, and different pharmacy/computer systems%3C/span%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EUtilizing multiple platforms, researching clinical studies for points of argument for appeals%3C/span%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EWrite and return assigned appeals to providers%26nbsp;%3C/span%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EUtilization of and proficiency in multiple internal processing systems for record keeping and tracking of determinations%3C/span%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EAssign appeal requests to coworkers as needed (rotating schedule)%3C/span%reputed company%3C/li%reputed company%3Cli%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EPerform other reputed company duties as assigned%3C/span%reputed company%3C/li%reputed company%3C/ul%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:%26quot;Open Sans%26quot;, %26quot;Segoe UI%26quot;, Frutiger, %26quot;Frutiger Linotype%26quot;, %26quot;Dejavu Sans%26quot;, %26quot;Helvetica Neue%26quot;, Arial, sans-serif;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%reputed company%26nbsp;%3C/span%reputed company%3C/p%reputed company%3Cp style=%22-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(0, 0, 0);font-family:%26quot;Open Sans%26quot;, %26quot;Segoe UI%26quot;, Frutiger, %26quot;Frutiger Linotype%26quot;, %26quot;Dejavu Sans%26quot;, %26quot;Helvetica Neue%26quot;, Arial, sans-serif;font-size:13.02px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;letter-spacing:normal;margin:0px 0px 12px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;%22%reputed company%3Cspan style=%22color:black;font-family:Tahoma, Geneva, sans-serif;font-size:10px;%22%3EYou’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.%3C/span%reputed company%3C/p%reputed company
Required Qualifications
- Active, Registered Nurse License
- Willingness to obtain Case Management Certification (CCM) once eligible
- 2+ years of clinical experience as a Registered Nurse
- 1+ years of experience working with prior authorization, pre-certification, utilization review, and / or appeals experience
- Understanding of clinical documentation from physician offices
- Proficiency with reputed company, reputed company, SharePoint
- Proven ability to work independently (At home or office)
Preferred Qualifications
- Bachelor’s degree
- RN licenses in multiple states (reputed company of compact states)
- Case Management Certification (CCM)
- PBM and / or Managed Care experience
- Prior Authorization/Appeal Experience
- Knowledge of healthcare insurance plans, denials, and appeal procedures
- Advanced computer skills; Experience in a paperless role
*reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission.
Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative Action employer and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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