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Remote Appeals Nurse

A-Line Staffing Solutions

This is a Full-time position in Austin, TX posted October 25, 2021.

Appeals Nurse RN openings with a major health insurance / managed care company based in the San Antonio, Texas 78251 area! Starting ASAP!! Apply now with Jake Z. at A-Line!

**Remote anywhere in Texas near an office – ex. Heather gave: San Antonio, Austin, Tyler, Dallas. Contract will most likely be fully remote due to the time frame but could return in October, November**

Position Summary: This position will be reviewing Behavioral Health appeals and adverse determination for services requested by providers utilizing policies, procedures and best practices; applicants will need to have experience and be knowledgeable in applying policies/criteria to clinical information. Highly prefer Behavioral Health experience.

Pay: $40-$45 hourly (determined on licensure and experience)

Shift: 8am-5pm from Monday-Friday, possibility of overtime due to workloads. Past 5 on weekdays if so, a couple of staff that work on weekends but contractors would most likely do the after 5pm instead if needed.

Required Skills:

  • Registered Nurse with Appeals and Long-Term Care experience
  • BSN/Bachelor’s Degree
  • Minimum 1 year of specific denials and/or behavioral health experience.
  • Must be an active RN in Texas with 2+ years of clinical nursing experience
  • Proficient with Microsoft Office applications; Knowledge of InterQual criteria preferred.

Why Apply:

  • Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
  • 401k after 1 year of employment: With employer match and profit sharing
  • GREAT Hours! Monday through Friday, 40 hours per week
  • Competitive Pay Rate!

Keywords: Medical Coding, Concurrent Review, Denials, Grievance, Grievance and Appeals, Appeals and Denials, Utilization Review, Case Management, CCM, Case Manager, URAC, HEDIS, STARS, InterQual, CMS, Medicare, Medicaid, Utilization Management, Registered Nurse, Telephonic Nurse, PBM, Claims, Rx, Certified Case Manager, Care Coordination, Health Plan, Health Insurance, MCO, RN, Nurse, Managed Care, Medical Claims, Appeals, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Patient Counselor, Healthcare.

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