Job Description
Grievance & Appeals
• Creates complete appeal records for external appeal reviews, using standardized Independent Review Entity (IRE) forms and including all required documentation.
• Creates a detailed case summary in narrative format for each appeal.
• Submits cases as directed for each applicable geographic region.
• Presents verbal and written case summaries to client's Grievance Team and client Medical Directors.
• Completes assignments within client-designated turnaround times.
Priority Skill
Nursing
- Bachelor of Science Nursing (BSN) degree or General Nursing & Midwifery (GNM) Diploma or Basic Bachelor of Science (BSC) in Nursing degree or Associate Nursing Degree or Nursing Diploma
- Holds current and unrestricted US Registered Nurse license
- 3 months clinical experience (480 hours of working experience as a RN)
- Work experience as an active RN license and providing direct patient care
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