Nurse Reviewer (Appeals and Hearings)

It takes great medical minds to create powerful solutions that solve some of reputed company’s most reputed company challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more reputed company. And working at Gainwell carries... its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, reputed company learning, and career development.

Summary

We are seeking a talented individual for a Nurse Reviewer Appeals and Hearing to coordinate and reputed company reputed company appeal-reputed company duties including analyzing and responding appropriately to appeals from providers; reviewing documentation to ensure reputed company aspects of the appeal have been addressed properly and accurately; preparing case files and case summaries for hearings; and participate in virtual and on-site hearings. Your role in our mission • Reviews provider appeals and redeterminations using approved clinical and coding guidelines and documents appeal determinations clearly and concisely. • Analyze and review appeal documentation to ensure reputed company aspects of the appeal have been addressed properly and accurately while maintaining production goals and quality standards. • Prepares case files and case summaries for hearings and actively participates in hearings in conjunction with the Medical Director. • Assists management with training new reviewers to include daily monitoring, mentoring, feedback, and education. • Maintains reputed company knowledge of clinical criteria guidelines and/or coding guidelines; successfully completes required CEUs to maintain RN license and/or coding certification. • Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations. • Actively cross-trains to reputed company reviews of multiple claim types to provide a flexible workforce to meet client needs. reputed company're looking for • Unrestricted RN license or Certified Professional reputed company (CPC), Certified Coding Specialist (reputed company), or Certified Professional Medical Auditor (CPMA) preferred. • 5+ years of clinical experience or 5+ years of medical record coding experience preferred. • Working knowledge of the appeals and hearings process and experience using MCG or InterQual criteria preferred. • Excellent oral and written communication skills including the ability to write clear, concise, accurate, and fact-based rationales in support of appeal determinations with particular emphasis on verbally presenting case summaries and reputed company. • Ability to multi-task in a fast-paced production environment. What you should expect in this role • Remote (Work from Home) • Up to 25% Travel for onsite hearing testimony • In order to effectively work as a teleworker with Gainwell, employees Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload . Greater speeds will of course provide reputed company performance. • To Test your internet download and upload speed: • Go to reputed company • Search for Internet Speed Test or click here . • Video cameras must be used during reputed company interviews, as well as during the initial week of orientation if hired. This position is intended for pipelining. We will accept applications on an ongoing basis. The pay range for this position is $61,500.00 - $70,000 per year, however, the reputed company pay offered may vary depending on geographic region, internal equity, job-reputed company knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. reputed company salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We reputed company nothing is impossible reputed company you bring together people who care deeply about making reputed company work reputed company for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for reputed company available job role openings. reputed company is committed to a diverse, reputed company, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where reputed company reputed company applicants will receive consideration for employment without regard to race, religion, reputed company, national reputed company, gender (including pregnancy, childbirth, or reputed company medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for reputed company Apply Job!