Overview
Remote
Depends on Experience
Contract - W2
Job Details
Utilization Management Appeals Nurse | 3 years | Remote | Contract
Walker Healthforce is seeking a Utilization Management Appeals Nurse with 3 years of experience to support a healthcare client based out of New Jersey. This is a 6-month contract opportunity.
START DATE: ASAP
WORKER TYPE: W2
CORE REQUIREMENTS:
ADDITIONAL REQUIREMENTS:
WE CONSIDER IT A BONUS IF YOU ALSO HAVE:
JOB RESPONSIBILITIES:
WHAT WE OFFER:
WHY WORK WITH WALKER?
Contact our Recruiting Team today to experience the Walker Healthforce difference!
ABOUT US:
Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we’re custom not commodity and we’ve been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!
We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.
#IND1
Walker Healthforce is seeking a Utilization Management Appeals Nurse with 3 years of experience to support a healthcare client based out of New Jersey. This is a 6-month contract opportunity.
START DATE: ASAP
WORKER TYPE: W2
CORE REQUIREMENTS:
- Minimum of 3 years clinical experience.
- 3 years’ experience in the health care delivery system/industry.
- Must have effective verbal and written communication skills and demonstrate the ability to work well within a team.
- Demonstrated ability to deliver highly technical information to less technical individuals.
- Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.
- Proven time management skills are necessary. Must demonstrate the ability to manage multiple priorities [or tasks], deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required.
- Demonstrated ability to work in a production focused environment.
- Proven ability to exercise sound judgment and strong problem-solving skills.
- Proven ability to ask probing questions and obtain thorough and relevant information.
- Must be client service focused with effective ability to empathize.
- Must be proficient in the use of PC and various claim systems.
- High School Diploma or GED equivalent
ADDITIONAL REQUIREMENTS:
- Must reside in New York, New Jersey, Pennsylvania, Connecticut, or Delaware
- Active Unrestricted RN License Required; NJ License Preferred
WE CONSIDER IT A BONUS IF YOU ALSO HAVE:
- Bachelor’s degree from an accredited college or university
- Certified Professional Coder credentials
JOB RESPONSIBILITIES:
- Provide timely and accurate responses to inquiries from the claim policy teams in relation to courtesy pre-d requests, claims pending for medical review and appeal inquiries.
- Prepares cases for Medical Director Review and or outside consultant review and response where appropriate.
- Responsible for processing pends for which the Medical Policy Inquiry Resolution team has authority to do so.
- Identifies opportunities for development of or revisions to Horizon Medical Policy based on case review.
- Responsible for identifying areas and pursuing solutions where medical policy is not being applied correctly in claim payment outcome.
- Responsible for managing inventory assigned, documenting production in RMRS and following through on all assigned inquiries.
- Responsible for staying abreast of all mandates, policy changes, workflow changes impacting outcomes.
- Performs special projects as assigned by management.
- Demonstrates knowledge and understanding of the laws regulations and policies that pertain to the organization unit's business and conforms to these laws, regulations and policies in carrying out the accountabilities of the job.
WHAT WE OFFER:
- Competitive compensation package
- Weekly pay via Direct Deposit
- Medical, Dental & Vision available
- 401k options
WHY WORK WITH WALKER?
- Access to our top ranked team of recruiting and placement specialists
- Continuous, one-on-one support from a dedicated engagement manager
- Professional resume development and interview preparation
Contact our Recruiting Team today to experience the Walker Healthforce difference!
ABOUT US:
Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we’re custom not commodity and we’ve been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!
We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.
#IND1
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.