Nurse Appeals

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Elevance Health
Nurse Appeals
Full Time

Job Description



Job Description: External


Location: Remote


Schedule: 7:30-5:30pm EST or Central time zone


Annual Salary Range: 62,000- 77,500


The Nurse Appeals is responsible for investigating and processing quality of care issues, clinical grievances, and critical incidents from members, providers, and internal staff. Primary duties may include, but are not limited to:



  • Conducts investigations and reviews of member grievances and potential quality of care issues

  • Reviews medical records for potential quality of care issues

  • Extrapolates and summarizes medical information for medical director.

  • Ensures that Quality of care reviews and clinical grievances are resolved timely to meet regulatory timeframes.

  • Documents and logs grievance information and quality of care investigations on relevant tracking systems and mainframe systems.

  • Generates written correspondence to providers, members, and regulatory entities.

  • Utilize leadership skills and serves as a subject matter expert for critical incidents/grievances/quality of care issues and is a resource for clinical and non-clinical team members in expediting the resolution of outstanding issues.



Applicable to Colorado Applicants Only


Annual Salary Range*: 62,000- 77,500
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.* The hourly or salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.



Qualifications - External



  • 2 years of experience in a managed care healthcare setting; or any combination of education and experience, which would provide an equivalent background.

  • Current active unrestricted RN license to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required.



Preferred Requirements:



  • AS or BS in Nursing preferred.

  • For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.



Be part of an Extraordinary Team


Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.


We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?


We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Elevance Health approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.


Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.elevancehealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.



Company Information

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

Digital and Technology professionals at Elevance Health drive the future of health care, delivering innovative and reliable solutions that address consumer and health care provider needs. Join us as we harness the power of advanced technology to deliver trusted and caring solutions that improve the health of our members and transform health care.

We have career paths in Information Security, Quality Assurance, Engineering, Innovation and Portfolio Management, Service Delivery, Solutions Development and Strategy/Planning.

Dice Id : 10121414
Position Id : JR22111-349
Originally Posted : 3 weeks ago

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