UM Appeals Nurse in Wall, NJ

  • Title: UM Appeals Nurse
  • Code: RCI-8733-1
  • RequirementID: 119368
  • Location: Wall, NJ 07727
  • Posted Date: 07/10/2024
  • Duration: 3-6 Months
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  Job Description

May likely be a 6 month requirement based on staff on leave and their return date.

The Client UM Appeals Department is looking for a seasoned UM Appeals Nurse to join our team for a 6 month time frame.

The primary role includes:

  • Review of Level I Pharmacy Appeals.
  • This includes review and investigation of the reason for the UM denial, appeal request and review of additional information provided.

  

Qualifications:

  • Active Unrestricted RN License NJ or Compact
  • Technology Savvy – Ability to navigate through multiple systems and type 100 words per minute. Client utilized systems including: Novologix, Micromedex, Care Radius, Outlook, Teams, Onenote, Microsoft suite. Knowledge of these is a plus.
  • Thrive in a fast paced environment
  • Solid ability to present clinical information to a committee
  • Make sound clinical judgements quickly to maintain turnaround time
  • Proficient in review and investigation of a UM appeal. This includes understanding of regulations that guide our practices
  • Health plan Appeals experience is a must.
  • Prefer knowledge of UM Pharmacy appeals if possible
  • Proficient with navigating UM policies and clinical guidelines


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