Appeal Analyst RN in US-Remote

Remote

8am-5pm

The primary role includes:

• Review of Level 2 Commercial 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: 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

Rangam Consultants is a minority, women-owned, disability workforce solutions global organization. Specialized in attracting and retaining talents globally for a rewarding career in IT, Engineering, Scientific, Clinical, Healthcare, Administrative, Finance, Business Management, and many more, while integrating veterans and individuals with disabilities into the workforce. Indeed, we connect career aspirants to relevant job opportunities, be it jobs in USA, UK, India, or Ireland. Also remote jobs, work-from-home jobs, or contract jobs in different verticals and industries.
Rangam strives to put job seekers first, giving them free access to search for jobs, post resumes, and research companies.Every day, we connect millions of people to new opportunities.