Appeals and Grievances Clinical Specialist - RN or LPN
Company: VirtualVocations
Location: Gainesville
Posted on: November 8, 2024
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Job Description:
A company is looking for an Appeals and Grievances Clinical
Specialist - RN or LPN, 100% Remote.
Key Responsibilities
Manage clinical case development and resolution for member and
provider complaints
Prepare cases for Medical Director Review and external appeals
processes
Ensure compliance with Federal and State regulations while managing
caseloads
Required Qualifications
Must be an RN, LPN, or Dental Hygienist
Bachelor's degree preferred
Experience in clinical practice, appeals & grievances, or
utilization management
Understanding of Utilization Review Guidelines and related
regulations
Ability to work with care management systems and multiple computer
applications
Keywords: VirtualVocations, Sanford , Appeals and Grievances Clinical Specialist - RN or LPN, Healthcare , Gainesville, Florida
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