Appeals Nurse

Summary:

• Work Mode: 100% Remote, possible on-site if hired full-time
• Location: Preferred Iowa Candidates
• Duration: 10 months, contract to hire possible
• Shift: 8 am to 5 pm CST, no overtime

Responsibilities:

• Review and process Iowa Medicaid Member Appeals
• Manage the entire appeal process from start to finish
• Conduct outreach to members/providers
• Complete clinical reviews and send cases to specialty review/MD
• Write determination letters and close cases
• Complete standard cases within 30 calendar days
• Acknowledge receipt of cases within 3 business days
• Handle all Iowa Medicaid appeals except behavioral health

Requirements:

• Education: Associates degree required
• Licensure: LPN required
• Minimum 2 years of nursing experience
• Utilization Management (UM) experience helpful

Preferred Skills:

• RN licensure preferred
• Ability to thrive in a fast-paced environment with frequently changing workloads
• Strong prioritization, organization, and adaptability
• Customer service skills
• Time management skills
• Computer skills and ability to learn new systems