Clinical - Clinical Review Clinician - Appeals
$30 - $39 per hourPacer Group
Position Title: Clinical Review Clinician - Appeals
Location: Remote
Duration: 5 Months | Possibility to extend or convert
Schedule: 8-5 EST or CST time zone (weekend rotation required.)
Pay rate: $30 to $39.00/hr..
Note: This is a part-time role with 20-hour work weeks. When the schedule is agreed upon, they must work that schedule. They can work 5 days a week, 5 hours per day or they can work 3 days a week to hit their 20 hours. Example: if the candidate chooses MWF they cannot change it up after it is approve. It must remain consistent.
Team handles various types of authorization and claim review requests from various markets nationwide. Processing clinical reviews to ensure members have the best outcomes and access to care needed. Help reduce provider abrasion by processing retrospective claim reviews.
Education/Certification
- Required: Associate in nursing, Bachelor's in nursing or higher.
Licensure
- Required: RN, LPN
Must haves:
- Medicare knowledge, InterQual or Milliman Experience, Clinical reviews for Utilization Management or Appeals
Nice to haves:
- Medicare Appeals Experience
Disqualifiers:
- Not having a valid/active RN/LPN license
Performance indicators:
- Productivity expectations vary based on platform. Prime 7 CPD, iCP 9 CPD and CenPas is 20 CPD cases per day with 95% quality on all cases
Best vs. average:
- Productivity expectations are set based on platform.
Top 3 must-have hard skills
- Utilization Management or Appeals review background (1 plus year)
- Medicare NCD/LCD and InterQual/Milliman Software (1 plus year)
- Retrospective claims clinical reviews (1 plus year)
Vacancy posted 2 days ago
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