Arizona RN Med Appeals Coordinator

Working remotely on a contract basis, the Arizona RN Med Appeals Coordinator will perform in-depth analysis and resolution of provider appeals, member grievances, and inquiries while maintaining compliance with regulatory standards. Key responsibilities Conduct clinical reviews and manage the resolution of provider appeals and member grievances across all lines of business Analyze medical records and benefit plan requirements to determine the appropriateness of appeal and grievance requests Maintain accurate records and meet performance goals in accordance with department guidelines and regulatory requirements Required qualifications Active, current, and unrestricted RN license in Arizona or a compact state Associate's Degree in a healthcare field or Nursing Diploma Minimum of 1 year of experience in clinical and health insurance or a related healthcare field Intermediate proficiency in PC and office equipment Advanced clinical knowledge and the ability to interpret policies and procedures