Nebraska Licensed Appeals Specialist

Virtual Vocations Inc

To support a mission-driven organization, the full-time Nebraska Licensed Appeals Specialist will perform appeals medical reviews remotely, ensuring compliance with regulations and accurate resolutions for claims, pre-certifications, and pre-authorizations. Key responsibilities Adhere to State and Federal regulations and BCBSNE policies during the appeal resolution process Conduct accurate and timely medical reviews of appeal requests and related inquiries Collaborate with healthcare providers and internal teams to promote high-quality, cost-effective care Required qualifications Bachelor's degree in Nursing or a health-related field Three years of clinical/medical-surgical experience in an acute care setting Active, current, and unrestricted Registered Nurse license from Nebraska or a participating consortium state Ability to work rotating weekend/holiday shifts as needed Demonstrated clinical skills and problem-solving abilities

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Vacancy posted 3 days ago

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