Clinical - Clinical Review Clinician - Appeals - J00923
$30 - $40 per hourPacer Group
Position Title: Clinical Review Clinician - Appeals
Location: Remote
Duration: 6 Months | Possibility to extend or convert
Schedule: 8-5 EST or CST time zone-weekend rotation required.
PR: $30-40.00/HR
Responsibilities:
-
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
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
Best vs. average:
-
Productivity expectations are set based on the platform.
Disqualifiers:
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Not having a valid/active RN/LPN license
Top 3 must-have hard skills
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Utilization Management or Appeals review background (1 plus year)
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Medicare NCD/LCD and InterQual/Milliman Software (1 plus year)
-
Retrospective claims clinical reviews (1 plus year)
Vacancy posted 3 days ago
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