What are the responsibilities and job description for the Clinical Appeals RN position at Staffingine LLC?
Position : Clinical Appeals RN REMOTE part time
Location : Corvallis OR 97330
Job Description :
JOB SUMMARY / PURPOSE
Performs clinical appeal functions for all lines of business. Ensures that provider and member appeals are processed and documented to meet state and federal guidelines for quality accuracy timeliness and completeness.
DEPARTMENT DESCRIPTION
Client operates a portfolio of health plan products under several different legal structures : Intercommunity Health Plans Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Client Inc. offers Medicare Advantage Commercial Large Group and Commercial Large Group PPO and EPO plans; SHP is also the thirdparty administrator for Client selffunded employee health benefit plan. As part of an Integrated Delivery System Client Plans is strategically and operationally aligned with Client mission of Building Healthier Communities Together.
NOTE : During Training this role will need to be fulltime and then PT after training and nesting has been completed. (10 hours per week)
This is a remote position.
EXPERIENCE / EDUCATION / QUALIFICATIONS
Current unencumbered Oregon RN license required. BSN preferred.
Three (3) years recent clinical experience required. Experience in a managed care setting preferred.
Experience or training with computer applications required.
Experience or training in case management and utilization management preferred.
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