Appeals Review Nurse

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Position Summary:

• Reviews clinical information provided by the facility and providers to evaluate the medical necessity and clinical appropriateness of requested services for a member
  
• Collects information concerning eligibility, provider status, benefit coverage, coordination of benefits and subrogation necessary to reach prospective, concurrent and retrospective decisions in the appeals process
• Produces approval and denial letters on behalf of the Medical Director for submission to member, provider or hospital

Hours for this Position: Monday-Friday 8:00-5:00

Advantages of this Opportunity:

• Competitive salary, negotiable based on relevant experience
  
• Benefits offered, Medical, Dental, and Vision
• Fun and positive work environment

Qualifications

What We Look For:

• LVN/LPN
• Experience in acute care facility
• Experience managing patients in an inpatient environment
• Knowledge of MS applications

Additional Information

Are you an experienced LVN or LPN with claims and appeals experience looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

Interested in hearing more about this great opportunity? Please click on the apply button for immediate consideration.