Appeals and Grievances Clinical Specialist - RN or LPN

Company: VirtualVocations
Location: Gainesville
Posted on: November 8, 2024

Job Description:

A company is looking for an Appeals and Grievances Clinical Specialist - RN or LPN, 100% Remote.

Key Responsibilities

Manage clinical case development and resolution for member and provider complaints
Prepare cases for Medical Director Review and external appeals processes
Ensure compliance with Federal and State regulations while managing caseloads

Required Qualifications

Must be an RN, LPN, or Dental Hygienist
Bachelor's degree preferred
Experience in clinical practice, appeals & grievances, or utilization management
Understanding of Utilization Review Guidelines and related regulations
Ability to work with care management systems and multiple computer applications

Keywords: VirtualVocations, Palm Coast , Appeals and Grievances Clinical Specialist - RN or LPN, Healthcare , Gainesville, Florida

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