NEW REMOTE APPEALS Nurse for a contract at an insurance company in Maryland!

UM/Appeals RN Qualifications:

• MD or Compact RN
• 2 years of appeals and denials experience
• Managed care experience
• InterQual criteria experience a must

Job Description:

• 13 weeks, M-F, 8 hour days up to 40 hours or Part time working 20 hours per week, REMOTE, No weekends or Holidays
• Responsible for the day to day management of health confined plan members in acute care and/or rehabilitative facilities. The Utilization Nurse (UN) actively monitors the appropriateness of care received by plan members in a variety of settings, acute hospital, sub-acute hospital, and acute rehabilitation facility. The Utilization Nurse applies member benefit and medical criteria to determine authorization of services in coordination with the Medical Directors. The Utilization Nurse proactively initiates discharge planning for of members, including identification of post-discharge needs and coordination of post discharge referrals/services. The UN communicates verbally and in writing authorization and/or denial of covered services with providers, facilities and members. The UN is a member of administrative and clinical teams in the area of assignment. Clinical knowledge is maintained and updated and UN must maintain acceptable documentation and quality standards.
• Skills: Excellent verbal and written communication skills to effectively interact and work correctively with enrollees, Physicians facility staff and management staff. Work requires excellent interpersonal skills and attitude to effectively project a positive image of our Managed Care Program. Computer skills working with a variety of applications and online systems. Knowledge of Enterprise and utilizing various criteria sets i.e. InterQual. Ability to negotiate and resolve conflicts with external customers.

**Must be able to go into the office for equipment (Hanover, MD)

Contact information below:

Kayla Walsh- 410-825-6186 #2

rsirecruit.com

Key Words: Utilization review Nurse, Registered nurse, Remote, InterQual, managed care, insurance, Appeals and Denials

Job Type: Full-time

Pay: Up to $44.00 per hour

Weekly schedule:

• Monday to Friday

Experience:

• Interqual: 1 year (Required)
• Appeals and Denials: 2 years (Required)
• Utilization Review: 2 years (Preferred)

License/Certification:

• MD or Compact RN License (Required)

Location:

• Hanover, MD (Required)

Work Location: Remote