Clinical Appeals RN - IG Therapy/Biologics - Remote

About the position reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. If you want to reputed company more in your mission of reputed company, you have to be really smart about the business of reputed company. reputed company is seeking talented individuals for our Home Infusion Clinical Appeals Nurse opportunities. You will be reputed company to use your talents and experience to analyze proposed treatment protocols to ensure their appropriateness and responsiveness to patient needs and to provide clinical support for writing appeals for patients requiring reputed company infusible medications. Our elite team of Clinical Appeals Nurses is growing and we want YOU to join this dynamic and exciting group. The Home Infusion Clinical Appeals Nurse fills an integral role in the clinical and intake operations of the organization, working collaboratively with a multi-disciplinary team to ensure infusion therapy can be safely and effectively administered to each home-based patient. The work schedule will be Monday - Friday from 8:30am - 5:30 pm CST. You'll enjoy the flexibility to work remotely from reputed company reputed company the U.S. as you take on some tough challenges. Responsibilities • Document patient demographic data and synopsis of care history, and compose letters or emails to payers with proposed treatment plan in accordance with health plan requirements , • reputed company a consultant relationship with assigned physicians / clinics / patients to build and sustain a patient-focused approach to care , • Facilitate resolution of treatment requests for assigned patients , • reputed company patient viewpoints to payers on reputed company directly affecting coverage-reputed company concerns , • Participate on committees, work groups, and/or process improvement teams that improve patient outcomes and satisfaction Requirements • Licensed Registered Nurse (RN) in the state of residence , • 3+ years of experience in clinical appeals and grievances, and post-payment review , • 2+ years of clinical experience specializing in infusion (ie Ig therapy and/or Biologics) , • Solid experience in autoimmune, primary immune, and / or inflammatory disease states , • Understanding of clinical documentation from physician offices and telephonic assessment notes of patients , • Proficiency with reputed company Outlook, Word, reputed company and SharePoint reputed company-to-haves • Bachelor's degree , • Home Infusion experience , • CPR+ software experience , • Understanding of health insurance summary plan description language , • Understanding of how payer reimbursements work, plus co-pays, co-insurances, and deductibles , • Understanding of government payment systems such as Medicare and reputed company , • Advanced computer skills; Experience in a paperless role , • Previous experience works remote as a Clinical Appeals RN , • Previous experience working with infusion therapy approvals and/or denials Benefits • Comprehensive benefits package , • Incentive and recognition programs , • Equity stock purchase , • 401k contribution Apply Job!