Appeals Nurse Consultant (Remote)

Job Summary

Job Type: Full-time, Remote

Salary: Competitive and commensurate with experience

Company: HealthCare Solutions, Inc.

Location: Remote

Benefits: Comprehensive benefits package including health, dental, vision, 401(k) match, generous PTO, and ongoing professional development opportunities.

Description

HealthCare Solutions, Inc. is seeking a highly motivated and experienced Appeals Nurse Consultant to join our remote team. As an Appeals Nurse Consultant, you will play a critical role in ensuring our clients receive the highest standard of care by reviewing and processing medical appeals and grievances. This is a fully remote position offering a unique opportunity to work from home while contributing to the healthcare sector.

Requirements

• Active and unrestricted RN license.


• Minimum of 3 years of clinical experience, with at least 2 years in a utilization review, appeals, or case management role.


• Strong understanding of healthcare insurance policies, medical terminology, and coding.


• Exceptional analytical, organizational, and problem-solving skills.


• Proficiency in Microsoft Office Suite and electronic medical record (EMR) systems.


• Excellent communication skills, both written and verbal.


• Ability to work independently in a remote environment and meet deadlines.

Responsibilities

• Review and analyze medical records to determine the appropriateness of medical necessity and level of care.


• Prepare detailed appeal summaries and correspondence for denied claims.


• Communicate effectively with healthcare providers, insurance companies, and patients regarding appeal status and outcomes.


• Stay current with regulatory and industry changes affecting the appeals process.


• Maintain accurate documentation and records in compliance with company policies and regulatory requirements.


• Participate in ongoing training and professional development to enhance skills and knowledge.

Benefits

• Competitive salary based on experience.


• Comprehensive health, dental, and vision insurance.


• 401(k) retirement plan with company match.


• Generous paid time off (PTO) and holiday schedule.


• Ongoing professional development and training opportunities.


• Flexible work hours and the ability to work from home.

Educational Qualifications

• Bachelor of Science in Nursing (BSN) preferred; Associate Degree in Nursing (ADN) with relevant experience considered.


• Certification in Case Management (CCM) or equivalent is a plus.

Company Overview

HealthCare Solutions, Inc. is a leading provider of healthcare management and consulting services. Our mission is to improve patient outcomes and healthcare efficiency through innovative solutions and exceptional service. We pride ourselves on our collaborative and supportive work environment, where every team member is valued and empowered to succeed. Join us in making a meaningful impact on the healthcare industry while enjoying the flexibility and benefits of a remote position.

If you meet the above qualifications and are passionate about making a difference in the healthcare industry, we encourage you to apply for this exciting opportunity.

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