Registered Nurse 4

1 day ago Be among the first 25 applicants This range is provided by Aditi Consulting. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $50.00/hr - $52.00/hr Payrate: $50.00 - $52.00/hr. Summary: The Medicare Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either preservice, post service or claim denial. Responsibilities:

• The Medicare Appeals and Grievances RN will report to the Appeals and Grievances Manger.
• In this role you will be responsible for performing first level appeal reviews for members utilizing the National Coverage Determination (NCD) guidelines, Local Coverage Determination (LCD) Guidelines, pharmacy policies and nationally recognized sources such as MCG, NCCN, and ACOG.
• Reviews may also be performed for medical necessity, non-covered benefits and to meet the criteria for the coding billed. Desired Skills:
• Knowledge of Medicare benefits and appeal reviews
• Requires 2-4 years of health insurance or related experience
• Demonstrate the ability to act independently using sound clinical judgement
• Works well in a fast-paced team environment Qualifications:
• The ideal candidate will have previous insurance/managed care experience and hold at least a bachelor’s degree in nursing.
• Higher-level certifications are highly desirable.
• Associate’s degree in nursing required. Bachelor’s degree preferred.
• Nursing license required.
• 8-10 years’ experience required. Pay Transparency: The typical base pay for this role across the U.S. is: $50.00 - $52.00 /hr. Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education and experience and the benefits package you select. Full-time employees are eligible to select from different benefits packages. Packages may include medical, dental, and vision benefits, 10 paid days off, 401(k) plan participation, commuter benefits and life and disability insurance. For information about our collection, use, and disclosure of applicant's personal information as well as applicants' rights over their personal information, please see our Privacy Policy ( Aditi Consulting LLC uses AI technology to engage candidates during the sourcing process. AI technology is used to gather data only and does not replace human-based decision making in employment decisions. By applying for this position, you agree to Aditi’s use of AI technology, including calls from an AI Voice Recruiter. #AditiConsulting Seniority level
• Seniority levelEntry level Employment type
• Employment typeContract Job function
• Job functionHealth Care Provider
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