Remote - Appeal Management Nurse

Education:

Graduate of an accredited School of Nursing required.

Experience:

2 years in acute care hospital setting required.

Licensure:
Current license in the state of residence and/or employment required.

Preferred Qualifications:

Experience:

Care Management, Utilization Management, and/or Appeal Management experiences preferred.

Other Skills, Knowledge, Abilities:

• Excellent interpersonal, verbal and written communication skills, particularly telephone.

• Strong analytical and organizational skills with the ability to multi-task.

• Must have the ability to work independently and meet deadlines with attention to detail.

• Excellent time management and organizational skills.

• Must have a good understanding of medical terminology with ability to read, discuss and understand patient medical information.

• Must have the ability to interact effectively with a variety of people and situations at all levels of the organization.

• Ability to stay current on changing governmental and payor regulations related to authorization/certification processes.

• Knowledge of and adherence to commercial, managed care, government and audit appeal processes and timelines and the financial implications to the Ministry.

• Ensures knowledge is kept relevant on all nationally recognized Payor Criteria guidelines.

• Maintains technical knowledge and skills of computer system including but not limited to Office 365, EPIC and Payor based websites.

• Ability to fully utilize automation to achieve departmental goals.

• Ability to demonstrate personal qualities such as kindness, compassion, understanding, creativeness, integrity, interest, influence and respect for others.

Preferred Education:

Bachelor of Science in Nursing.

Physical Requirements:

•    Position requires the ability to push, pull, and/or lift 50 lbs on a regular basis.
•    Position requires prolonged standing and walking during each shift.
•    Position requires the ability to grip, reach, bend, kneel, twist, and squat to perform duties.

From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.

Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.

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