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Clinical - Clinical Review Clinician - Appeals - J00923

Pacer Group

  • NULL, AK
  • 27 days ago
  • Remote
  • $30–$40

Highlights

Must haves: Medicare knowledge, InterQual or Milliman Experience, Clinical reviews for Utilization Management or Appeals . Processing clinical reviews to ensure members have the best outcomes and access to care needed.

Numbers & Facts

LocationNULL, AK (
Remote)
Salary$30–$40

Description

Position Title: Clinical Review Clinician - Appeals

Location: Remote

Duration: 6 Months | Possibility to extend or convert

Schedule: 8-5 EST or CST time zone-weekend rotation required.

PR: $30-40.00/HR

Responsibilities:
  • Team handles various types of authorization and claim review requests from various markets nationwide.
  • Processing clinical reviews to ensure members have the best outcomes and access to care needed.
  • Help reduce provider abrasion by processing retrospective claim reviews
Licensure
  • Required: RN, LPN
Must haves:
  • Medicare knowledge, InterQual or Milliman Experience, Clinical reviews for Utilization Management or Appeals
Nice to haves:
  • Medicare Appeals Experience
Best vs. average:
  • Productivity expectations are set based on the platform.
Disqualifiers:
  • Not having a valid/active RN/LPN license

Top 3 must-have hard skills

  • Utilization Management or Appeals review background (1 plus year)
  • Medicare NCD/LCD and InterQual/Milliman Software (1 plus year)
  • Retrospective claims clinical reviews (1 plus year)

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