CareFirst BlueCross BlueShield
Appeals Specialist I (Remote)
This job is now closed
Job Description
- Req#: 14169435
Employer Industry: Healthcare Services
Why Consider this Job Opportunity:
- Salary up to $60,000
- Comprehensive benefits package including medical, dental, and vision insurance
- Opportunities for career advancement and professional growth within the organization
- Remote work flexibility available
- Collaborative and supportive team environment
- Chance to make a positive impact on patient care and outcomes
What to Expect (Job Responsibilities):
- Conduct medical management activities to optimize member outcomes
- Collaborate with healthcare providers to ensure appropriate treatment plans
- Review medical records and claims to determine medical necessity and appropriateness of care
- Utilize evidence-based guidelines to make clinical decisions
- Coordinate with internal and external stakeholders to facilitate member care
What is Required (Qualifications):
- Registered Nurse (RN) with active and unrestricted license
- Minimum of 2 years of clinical experience in a healthcare setting
- Strong critical thinking and decision-making skills
- Excellent communication and interpersonal abilities
- Proficiency in Microsoft Office suite
How to Stand Out (Preferred Qualifications):
- Certification in Case Management or Utilization Management
- Experience working in a managed care environment
- Knowledge of healthcare regulations and guidelines
- Familiarity with electronic health record systems
- Bilingual in English and Spanish
#HealthcareServices #MedicalManagement #CareerGrowth #RemoteWork #PatientCare
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