Mindlance
Clinical Appeals Analyst
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Job Description
- Req#: 26-02529
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Work remotely from anywhere within the 28 allowed states
- Competitive pay for qualified candidates
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on member experiences and healthcare outcomes
What to Expect (Job Responsibilities):
- Provide clinical consultation with non-clinical staff within the Appeals Department
- Coordinate all aspects of the appeals process to ensure compliance with medical necessity criteria and corporate policies
- Analyze complex member and provider appeals and grievances across all lines of business
- Identify appropriate documentation collection from various external sources
- Provide written documentation of case determinations to appellants and involved parties in a timely manner
What is Required (Qualifications):
- Registered Nurse licensed in the state of North Carolina
- Minimum of 3 years of clinical experience
- OR Licensed Practical Nurse, Physical Therapist, or Occupational Therapist licensed in North Carolina with 5 years of clinical experience
- Strong analytical skills to review complex appeals and grievances
- Excellent communication skills for professional interaction with members and providers
How to Stand Out (Preferred Qualifications):
- Experience in appeals or grievance processes within a healthcare setting
- Familiarity with NCQA requirements and corporate medical policies
- Ability to work collaboratively with a diverse team
- Strong organizational skills to manage multiple cases effectively
#HealthcareServices #RemoteWork #ClinicalConsultation #CareerOpportunity #EqualOpportunityEmployer
"We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer."About the company
Mindlance is one of the largest diversity-owned staffing firms in the US . As a recruitment centric talent acquisition company, Mindlance provides Technology, Engineering, Digital / Creative / Marketing, Clinical Research, Scientific, Finance, Professional and Payroll Management staffing services to Global 1000 companies across the US, Canada and India.
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