Appeals Nurse Consultant
Location: Chattanooga, Tennessee
Description: Blue Cross Blue Shield of Tennessee is at the momment seeking for Appeals Nurse Consultant right now, this career will be assigned in Tennessee. For complete informations about this career opportunity please read the description below. The purpose of this position is to support the BlueCare Member Appeals Department and Medicaid Compliance Program. Primary responsibilities include providi! ng clinical leadership of staff to ensure compliance with the member appeals process. The responsibility of this position is the detailed evaluation of medical necessity documentation submitted for clinical review, conducting training of new nurse consultants, training non-clinical member appeal staff, coordinating questions related to reviews for Medical Director consultation/review, and assisting with provider education. This position performs in-research and depth reviews of complex situations, which have been denied, and either resolves them, sends for additional review by a Medical Consultant. It is this positionÂ's responsibility to conduct a review of the appeal, ascertain that the necessary medical records and documentation are included.
Registered Nurse licensed to practice in the State of Tennessee.
Minimum 3 years varied clinical nursing experience and a minimum of 12 months of medical! management/ utilization review experience required.
Minim! um 2 years of managed care experience, or experience with regulatory or accrediting body requirements (i.e., NCQA, URAC, EQRO, CMS, TennCare) preferred.
Excellent computer skills with direct experience in MS office, Word, PowerPoint, and Excel required. Must be able to pass Windows navigation test
Â Must be self-motivated and able to manage multiple tasks and priorities within specified time frames.
If you were eligible to this career, please deliver us your resume, with salary requirements and a resume to Blue Cross Blue Shield of Tennessee.
Interested on this career, just click on the Apply button, you will be redirected to the official website
This career will be opened on: Wed, 13 Mar 2013 02:19:45 GMT