Medical Appeals and Grievance (MAG) Registered Nurse Specialist II - Remote

Responsible for utilizing clinical acumen and managed care expertise related to researching, resolving and responding to requests for member and provider appeals, grievances, reconsiderations and corrected claims for all lines of business with emphasis on privacy, accuracy, meeting all regulatory and compliance timelines. Perform in-depth analysis, clinical review and resolution of provider appeals/inquiries, corrected claims and subscriber reconsiderations, member appeals and provider grievances. Requires active unrestricted RN license in Arizona or compact state.

Multiple levels with varying experience requirements from 1 to 8 years in clinical and health insurance or healthcare related field. Managed care experience with focus in Utilization Management, Prior Authorization, Claims, Case Management and/or Medical Appeals and Grievance preferred. Associate's Degree in healthcare field or Nursing Diploma required; Bachelor's in Nursing preferred.