Nurse Appeals – Litigation & Legal Support
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Durham • Florida, New York, North Carolina, Texas, Virginia • 🇺🇸 United States
Visit company websiteSalary
💰 $69,972 - $119,952 per year
Job Level
JuniorMid-Level
About the role
- Investigating and processing medical necessity appeals requests from members and providers
- Supporting legal, management, and executive leadership by managing State Fair Hearing and External Medical Review requests
- Acting as a resource for both clinical and non-clinical teams
- Documenting and logging appeal information in relevant tracking systems
- Generating written correspondence with members, providers, and regulatory entities
- Serving as a subject matter expert for appeals, grievances, and quality of care issues
Requirements
- Requires a HS diploma or equivalent
- Minimum of 2 years of experience in a managed care healthcare setting
- Current active unrestricted RN license to practice
- AS or BS in Nursing preferred
- Background or exposure in litigation, legal proceedings, and/or paralegal experience is strongly desired
- Understanding of the grievance and appeals process is strongly preferred
- Basic knowledge of Medicare and Medicaid guidelines is preferred
- Proficiency in Microsoft Suite Products (e.g. Outlook, Excel, and Word)
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
- Paid Time Off
- medical, dental, vision, short and long term disability benefits
- merit increases
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical necessity appealsgrievance processappeals processlitigationlegal proceedingsparalegal experienceMedicare guidelinesMedicaid guidelines
Soft skills
communicationdocumentationresource managementsubject matter expertise
Certifications
RN licenseHS diplomaAS in NursingBS in Nursing