Clinical Appeals Nurse
Job Title: Clinical Appeals Nurse Job Description... The Clinical Appeals Nurse is responsible for managing clinical appeals and state hearings across all states. This role involves reviewing and completing both provider and member clinical appeals within designated timeframes, preparing State Hearing packets, and ensuring communication with state agencies and internal departments. The successful candidate will attend State Hearings, issue notification letters, refer medical necessity denials, and maintain accurate documentation. Additionally, this role requires collaboration with the Quality Improvement and Clinical Operations Team to manage requests for Independent External Review and ensure compliance with regulatory standards.
Work Environment
Fully remote role. Consultants will need to provide their own equipment including phone, internet, computer, and monitors. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. Diversity, Equity & Inclusion At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through: Hiring diverse talent Maintaining an inclusive environment through persistent self-reflection Building a culture of care, engagement, and recognition with clear outcomes Ensuring growth opportunities for our people The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email [email protected] for other accommodation options Apply Job!