FAQs
What are the primary responsibilities of a Nurse Appeals?
The Nurse Appeals is responsible for investigating and processing medical necessity appeals requests from members and providers, reviewing medical records, summarizing medical information, preparing recommendations for appeals, ensuring timely resolution of grievances, documenting appeal information, and generating written correspondence.
What is the work schedule for this position?
The Nurse Appeals position operates on a Monday to Friday schedule, from 9:00 am to 5:30 pm EST.
Is this position remote, and are there any location requirements?
Yes, this is a virtual position, but candidates are preferred to reside within 50 miles of an Elevance Health PulsePoint location listed in the job requisition.
What are the minimum qualifications required for this role?
Candidates must have a minimum of 2 years of experience in a managed care healthcare setting or an equivalent combination of education and experience. Additionally, a current active unrestricted RN license to practice is required.
Are there any preferred qualifications for candidates applying for this position?
Preferred qualifications include an AS or BS in Nursing, ER experience, managed care experience, familiarity with MCG (Milliman Care Guidelines), and strong communication, problem-solving, facilitation, and analytical skills.
What is the salary range for this position?
The salary range for this specific position is between $68,376 and $107,448, depending on factors such as geographic location, work experience, education, and skill level.
What benefits does Elevance Health offer to its employees?
Elevance Health offers a comprehensive benefits package, including incentive and recognition programs, equity stock purchase options, and 401k contributions, all subject to eligibility requirements.
How does Elevance Health ensure equal pay opportunities?
Elevance Health is fully committed to ensuring equal pay opportunities for equal work, regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
Can the salary range change over time?
Yes, the salary range may be modified in the future based on various factors such as market conditions, business considerations, and individual candidate qualifications.
What happens if an employee does not meet the eligibility requirements for benefits?
The availability of benefits and any specific eligibility requirements will determine if an employee qualifies for various compensation and benefits, which may be subject to modification at the Company’s sole discretion.
What kind of skills are expected from associates in this nurse appeals role?
Associates in this role are expected to have strong oral and written communication skills, problem-solving abilities, facilitation skills, and analytical competencies.