Clinical Appeals Nurse (RN) Remote
Molina Healthcare Job ID 2025531
JOB DESCRIPTION
Job Summary
Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance standards.
We are seeking a Registered Nurse with previous Inpatient/outpatient appeals knowledge/experience. The candidate should have MCG criteria knowledge, critical thinking skills, and strong organizational skills. Experience with Medicare review UM/Appeals and skilled computer skills highly preferred. Must be able to work independently in a high-volume environment. Further details to be discussed during our interview process.
Remote position.
Work schedule M-F 8:30 AM to 5:00 PM, weekend overtime eligibility. There is weekend and holiday rotation in the appeals department.
KNOWLEDGE/SKILLS/ABILITIES
JOB QUALIFICATIONS
Required Education
Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred.
Required Experience
Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.
Preferred Education
Bachelor’s Degree in Nursing
Preferred Experience
5+ years Clinical Nursing experience, including hospital acute care/medical experience.
MCG criteria knowledge
Critical thinking skills
Strong organizational skills
Medicare review UM/Appeals experience
Skilled computer skills
Preferred License, Certification, Association
Any one or more of the following:
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $54,373.27 – $117,808.76 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time