Utilization Review Nurse (Medicare/Medicaid Appeals) - Birmingh
Location: Birmingham Alabama
Description: Cigna is in need of Utilization Review Nurse (Medicare/Medicaid Appeals) - Birmingh right now, this career will be placed in Alabama. For complete informations about this career opportunity please read the description below. Job Description
Responsible for processing appeals for the IL Medicare/Medicaid market. This person will also be cross-tra! ined to process member, nonpar and par provider appeals of Part C Medicare denials. The candidate for this role will be involved in clinical review of medical records to present to Medical Director for coverage decisions; written/oral communication with doctors, other providers, and members; research of coverage criteria for Medicare and Medicaid services/items; some weekend call; meeting strict time frames for processing appeals; able to meet Medicare/Medicaid requirements for processing appeals as described in Chapter 13 of the Medicare Managed Care Manual, the IL MMAI Contract and the IL ICP Contract; preparation of appeals cases for the Medicare Independent Review Entity (IRE); presentation of appeals cases to the IRE review group (internal) and presentation of appeals cases before a State Fair Hearing officer (Medicaid-external).
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Requirements
RN, active RN license without restrictions, as well as previous clinical experience (at least 2 yea! rs); experience with performance of medical review activities;! utilize established criteria and guidelines in making clinical decisions; excellent oral/written communication skills; decision making and organizational skills are a must. Results-oriented with proven ability to meet multiple deadlines while insuring quality work.
Preferred Requirements:
Familiar with ICD/CPT coding; Claims appeal experience; QNXT/CCMS system familiarity; appeals experience; knowledge of Medicare policies and guidelines; knowledge of Medicaid (State of IL) processes and requirements, including Medicaid waiver program. .
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to Cigna.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Thu, 31 Oct 2013 18:18:44 GMT
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