Job Description
Position Title: Appeals Nurse
Work Location: Remote, preferred Iowa Possible to work on-site
Assignment Duration: 10 months with possible extention or conversion
Work Arrangement: Remote
Position Summary:
Review and process Iowa Medicaid Member Appeals
Volume of appeals continues to increase and is at an all-time putting team at risk for liquidated damages if cases are not 100% resolved in 30 days.
Background & Context:
The Organization’s appeals team is experiencing a surge in volume, requiring efficient case handling to avoid compliance penalties.
Key Responsibilities:
• Member appeal requests are received and assigned by the team lead, the appeals nurse is responsible for working the appeal start to finish
• Outreach attempts are made to member/provider
• A clinical review is completed and case sent to specialty review/MD
• Appeals nurse will write determination letters and close the case
• 30 calendar days to complete standard cases and 3 business days to acknowledge receipt of the case
Qualification & Experience:
• Education/Certification Required: Associates
• Licensure Required: LPN Preferred: RN
• Years of experience required: at least 2 years nursing experience, UM experience helpful
• Additional qualities to look for: The ideal candidate will thrive in a fast paced environment with frequently changing workloads. This role requires strong prioritization, organization, and adaptability.
• Top 3 must-have hard skills stack-ranked by importance
1 Customer service
2 Time management
3 Computer skills/ability to learn new systems
| Candidate Requirements | ||||
| Education/Certification | Required: Associates | Preferred: | ||
| Licensure | Required: LPN | Preferred: RN | ||
| Years of experience required: at least 2 years nursing experience, UM experience helpful Disqualifiers: none Additional qualities to look for: The ideal candidate will thrive in a fast?paced environment with frequently changing workloads. This role requires strong prioritization, organization, and adaptability. | ||||
| 1 | Customer service | ||
| 2 | Time management | |||
| 3 | Computer skills/ability to learn new systems | |||
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At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $ 26.00/daily.