Remote Clinical Appeals Coordinator at Jobgether

, Massachusetts, United States -

Full Time

Start Date

Immediate

Expiry Date

26 Jun, 26

Salary

0.0

Posted On

28 Mar, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Utilization Management, Concurrent Denials, Denial Management, Medical Record Review, Payor Agreements, Peer-to-Peer Discussions, Physician Advisors, Medicare Conditions of Participation, Metric Analysis, Training Development, Registered Nurse License, Clinical Experience, Appeals Processes, Communication, Interpersonal Skills, Medical Terminology

Industry

Internet Marketplace Platforms

Description

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Utilization Management Coordinator - REMOTE. The Utilization Management Coordinator plays a pivotal role in streamlining healthcare authorizations by assessing and mitigating concurrent denials. This position works closely with healthcare teams to ensure optimal reimbursement and manage patient status determinations effectively. The incumbent will utilize their expertise in utilization management, payor behaviors, and appeals processes to foster collaboration among various stakeholders. By enhancing operational efficiencies and implementing educational initiatives, this role significantly impacts the financial and quality outcomes of healthcare delivery. \n Accountabilities Assess referred concurrent denials and determine next steps for resolution. Review medical record documentation to support denial management strategies. Collaborate with leadership to optimize payor agreements. Coordinate peer-to-peer discussions with physician advisors. Advocate for patients to ensure coverage and reimbursement. Comply with Medicare Conditions of Participation. Analyze and report on key metrics for utilization projects. Develop and deliver training for staff on denial management processes. Requirements Current Registered Nurse license or multi-state Registered Nurse license. Four years of clinical experience in a hospital setting. Three years in Utilization Review or Clinical Appeals. Bachelor's Degree in Nursing preferred. Strong communication and interpersonal skills. Knowledge of medical terminology and third-party payers. Detail-oriented with excellent customer service skills. Ability to operate computers and relevant office equipment. Benefits Flexible working hours with remote work options. Opportunities for professional development and training. Collaborative environment with interdisciplinary teams. Competitive salary and benefits package. Supportive company culture promoting work-life balance. Participation in process improvement initiatives. Access to modern technology and resources for effective remote work. \n Why Apply Through Jobgether? We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1

Responsibilities

The coordinator assesses concurrent denials, reviews medical documentation to support resolution strategies, and collaborates with leadership to optimize payor agreements. This role involves coordinating peer-to-peer discussions and advocating for patient coverage and reimbursement while ensuring compliance with Medicare regulations.