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RN Clinical Appeals
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![]() United States, Michigan, Southfield | |
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Must have a Michigan RN License Scope of Work:
Responsible for completing retrospective clinical appeals for full or partially denied claims for Managed Care, Government, Non-Government and Commercial payors when the third-party payors do not meet the expected payment as modeled. The Clinical Appeals Nurse will write comprehensive, factual arguments to present to third party payers, medical review boards, or other responsible parties applying clinical criteria to establish medical necessity. This position reports to the Manager, Denials.
Qualifications
Primary Location SITE - Beaumont Service Center - 26901 Beaumont BlvdDepartment Name Utilization Management - CH EastEmployment Type Full timeShift Day (United States of America)Weekly Scheduled Hours 40Hours of Work 7:00 am to 3:30pmDays Worked Monday to FridayWeekend Frequency N/ACURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only. Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief. Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category. An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team. You may request assistance in completing the application process by calling 616.486.7447. |