We are currently looking for a Registered Nurse in the Seattle area that is available on a full-time basis over the next three months. Job description is listed below. Please apply now to be considered!
Responsible to investigate and process grievances and appeals requests from members and providers.
Conducts investigations and reviews of member and provider grievances and appeals. Reviews prospective, concurrent or retrospective medical records of denied services for medical necessity. Extrapolates and summarizes essential medical information for medical director, consultants and other external review. Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval. Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. Documents and logs appeal/grievance information on relevant tracking systems and mainframe systems. Generates appropriate written correspondence to providers, members, and regulatory entities.
Requires broad and deep knowledge of medical policy, emerging technology and analysis of emerging evidence. Requires oral and written communication skills, problem-solving skills, PC skills, and research and analytical skills.
Requires Associate's Degree in Nursing and 2-3 years experience in a managed care healthcare setting, or any combination of education and experience, which would provide an equivalent background. Requires current unrestricted RN license in applicable state(s). BSN preferred.
Additional Details: 2-3 years experience doing appeals for a managed care organization Medicaid/ Medicare experience 2-3 years Software Experience- FACETS-proficient MACESS-proficient PEGA-proficient MIcrosoft Ofice applications-Word/Excel/Outlook/PowerPoint-proficient
Maxim employees are our greatest asset. We offer the following benefits:
• Medical, Dental, Vision, and Life Insurance
• 401k Program
• Competitive Pay
• Flexible Scheduling
• Direct Deposit
• Positive Work Environment and Friendly Staff Bonuses
• Travel Benefits (as applicable)
• 24 hour on- call service
Since 1988, Maxim Healthcare Services has become one of the largest employers of clinicians in the nation. At Maxim Staffing Solutions, a division of Maxim Healthcare Services, we’re known for our quality of patient care, commitment to employee development and emphasis on customer service. Maxim knows that you deserve great benefits, flexible scheduling and rewarding assignments, so our Healthcare Recruiters will match your skills, experience and schedule in order to find you the best assignments in top medical facilities. Maxim Recruiters are always available to provide you with the assistance you need to get your job done, so call us today; Maxim has a solution for you.
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