About this role
A&G Clinical Specialist at Healthfirst. Location: New York or West Virginia or North Dakota or Wisconsin or Indiana or Virginia or Texas or Tennessee or South Carolina or Pennsylvania or Ohio or Nevada or New Jersey or North Carolina or Minnesota or Maryland or Massachusetts or Florida or Delaware or Connecticut or New Hampshire or Arizona or Vermont or Alabama or Maine or Wyoming or Montana or South Dakota or Nebraska or New Mexico or Washington or Michigan or Hawaii or Oklahoma. Role: processing appeals, classifying grievances, entering data Requirements: LPN or RN required; experience in clinical practice and appeals & grievances, claims processing, utilization review preferred. Knowledge of Utilization Review guidelines, InterQual or Medicare guidance; proficiency with Microsoft Word and Excel. Category: Healthcare Services - Nursing Seniority: Mid Level Tools: Microsoft Word, Microsoft Excel, Macess, InterQual Certifications: lpn, rn Commitment: Full Time Workplace: Remote Languages: English