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Clinical Nurse Appeals Specialist

2 months ago

Manila, National Capital Region, Philippines Dencom Consultanacy Full time
Job Description

We are seeking a Clinical Nurse Appeals Writer to join our team at Dencom Consultancy.

About the Role

This is a unique opportunity for a dedicated and experienced nurse to leverage their clinical expertise in appeals writing, working closely with our team to resolve denied claims.

The ideal candidate will possess a strong understanding of MCG/InterQual criteria, ensuring that all appeals are thoroughly researched and presented in a clear, concise manner.

Key Responsibilities:
  • To write comprehensive appeals on behalf of clients, using sound clinical judgment and knowledge of MCG/InterQual criteria.
  • To work collaboratively with internal stakeholders to ensure seamless communication and effective resolution of denied claims.
  • To stay up-to-date with relevant medical guidelines and regulatory changes, applying this knowledge to enhance appeal outcomes.
Requirements:

To be successful in this role, you will require:

  • A minimum of 3 years' experience as a PHRN/USRN with a solid foundation in clinical nursing practice.
  • Proven experience in appeals writing, particularly in I/OP settings.
  • Excellent written and verbal communication skills, with the ability to articulate complex ideas clearly and concisely.
  • Familiarity with MCG/InterQual criteria and the ability to apply this knowledge effectively in appeal writing.
  • A willingness to work onsite and adapt to an evening shift schedule.
What We Offer:

As a valued member of our team, you can expect:

  • A competitive salary range of $85,000 - $110,000 per annum, commensurate with experience.
  • A dynamic and supportive work environment, fostering collaboration and continuous learning.
  • Ongoing professional development opportunities, enabling you to stay ahead in your field.