Clinical Appeals Reviewer – AmeriHealth Caritas – Jobs in Newtown Square, PA | OpenJobs AI

Job Details

Overview Company

Clinical Appeals Reviewer

AmeriHealth Caritas

2 days ago

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OnsiteFull-timeMid

Summary

AmeriHealth Caritas is seeking a Clinical Appeals Reviewer to join their team in Newtown Square, PA. The role involves processing appeals and ensuring compliance with regulatory requirements while interacting with appellants and healthcare providers.

About the Role

As a Clinical Appeals Reviewer, you will be responsible for processing appeals, reviewing medical records, packaging information for case determination, and engaging with members and providers to understand appeals. You will also provide clinical expertise, perform regulatory functions, and ensure timely decisions by the Medical Director.

About You

Required:

Associate's Degree in Nursing (ASN) required.
3 or more years of experience in a related clinical setting and working with diagnosis procedure codes.
Current and unrestricted Registered Nurse (RN) licensure or compact state licensure.

Preferred:

Coding experience.
Working knowledge of InterQual criteria.
Familiarity with the appeals process within a managed care organization.

Benefits

Flexible work solutions including remote options and hybrid work schedules.
Competitive pay and paid time off.
Health insurance coverage for you and your dependents starting Day 1.
401(k) retirement savings plan and tuition reimbursement.

AmeriHealth Caritas

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in health care solutions, we impact the lives of millions of people through our national footprint of products, services, and award-winning programs. Headquartered in Newtown Square, PA, AmeriHealth Caritas is a mission-driven organization with more than 40 years of experience delivering comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other support services. In the process, we are dedicated to helping find solutions to end poverty so everyone can reach their American Dream.

Newtown Square, PA