Clinical Appeals RN

Optum is in search of an experienced and motivated Clinical Appeals Nurse to join our dynamic team. We are looking for an individual who is passionate about providing the best patient care possible and is dedicated to pursuing complex appeals cases with accuracy and efficiency. The ideal candidate for this position will have a deep understanding of clinical care, the appeals process, and excellent communication skills.The Clinical Appeals Nurse is responsible for researching, evaluating, and processing all appeals received from providers and patients with regard to post-payment reviews. They will develop strategies for complex appeals and coordinate with other departments to ensure Optum’s goals are met. The successful candidate will have a strong sense of ownership and commitment to providing the highest quality of service to our members and providers.The ideal candidate must possess the following qualifications:• Bachelor’s degree in Nursing, Healthcare Administration, or related field• At least 3 years of experience in clinical appeals and post-payment review• Knowledge of Medicare and Medicaid regulations and medical terminology• Ability to use critical thinking skills to identify and understand complex appeals issues• Excellent written and verbal communication skills• Ability to work independently and as part of a teamIf you are a motivated and organized individual who is passionate about providing the best patient care, we want to hear from you. Submit your resume today for consideration for this exciting opportunity.

According to JobzMall, the average salary range for a Clinical Appeals RN in Cypress, CA, USA is between $53,000 and $90,000 per year. The average salary for this position is $71,500 per year. Salaries may vary depending on experience, qualifications, and other factors.

Since 1992, HealthCare Partners has been committed to developing innovative models of healthcare delivery that improve our patients' quality of life while containing healthcare costs. Our strength is in our steadfast commitment to our guiding principle of coordinated care. Our physicians strive daily to bring the benefits of coordinated care to more than 600,000 managed care patients in California, who represent the diversity of cultures, socioeconomic groups, ages, and health statuses in the communities we serve.