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Nurse Appeals Auditor (LPN or RN) in Tampa, FL at Accounting Now

Date Posted: 8/27/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Tampa, FL
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    8/27/2019
  • Job ID:
    358038

Job Description


A managed care company is currently seeking a Licensed Practical Nurse (LPN) or Registered Nurse (RN) to join their staff as their new Nurse Appeals Associate. In this role, the Nurse Appeals Associate (LPN) will be responsible for supporting the development and implementation of quality improvement interventions and audits. Apply today!
Job Description

The Nurse Appeals Associate (LPN) will:

  • Research and collects data; submit and resolve administrative appeals
  • Contribute to external reviews site visit preparations by the State, accreditation review and Quality Management Committee
  • Conduct internal monitoring and audits timeline compliance standards
  • Process, track, trend, and report complaint and grievances issues
  • Prepare complaint and grievance files for Fair Hearings and serve as a subject matter expert on complaints and grievances for non-clinical staff
  • Participate in quarterly Plan HIPAA audits



Required Skills

  • 1+ year of relevant work experience
  • Associate's and/or Bachelor's Degree in a related field
  • NJS Licensed Practical Nurse (LPN) or Registered Nurse (RN)
  • Experience as a Nurse in a Managed Care setting completing medical necessity reviews for a Utilization Management or Appeals team
  • Knowledgeable of industry accepted Clinical guidelines and criteria (Interqual, Milliman, etc)
  • Solid assessment, clinical, and documentation skills
  • Patient oriented
  • Great interpersonal skills
  • Excellent communication skills (written and verbal)
  • Strong attention to detail
  • Highly organized