clinical appeals reviewer

Tanaq Health

<div>
 
 Description
 
 
 
 
 Overview
 
 
 
 Tanaq Support Services (TSS) delivers professional, scientific, and technical services and information technology (IT) solutions to federal agencies in health, agriculture, technology, and other government services. TSS is a subsidiary of the St. George Tanaq Corporation, an Alaskan Native Corporation (ANC) committed to serving Federal customers while also giving back to the Tanaq native community and shareholders.
 
 
 
 About The Role
 
 
 
 We are seeking a
 
 Clinical Appeals Reviewer
 
 to support a contract with our federal client. The Clinical Appeals Professional performs complex (senior-level) work. Provides dissatisfied parties with the opportunity to present documentation to demonstrate why an appeal should be allowed. Provides an independent second level determination based on the documentation, facts, laws, regulations, and guidelines. Works under general supervision, with moderate latitude for the use of initiative and independent judgment. Qualified candidates must be licensed health care professionals capable of rendering independent clinical judgment, including but not limited to Registered Nurses (RN), Physical Therapists (PT), Occupational Therapists (OT), and Respiratory Therapists (RT).
 
 
 This is a remote position that can be based anywhere in the United States. Must be able to work on a rotating schedule on weekends and holidays.
 
 
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Reviews medical records/case files, writes reconsideration decision letters that are clear, concise, and impartial, and support the determination made, and documents the review.
 </li>
 <li>
 Makes sound, independent decisions based on medical evidence in accordance with statutes, regulations, rulings, and policy.
 </li>
 <li>
 Responds to and ensures that all appeal issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.
 </li>
 <li>
 Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures.
 </li>
 <li>
 Conducts research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other related resources to complete an accurate and well-supported decision.
 </li>
 <li>
 Stays abreast of changes in regulations, medical and healthcare practices, policies, and procedures.
 </li>
 <li>
 Participates in case-specific verbal discussions.
 </li>
 <li>
 Conducts reviews of appeals/disputes with multiple beneficiaries/services in one case.
 </li>
 <li>
 Plans responses to statistical analysis challenges with assistance from statisticians.
 </li>
 <li>
 Attends meetings and participates in workgroups at management's direction.
 </li>
 <li>
 Conducts quality reviews, as needed.
 </li>
 <li>
 Serves as a subject matter expert.
 </li>
 <li>
 Mentors and/or trains staff.
 </li>
 <li>
 May conduct quality reviews and audits.
 </li>
 <li>
 Participates in special projects and performs other duties as assigned.
 
 
 </li>
 </ul>
 
 Requirements
 
 
 
 
 Required Skills and Experience
 
 
 
 <ul>
 <li>
 Three (3) years of experience in medical dispute resolution, Medicare appeals, medical review, clinical work, or related healthcare roles.
 </li>
 <li>
 Healthcare Professional with experience in Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy experience.
 </li>
 <li>
 Demonstrated experience writing or making medical necessity decisions.
 </li>
 <li>
 Proficiency in research techniques, medical terminology, and analyzing and interpreting policies, along with knowledge of state and federal laws and regulations.
 </li>
 <li>
 Must have experience and working knowledge of the Medicare program, including coverage and payment rules.
 </li>
 <li>
 Experience with Medicare regulations, claims processing, and the medical review process, as well as applicable laws, rules, and regulations.
 </li>
 <li>
 Prioritize and organize work tasks to handle multitasking and meet deadlines.
 </li>
 <li>
 Ability to prepare correspondence and documents using correct spelling, grammar, and punctuation; proofreading and reviewing documents for clarity and consistency.
 </li>
 <li>
 Practice logic and reasoning to identify problems, verify facts, and reach valid conclusions.
 </li>
 <li>
 Experience in making decisions that support business objectives and goals.
 </li>
 <li>
 Ability to identify and resolve problems or refer issues appropriately.
 </li>
 <li>
 Communicate effectively verbally and in writing.
 </li>
 <li>
 Adapt to the needs of internal and external customers.
 </li>
 <li>
 Show integrity and ethical behavior, respect confidentiality, business ethics, and organizational standards.
 </li>
 <li>
 Ensure compliance with company policies, procedures, and guidelines, including cybersecurity, regulatory, contractual, and accreditation entities.
 </li>
 <li>
 Experience directly relevant to Medicare managed care appeals or utilization management activities, preferred.
 </li>
 <li>
 Must have resided in the United States for a minimum of three (3) years out of the last five (5) years. This is a contractual requirement.
 </li>
 <li>
 Must possess a valid driver's license with a clear and satisfactory driving record.
 </li>
 <li>
 Ability to obtain and maintain public trust clearance and customer approval.
 </li>
 <li>
 Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.
 
 
 </li>
 </ul>
 
 Education and Training
 
 
 
 <ul>
 <li>
 Associate's degree or 60 or more credit hours towards a Bachelor&rsquo;s degree from an accredited college or university in healthcare or related discipline.
 </li>
 <li>
 Additional experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting may be substituted for an Associate&rsquo;s degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)
 
 
 </li>
 </ul>
 
 Physical Requirements And Work Environment
 
 
 
 <ul>
 <li>
 Requires working in an office/cubicle environment; sitting, standing, walking, bending, twisting, and/or reaching.
 </li>
 <li>
 Prolonged periods of sitting at a desk and working on a computer. May need to lift 25 pounds occasionally.
 </li>
 <li>
 May require the ability to operate a motor vehicle and travel by motor vehicle and commercial airline. May require overnight travel. Travel may be less than 5% annually.
 
 
 </li>
 </ul>
 
 Who We Are
 
 
 
 Tanaq Management Services (TMS) is a public health contractor, certified 8(a) business, owned by St. George Tanaq Corporation, an Alaska Native Corporation. (ANC). We listen to our stakeholders and leverage our science, technology, communication, and program expertise to understand and provide feedback as we develop solutions.
 
 
 
 Our Commitment to Non-Discrimination
 
 
 
 Tanaq is an Equal Employment Opportunity Employer. All qualified applicants will receive consideration for employment without regard to disability, status as a protected veteran or any other status protected by applicable federal, state, or local law. Tanaq complies with the Drug-free Workplace Act of 1988 and E-Verify.
 
 
 If you are an individual with a disability and need assistance completing any part of the application process, please email accommodation@tanaq.com to request a reasonable accommodation. This email is for accommodation requests only and cannot be used to inquire about the status of applications.
 
 
 
 Notice on Candidate AI Usage
 
 
 
 Tanaq is committed to ensuring a fair and competitive interview process for all candidates based on their experience, skills and education. To ensure the integrity of the interview process, the use of artificial intelligence (AI) tools to generate or assist with responses during phone, in person and virtual interviews is not allowed. However, candidates who require a reasonable accommodation that may involve AI are required to contact us prior to their interview at accommodation@tanaq.com.
 
 
 
 To Apply For This Positions, Visit
 
 
 
 https://recruiting.paylocity.com/Recruiting/Jobs/Details/4071254
</div>

Clinical Appeals Reviewer (Licensed Healthcare Professional)

TEEMA

<div>Claims Reviewer Opportunity
Join a dynamic team where your expertise in claims review can make a real difference! We're looking for a detail-oriented Claims Reviewer who can apply clinical and coding knowledge to ensure accurate claims processing. If you have a strong foundation in medical claims and are passionate about quality, we want to hear from you!
Position Highlights<ul><li>
Role: Conduct retrospective review of medical, surgical, and behavioral health claims.</li><li>
Focus: Evaluate claims for medical necessity, appropriateness, and adherence to program benefits.</li><li>
Collaboration: Work closely with medical directors, providers, peer reviewers, and various internal teams.</li></ul>
Key Responsibilities<ul><li>
Review and validate claims using established criteria and processing guidelines.</li><li>
Prepare cases for payment or further review.</li><li>
Identify opportunities for process improvement and flag quality or fraud concerns.</li><li>
Support peers and clinical/non-clinical staff with claims and coding inquiries.</li></ul>
What You Bring<ul><li>
Required:<ul><li>
High School Diploma or GED.</li><li>
2+ years of experience in medical claims review.</li><li>
Familiarity with medical claims processing and terminology.</li></ul></li><li>
Preferred:<ul><li>
Coding experience.</li><li>
Knowledge of behavioral health claims.</li></ul></li></ul>
Skills for Success<ul><li>
Strong technical skills in claims tools (e.g., CDST, Supercoder).</li><li>
Organizational and team-building abilities.</li><li>
Resilience in a fast-paced, high-intensity environment.</li><li>
Effective communication and problem-solving.</li></ul>
Additional Requirements<ul><li>
Must pass background, credit, and drug screening.</li><li>
Adherence to federal THC policies (medical card required if applicable).</li></ul>
Eligible Locations 
The position is remote, but you can only reside in the following states: AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY.
Ready to bring your claims expertise to a rewarding role? Apply today to be part of our team!
#Workwolf #BCDC_Consulting</div>

Claims Reviewer

Pantherx Specialty Llc

<div>7,000 Diseases - 500 Treatments - 1 Rare Pharmacy
PANTHERx is the nation&rsquo;s largest rare disease pharmacy, and we put the patient experience at the top of everything that we do.
If you are looking for a career in the healthcare field that embraces authentic dedication to patient care, you don&rsquo;t need to look beyond PANTHERx. In every line of service, in every position and area of expertise, PANTHERx associates are driven to provide the highest quality outcomes for our patients.
We are seeking team members who:
Are inspired and compassionate problem solvers;
Produce high quality work;
Thrive in the excitement of the ever-challenging environment of modern medicine; and
Are committed to achieving superior health outcomes for people living with rare and devastating diseases.
At PANTHERx, we know our employees are the driving force in what we do. We cultivate talent and encourage growth within PANTHERx so that our associates can continue to explore their interests and expand their careers. Guided by our mission to provide uncompromising quality every day, we continue our strategic growth to further reach those affected by rare diseases.
Join the PANTHERx team, and define your own RxARE future in healthcare!
Location: Pittsburgh, PA; Hybrid 
Classification: Non-Exempt
Status: Full Time
Reports to: Manager, Clinical Programs
Purpose:
The Clinical Authorization and Appeals Specialist provides support and education to health care providers for prescribed treatment therapies. This role serves as a single point of contact for health care providers to coordinate alignment of documentation with prior authorization and appeals criteria. This role submits timely prior authorizations requests, appeals, initiatives to increase patient adherence, and closes collaboration with both internal and external stakeholders.
Responsibilities:<ul><li>
Educates health care providers regarding prior authorization and appeals criteria for prescribed therapies.</li><li>
Assesses clinical documentation provided and assist the health care provider with alignment to specific plan criteria.</li><li>
Creates initiatives to increase patient adherence and optimize patient care.</li><li>
Possess a broad and deep understanding of assigned disease states, products, and clinical programs.</li><li>
Closes collaboration with program team members as well as external stakeholders.</li><li>
Performs appropriate and accurate documentation of cases using call management software.</li><li>
Demonstrates appropriate judgment skills to be able to make independent clinical decisions.</li><li>
Fosters teamwork by trusting and supporting each other while encouraging collaboration at all levels of the organization. Embraces diversity and demonstrates the ability to work together.</li><li>
Provides superior customer service to internal and external clients, customers, and patients.</li><li>
Assumes accountability for own professional practice in achieving patient outcomes.</li><li>
Completes all other duties as assigned.</li></ul>
Required Qualifications:<ul><li>
Associate degree or bachelor&rsquo;s degree from an accredited nursing school as a Registered Nurse (RN).</li><li>
Must have demonstrated competence in community health or patient care setting, providing direct patient care with patients for 1-3 years.</li><li>
Strong writing and grammar skills.</li><li>
Strong organizational skills and a thorough knowledge of computers (Microsoft Office and Windows) are required.</li><li>
Demonstrated ability to work independently and meet goals.</li></ul>
Preferred Qualifications:<ul><li>
1-3 years of specialty pharmacy experience</li></ul>
Work Environment:
PANTHERx Rare Pharmacy offers flexibility only to eligible employees to work hybrid or remotely without compromising work performance, productivity, or team collaboration. This role routinely uses standard office equipment such as computers and phones.
Physical Demands:
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands and fingers, handle or feel; and reach with hands and arms. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function of the job.
Benefits:
Hybrid, remote and flexible on-site work schedules are available, based on the position. PANTHERx Rare Pharmacy also affords an excellent benefit package, including but not limited to medical, dental, vision, health savings and flexible spending accounts, 401K with employer matching, employer-paid life insurance and short/long term disability coverage, and an Employee Assistance Program! Generous paid time off is also available to all full-time employees, as well as limited paid time off for part-time employees. Of course we offer paid holidays too!
Equal Opportunity:
PANTHERx Rare Pharmacy is an equal opportunity employer, and does not discriminate in recruiting, hiring, promotions or any term or condition of employment based on race, age, religion, gender, ethnicity, sexual orientation, gender identity, disability, protected veteran's status, or any other characteristic protected by federal, state or local laws.</div>

Clinical Authorization and Appeals Specialist

Patriot Care Center

Job descriptionMedical case reviewer will assist physicians in providing medical opinions by doing a thorough review of the patient's Medical records and help evaluate if a disability was caused by service.Key Responsibilities:<ul><li>Analyze medical records and transcribe key medical evidence</li><li>Accurately transcribe patient history, physical examinations, consultations, and other medical reports</li><li>Enter information into electronic health records (EHR) systems efficiently</li><li>Assist healthcare providers with documentation during patient exams</li><li>Maintain confidentiality of all patient information</li><li>Ensure accurate and timely documentation of medical procedures and treatments</li><li>Collaborate with physicians to update and maintain patient records</li></ul>Qualifications:Emergency Room/Emergency Department experience is required.Medical School Experience is preferred.Education and Experience:<ul><li>College Degree (required).</li><li>Medical Background</li><li>Experience working in Hospital/ER/Urgent Care</li><li>Proficiency in Microsoft Office Suite (Outlook, Word, Excel) is a must.</li><li>Previous experience in a medical office</li><li>Knowledge of medical terminology, anatomy, and physiology</li></ul>Skills and Requirements:<ul><li>Extremely organized and detail-oriented.</li><li>Excellent multitasking and time management abilities.</li><li>Independent worker with a self-motivated attitude.</li><li>Strong communication skills with a pleasant voice and good grammar.</li><li>Fluent in written and spoken English.</li><li>People-oriented approach, fostering positive interactions with colleagues and clients.</li></ul>Why Join Us?<ul><li>Opportunity to contribute to meaningful work in a supportive and friendly environment.</li><li>Ample room for growth within the organization.</li></ul>Application Instructions: To apply, please send your resume with the subject line &ldquo;Senior Medical Scribe Application.&rdquo; Applications will be reviewed on a rolling basis.Equal Opportunity Statement: We are an equal opportunity employer and welcome applications from all qualified individuals. Employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.Job Types: Full-time, Part-time, ContractPay: $25.00 - $28.00 per hourBenefits:<ul><li>Flexible schedule</li><li>Professional development assistance</li></ul>Work Location: In person

Medical Case Reviewer

Tender Touch Rehab Services LLC

<div>
 
 Job Description:
 
 
 Need to be proficient in basic writing skills to email clients.
 
 
 Comfortable on the computer to&nbsp;review and compile medical records on the computer.&nbsp;
 
 
 Should be able&nbsp;to follow instructions set by the Claims Dept Manager for logging the requests of claims and /or appeals from the facility, and update the spreadsheet database&nbsp;with all necessary details as per the set standards of the department.
 
 
 Ensure&nbsp;all the medical records from Net-Health and SharePoint have been organized and provided to the reviewer for review.
 
 
 Maintain tracking of requests, submissions, denials, appeals, etc., as per department standards.
 
 
 
 
 
 Qualifications
 
 
 &bull;	College Graduate
 
 
 &bull;	Yearning to work in a fast-paced job
 
 
 &bull;	Have ability to communicate clearly and courteously
 
 
 &bull;	Have skills in writing professional emails
 
 
 &bull;	Have experience or willingness to learn to use Microsoft Excel and similar programs
 
 
 &bull;	Be thorough and pay attention to details
 
 
 &bull;	Be efficient and productive&nbsp;
 
 
 &bull;	Be a fast Learner
 
 
 
 
 
 Job Responsibilities
 
 
 1.	In charge of emails. Communication and action as needed based on the email
 
 
 2.	Respond to facility requests in a reasonable time frame&nbsp;
 
 
 3.	Communicate effectively
 
 
 4.	Submit records online/ Mail them physically&nbsp;
 
 
 5.	Be able to pull necessary reports when requested&nbsp;
 
 
 6.	Pull Medical records from Net Health
 
 
 7.	Organize and use PDF Xchange&nbsp;
 
 
 8.	Maintain a clean and accurate Spread Sheet&nbsp;
 
 
 9.	Organize the medical records as per the Checklist provided&nbsp;
 
 
 
 
 
 Physical Demands&nbsp;
 
 
 Extended sitting and being on the computer. Work will be in the office with accommodations for&nbsp;working from home occasionally.
 
 
 
 
</div>

Clinical Assistant

ForHealth Consulting at UMass Chan Medical School

<div>
 
 Position Summary
 
 
 
 ForHealth Consulting at UMass Chan Medical School is seeking a detail-oriented
 
 Nurse Reviewer II
 
 with experience caring for individuals with complex medical needs to join our Community Case Management Program. In this role, you will manage a caseload of members, ensuring they receive the long-term services and supports (LTSS) they need to thrive in the community. This position combines the flexibility of remote work with meaningful field interactions through home and site visits.
 
 
 Youll play a key role on a multidisciplinary team - assessing, planning, coordinating, and authorizing care for individuals with complex medical needs, while collaborating closely with providers, state agencies, and other healthcare partners to ensure continuity and quality of care.
 
 
 
 Major Responsibilities
 
 
 
 <ul>
 <li>
 Serve as the clinical manager for an assigned caseload of Members.
 </li>
 <li>
 Contribute as an active member of a multi/inter-disciplinary team to assess, plan, organize, review and evaluate the care needs of Members requiring health care services, to include outpatient and home based therapy services.
 </li>
 <li>
 Conduct on-site reviews and assessments of Members community long term care needs to determine medical necessity and clinical eligibility for Community Case Management and Continuous Skilled Nursing Services Determine and authorize services for Members in accordance with program guidelines and regulations, meeting all established deadlines.
 </li>
 <li>
 Prepare and implement Member service records.
 </li>
 <li>
 Coordinate, facilitate and monitor the delivery of services to members.
 </li>
 <li>
 Review and document all relevant information into data system applications in accordance with program guidelines and regulations.
 </li>
 <li>
 Conduct routine and ad-hoc evaluations and re-evaluations of Members services.
 </li>
 <li>
 Contact and engage providers, state agency offices, and Members to obtain information and records needed to conduct a comprehensive clinical review of the case and final determination.
 </li>
 <li>
 Evaluate and document the appropriateness of Members services and make modifications, as required.
 </li>
 <li>
 Maintain individual records documenting all Member encounters and contacts; write clinical summaries.
 </li>
 <li>
 Foster and promote continuity of care and cooperative partnerships by liaising with health care providers, acute care hospitals and other programs/organizations involved in the provision of services.
 </li>
 <li>
 Prepare and respond to inquiries related to appeals on clinical determinations.
 </li>
 <li>
 Maintain positive working relationships with peers, leadership, Members, relevant informal supports, provider organizations, and state agencies.
 </li>
 <li>
 Maintain the confidentiality of all business documents and correspondence per UMass Chan Medical School/ForHealth Consulting procedures and HIPAA regulations.
 </li>
 <li>
 Participate in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
 </li>
 <li>
 Participates in training and onboarding of new clinical staff
 </li>
 <li>
 Comply with established departmental policies, procedures and objectives.
 </li>
 <li>
 Perform other duties as required.
 
 
 </li>
 </ul>
 
 Required Qualifications
 
 
 
 <ul>
 <li>
 RN licensed to practice in Massachusetts
 </li>
 <li>
 5-7 years of work experience with at least 3 recent years providing direct service or case management to the pediatric, young adult, or adult medically complex population
 </li>
 <li>
 Ability to travel statewide to Member homes and service providers places of business
 </li>
 <li>
 Experience with Office Application and database
 </li>
 <li>
 Valid Drivers license required
 
 
 </li>
 </ul>
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 Experience with home care
 </li>
 <li>
 Knowledge of applicable state regulations
 </li>
 <li>
 Experience with prior authorization and/or eligibility determinations
 </li>
 <li>
 Experience with the care of medically complex individuals
 
 
 </li>
 </ul>
 
 Why Join Us
 
 
 
 At ForHealth Consulting, part of
 
 UMass Chan Medical School
 
 , we are dedicated to advancing health and well-being across Massachusetts communities. Youll be part of a mission-driven organization that values collaboration, innovation, and compassion in care management.
 
 
 The University of Massachusetts Chan Medical School welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.
 
 
</div>

Nurse Rev II-Case Mgt (Home Based with Client Visits)

Staffing Solutions Organization LLC (SSO)

Staffing Solutions Organization LLC (SSO), an affiliate of Public Consulting Group LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve.
 
Nurse Reviewer – State of Illinois
 Location: Remote with on site visits across Illinois
 We are currently seeking Nurses who reside in Central Illinois - preferably in McLean and Sangamon Counties.
 
Position Overview
 The Nurse Reviewer conducts provider compliance reviews to ensure adherence to state regulations, quality standards, and program requirements. This role includes conducting onsite visits, evaluating documentation, and determining provider compliance. The Nurse Reviewer works independently, exercises sound judgment, and provides recommendations that guide provider improvement and support statewide oversight efforts.
 
Duties & Responsibilities
 <ul>
<li>Build and maintain effective relationships with providers and users to support high quality customer service.</li>
<li>Evaluate providers for compliance with applicable state and program regulations.</li>
<li>Coordinate and schedule on site provider visits; clearly communicate visit requirements.</li>
<li>Conduct compliance interviews with providers and gather all necessary information.</li>
<li>Review provider documentation, policies, and business practices for regulatory alignment.</li>
<li>Collect, organize, and submit documentation supporting compliance findings.</li>
<li>Utilize technology and web based systems to convert paper documentation to electronic format.</li>
<li>Conduct in person assessments of provider sites to evaluate compliance with oversight requirements.</li>
<li>Summarize on site visit findings accurately and professionally.</li>
<li>Exercise independent judgment to evaluate compliance and make final determinations based on documented evidence.</li>
<li>Identify deficiencies and recommend appropriate next steps to support provider improvement.</li>
<li>Analyze trends in non compliance and identify gaps in provider business processes.</li>
<li>Provide timely recommendations and updates to the Supervisor.</li>
<li>Maintain HIPAA standards and confidentiality at all times.</li>
<li>Perform other duties as assigned.</li>
</ul>
Required Skills
 <ul>
<li>Strong interpersonal skills with the ability to relate well to staff and providers.</li>
<li>Active listening and effective communication skills.</li>
<li>Proficiency in MS Word, Excel, Outlook, and web based applications.</li>
<li>Process oriented and results driven work approach.</li>
<li>Ability to foster teamwork and collaborate across levels of management and staff.</li>
<li>Ability to work independently and within a team environment.</li>
<li>Excellent written and verbal communication skills and customer service techniques.</li>
<li>High accuracy, strong attention to detail, and commitment to quality.</li>
<li>Proven ability to meet deadlines and follow strict standards.</li>
<li>Ability to travel regularly to provider sites across Illinois.</li>
</ul>
Qualifications
 Experience
 <ul>
<li>Minimum 2 years of clinical experience working with critical care providers, public health providers, or providers serving children, older adults, individuals with traumatic brain injury, or individuals with developmental disabilities.</li>
<li>Minimum 1 year of experience conducting quality assurance reviews.</li>
</ul>
Education
 <ul>
<li>Bachelor’s degree preferred</li>
</ul>
Certification
 <ul>
<li>Active Illinois Registered Professional Nurse (RN) license required.</li>
</ul>
Working Conditions
 <ul>
<li>Remote work with 2–3 on site provider visits per week throughout the state of Illinois.</li>
</ul>
Benefits (Through SSO)
 SSO offers a competitive benefits package that supports your health, financial well being, and long term growth, including:
 <ul>
<li>Medical, dental, and vision insurance</li>
<li>401(k) with discretionary employer match</li>
<li>Paid time off and holidays</li>
<li>Flexible spending accounts</li>
<li>Additional employee perks</li>
</ul>
Keyword Search Terms
 Nurse Reviewer, RN Reviewer, Provider Management Specialist, Compliance Nurse, Healthcare Quality Review, Provider Compliance, Medicaid Compliance, Clinical Reviewer, Illinois RN, Site Visit Nurse, Healthcare Auditor, Public Health Nursing, QA Nurse, Provider Monitoring.
 
Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides a reasonable range of compensation for this role. In addition, SSO provides a range of benefits for this role.
 
Applicants must be authorized to work in the U.S. This position is not eligible for work authorization sponsorship (including H-1B sponsorship) by SSO and under the federal laws relating to the F-1 STEM EAD program, this position is not eligible to support a STEM EAD extension application.
 
All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an E-Verify participant.

Nurse Reviewer

Search 8984+ Clinical appeals reviewer jobs near you this May. New roles added regularly across leading industries. Apply today.