Responsible for the timely review and resolution of clinical appeals submitted by providers and members across all lines of business. Communicates appeal determinations in accordance with regulatory requirements and serves as a clinical resource to support non-clinical staff with administrative denials and coding-related appeals. Maintains accurate tracking of appeals through logs, databases, and reporting tools.
Graduate of an accredited school of nursing required; BSN preferred. Licensure/Certification: Current Registered Nurse (RN) license in the State of Maryland required.
Minimum of three (3) years of acute care nursing experience required. Prior experience within a health insurance or payer environment strongly preferred, including case management, utilization management, appeals, or claims processing. Experience participating in quality improvement initiatives is a plus.
Salary Range: Minimum 39.64/hour - Maximum 61.45/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.
The Hospital reserves the right to modify employee schedules as needed. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices. Johns Hopkins Health System and its affiliates are an Equal Opportunity employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law. Johns Hopkins Health System and its affiliates are drug-free workplace employers.