Work Location: Remote – LA (can reside anywhere within US with compact license)
Schedule:
11:00 AM – 8:00 PM CST
Tuesday – Saturday
Rotating holidays
Compact license preferred
Business Unit: Marketplace - G&A-UM Health Support Ops
Position Overview
Generates, processes and maintains provider and member correspondence for preservice and concurrent review.
Day-to-Day Responsibilities
- Process denial management systems (claims, correspondence platform, appeals tracking)
- Prioritize tasks: review pending denial letters, escalations, and compliance deadlines
- Check emails and updates for policy changes, payer updates, or internal communications
- Once fully trained, productivity expectation is at least 2.6 denial letters per hour
- Starting ramp expectation is 5–10 letters per week
Clinical review nurse manages time and productivity without in-office oversight and combines technical expertise, compliance knowledge, and strong communication skills in a virtual setting.
Candidate Requirements
Education/Certification:
- Required: Registered Nurse or Licensed Practical Nurse
- Compact license to support LA
- Preferred: Registered Nurse licensure
Licensure:
- Required: Compact Nurse Licensure
Experience:
Disqualifiers:
- Cannot work shift times or not in required time zone
Additional Qualities:
- UM background (preferred but teachable)
- Denials experience (very beneficial)
- Medical terminology
Top 3 Required Skills
Multi-tasking
Adapt to change well
Attention to detail