Remote - Appeal Management Nurse

Find your calling at Mercy!

This position is designed to facilitate an effective process of the new care model; supporting quality patient care, safety and financial components; promoting integration of a seamless care model; collaborating to include coordination as evidenced by metrics, optimizing performance and adoption of best practices. The Appeal Management Nurse will provide guidance, coaching, staff development and problem solving for Mercys clinical improvement and compliance initiatives.

Position Details:

Education:

Graduate of an accredited School of Nursing required.

Experience:

2 years in acute care hospital setting required.

Licensure:
Current license in the state of residence and/or employment required.

Preferred Qualifications:

Experience:

Care Management, Utilization Management, and/or Appeal Management experiences preferred.

Other Skills, Knowledge, Abilities:
-    Excellent interpersonal, verbal and written communication skills, particularly telephone.
-    Strong analytical and organizational skills with the ability to multi-task.
-    Must have the ability to work independently and meet deadlines with attention to detail.
-    Excellent time management and organizational skills.
-    Must have a good understanding of medical terminology with ability to read, discuss and understand patient medical information.
-    Must have the ability to interact effectively with a variety of people and situations at all levels of the organization.
-    Ability to stay current on changing governmental and payor regulations related to authorization/certification processes.
-    Knowledge of and adherence to commercial, managed care, government and audit appeal processes and timelines and the financial implications to the Ministry.
-    Ensures knowledge is kept relevant on all nationally recognized Payor Criteria guidelines.
-    Maintains technical knowledge and skills of computer system including but not limited to Office 365, EPIC and Payor based websites.
-    Ability to fully utilize automation to achieve departmental goals.
-    Ability to demonstrate personal qualities such as kindness, compassion, understanding, creativeness, integrity, interest, influence and respect for others.

Preferred Education:

Bachelor of Science in Nursing.

Physical Requirements:

-  Position requires the ability to push, pull, and/or lift 50 lbs on a regular basis.
-  Position requires prolonged standing and walking during each shift.
-  Position requires the ability to grip, reach, bend, kneel, twist, and squat to perform duties.

Why Mercy?

From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.
Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.
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