Remote - Appeal Management Nurse

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.

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.