OR - Clinical Appeals RN - REMOTE - part time
Salary undisclosed
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Job Description
JOB SUMMARY/PURPOSE
Performs clinical appeal functions for all lines of business. Ensures that provider and member appeals are processed and documented to meet state and federal guidelines for quality, accuracy, timeliness and completeness.
Department Description
Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services mission of Building Healthier Communities Together.
NOTE: During Training, this role will need to be full-time and then PT after training and nesting has been completed. (10 hours per week)
This is a remote position.
Experience/Education/Qualifications
Current unencumbered Oregon RN license required. BSN preferred.
Three (3) years recent clinical experience required. Experience in a managed care setting preferred.
Experience Or Training With Computer Applications Required.
Experience or training in case management and utilization management preferred.
Position Urgency
Normal
State License Details
Not Needed
Minimum Years Of Experience
3
Minimum Guaranteed Hours
10
Sub Specialty
Clinical Research Coordinator
JOB SUMMARY/PURPOSE
Performs clinical appeal functions for all lines of business. Ensures that provider and member appeals are processed and documented to meet state and federal guidelines for quality, accuracy, timeliness and completeness.
Department Description
Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services mission of Building Healthier Communities Together.
NOTE: During Training, this role will need to be full-time and then PT after training and nesting has been completed. (10 hours per week)
This is a remote position.
Experience/Education/Qualifications
Current unencumbered Oregon RN license required. BSN preferred.
Three (3) years recent clinical experience required. Experience in a managed care setting preferred.
Experience Or Training With Computer Applications Required.
Experience or training in case management and utilization management preferred.
Position Urgency
Normal
State License Details
Not Needed
Minimum Years Of Experience
3
Minimum Guaranteed Hours
10
Sub Specialty
Clinical Research Coordinator