Appeals Resolution Analyst Ii-rn

Horizon Blue Cross Blue Shield of New Jersey

Remote
Base: $79,100 - $105,945; bonus/equity: not specif...
Utilization management principles
Health care contracts
Hospital structures
Horizon Blue Cross Blue Shield of New Jersey empowers members to achieve their best health through innovations that improve healthcare quality, affordability, and member experience

Job Summary

  • Horizon Blue Cross Blue Shield of New Jersey empowers members to achieve their best health through innovations that improve healthcare quality, affordability, and member experience.
  • This position is responsible for handling all Utilization Management medical appeal cases, ensuring compliance with regulatory requirements and providing clinical liaison support.
  • Horizon offers a comprehensive compensation and benefits package including health benefits, retirement plans, generous PTO, incentive plans, wellness programs, paid volunteer time off, and tuition reimbursement.

Matching Summary

Horizon Blue Cross Blue Shield of New Jersey empowers members to achieve their best health through innovations that improve healthcare quality, affordability, and member experience.

Salary

Base: $79,100 - $105,945; Bonus/Equity: Not specified; Benefits: Comprehensive health benefits, Retirement Plans, Generous PTO, Incentive Plans, Wellness Programs, Paid Volunteer Time Off, Tuition Reimbursement

Skills & Requirements

Must-have

  • Utilization management principles
  • Health care contracts
  • Hospital structures
  • Medical record review
  • Regulatory compliance
  • Problem-solving skills

Nice-to-have

  • Mentoring and clinical liaison
  • Cost-effective patient care
  • Enterprise meetings proxy
  • Client service focus
  • Empathy

Key Requirements

  • Registered Nurse License
  • 2 years clinical experience
  • 3 years health care delivery system experience
  • High School Diploma/GED
  • Bachelor degree in health care management preferred

Work Rights

Not specified

Tailored Resume

Cover Letter