Walker Healthforce is seeking an Appeal Analyst Registered Nurse for a healthcare client located remotely in Hopewell, NJ. This is a contract position.
Start Date: ASAP
Walker Healthforce Standard Perks:
- Weekly pay via Direct Deposit
- Medical, Dental, and Vision Available
- 401K
JOB DESCRIPTION
- Assess clinical needs to ensure appropriate inpatient care and length of stay.
- Evaluate the necessity and efficiency of medical services and procedures.
- Develop and implement care plans with members and providers.
- Coordinate out-of-network and local services, negotiating fees when needed.
- Ensure high-quality, cost-effective care across the continuum, following clinical guidelines.
- Monitor medical care activities and outcomes for appropriateness and effectiveness.
- Advocate for members and families, coordinating resources and services.
- Promote member participation and compliance in care programs.
- Document care accurately, adhering to standards and policies.
- Communicate with multidisciplinary teams to ensure care continuity and efficiency.
- Maintain fiscal accountability and focus on resource-efficient, self-care outcomes.
JOB REQUIREMENTS
- Active NJ RN License
- Associate’s or Bachelor’s Degree in Nursing and/or a health related field
- 2 Years of Clinical Experience
- Proficient with Microsoft applications (Excel, Outlook etc.)
PREFERRED JOB REQUIREMENTS
- Working knowledge of case/care management principles.
- Working knowledge of principles of utilization management.
- Knowledge of health care contracts and benefit eligibility requirements.
- Knowledge of hospital structures and payment systems.
Contact our Recruiting Team today to experience the Walker Healthforce difference!
ABOUT US
Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community! As a certified WMBE, we provide end-to-end healthcare IT and clinical solutions to hospitals, health systems, and payer organizations, including Fortune 100 firms nationwide. We are healthcare experts, we’re custom not commodity and we’ve been exceeding expectations for nearly 20 years. Join forces with us to experience unparalleled results today!
We are an Equal Opportunity Employer committed to a culturally diverse workforce. All qualified applicants will receive consideration for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability status or protected veteran status.
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