Appeals Nurse

IMCS Group is an IT, Healthcare, and Professional Staffing Company that helps Enterprises optimize the business value of their Staffing investments and enables them to achieve world-class business performance. IMCS Group supports strategic and operational aspects of IT implementations to help businesses implement growth strategies and leverage technology to achieve competitive advantage. In addition, IMCS provides hospitals and medical facilities with high-quality clinical professionals with the highest standards and compliance to provide the best medical care. At IMCS Group, quality and efficiency are of paramount importance. Our consistent growth, many successful customer engagements, and high customer retention are the hallmarks of our success. In addition, our passion for taking complex business processes and simplifying them by applying the right technology has been the key to our success. At all times, IMCS ensures the highest standards of quality in providing resources, time, and material to design, implement, and support to keep organizations operating efficiently.

Job Title: Clinical Review Clinician - Appeals Duration: 06 months Contract (Potential to Extend) Desired Start Date- End Date: 7/14/2025 - 1/16/2026 Location: Remote- Ohio (Columbus area preferred) Shift Type: 8am-5pm

Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical necessity for services in accordance with policies, guidelines, and National Committee for Quality Assurance (NCQA) standards. Perform appeal review for medical necessity, complete appeal cases (making determination, documenting outcome, sending out letter, and closing out appeal in system). Behavior and accountability and ability to pivot when new priorities come up. Emails and Team chats to ensure communication is reached and assistance is available, if needed The ability to be engaged with members to allow members to address overall issues about their care/coverage. Strong collaboration and positive interactions between team and leadership.