Contract Clinical Appeals RN

We are One Sutherland — a global team where everyone is working together to create great breakthrough solutions. Our workforce has thrived in an environment of diversity of thought, experience and background. We celebrate our diversity and embrace it whole-heartedly. Sutherland is an equal opportunity employer. We promote a positive work environment by conducting ourselves professionally and helping each other achieve our goal of One Sutherland Team, Playing to Win.

This role is contract and does not offer an hourly rate. Payment is a 1099 paid bi-weekly upon Reviews. We will pay $50 per Appeal, and $25 per Review if cannot be appealed. You will also be paid $25/hour for any IT/ Compliance trainings that require completion of your time. The Appeals Nurse will review medical records to construct compelling clinical appeals in order to overturn managed care denials based upon clinical nursing judgment and the medical necessity of services delivered.

Review of medical records to evaluate the validity of 3rd party denials. Assess strength of completed appeal to predict favorable outcomes. Ability to detect issues resulting in denials and constructively report on issue to assist in resolution. Construct 1st and 2nd level appeals by applying clinical rationale. Manage assigned workload of accounts so appeals are submitted timely in accordance with payer timeframes.