Clinical Appeal Consultant
Remote Available
Posted on 4/3/2023
INACTIVE
Wellmark

1,001-5,000 employees

Mutual insurance provider
Company Overview
Wellmark's mission is making health care better. The company is committed to being a trusted, innovative, and inclusive leader focused on improving the health of the people and communities it serves.
Financial Services

Company Stage

N/A

Total Funding

N/A

Founded

1939

Headquarters

Des Moines, Iowa

Growth & Insights
Headcount

6 month growth

1%

1 year growth

7%

2 year growth

11%
Locations
Des Moines, IA, USA
Experience Level
Entry
Junior
Mid
Senior
Expert
Desired Skills
Communications
Management
CategoriesNew
Consulting
Requirements
  • Associate's degree from an accredited nursing program
  • Role requires Active and Unrestricted Registered Nurse (RN) license in Iowa or South Dakota (individual must be licensed in the state in which they reside)
  • 4+ years of experience as a Registered Nurse (or related role) in a health care delivery or managed care setting. Ability to review medical cases and literature, familiarity with physician practice patterns and billing practices, and knowledge of diagnosis and procedure coding systems. Must be able to draw defensible conclusions from available information
  • Knowledge of the health insurance industry, as well as utilization and quality management practices - e.g., case and disease management, member certificates, accreditation coordination, or provider contracts. General understanding of UM criteria or provider payment rules, appeals, regulations, and workflow management
  • Excellent analytical, time management and problem solving skills. Strong attention to detail and the ability to identify, research, and analyze issues, organize information, and make appropriate decisions. Ability to identify root causes for opportunities for improvement in benefit determinations and assess downstream impacts
  • Strong written and verbal communication skills with the ability to negotiate and communicate complex concepts to internal and external stakeholders. Ability to present information to varying audiences
  • Ability to measure and evaluate work processes, and utilize appropriate resources to identify next steps, potential impacts/risks, and solutions
  • Strong deductive reasoning skills to probe, research, ask questions, actions and make decisions that incorporate data, and seek to understand. Ability to weigh alternative opinions, facts, tangible and/or intangible factors
  • Proficiency with Microsoft Office applications. Ability to run reports, construct documents, organize data, etc