-
CategoryHealthcare
-
No of Jobs1
-
Apply Before12/08/2025
Description
RN Provider Appeals Coordinator (Hybrid) - Medical Appeals - 40 Hours Weekly - Day Shift - HAP Health Alliance Plan
Health Alliance Plan - Troy, MI
Job Title: RN Provider Appeals Coordinator (Hybrid) - Medical Appeals - 40 Hours Weekly - Day Shift - HAP Health Alliance Plan
Position: Medical Appeals Coordinator
Job Type: Full Time
Pay:
Shift: Monday through Friday, 8:00 AM to 4:30 PM
Work Type: Remote with occasional in-person meetings
Location
Address:
City: Troy
State: MI
ZIP Code:
Job Responsibilities
- Investigate Provider Appeal requests and Code Review inquiries for all Utilization Management divisions.
- Summarize outcome of investigations for decision by Medical Directors.
- Utilize established medical criteria for reviewing appeals for medical necessity, readmission appeals, and administrative appeals.
Required Skills
Core Skills
- Excellent written and verbal communication skills
- Ability to prioritize and coordinate workflow
- Ability to manage multiple tasks simultaneously
- Knowledge of ICD-10 and CPT coding
- Knowledge of medical necessity criteria and medical terminology
- Computer skills including Windows and Microsoft Word, Excel, and Access
Preferred Skills
- Demonstrated knowledge of InterQual® or Milliman Care Guidelines® criteria
- Knowledge of Medicare, Medicaid and NCQA guidelines
- Prior Utilization management or case management experience
- Prior inpatient nursing experience in a hospital setting
Requirements
Experience: Minimum of two (2) years of experience in clinical management or three (3) years of experience in Utilization Management or Case Management.
Education: Nursing Diploma or equivalent; Bachelor's Degree in Health Care or related field preferred.
License & Certification:
- Registered Nurse (RN) with current Michigan licensure
Schedule:
- Not specified
COVID-19 Requirements: Not Specified
Benefits
- Not specified
Supplemental Pay
- Not specified
Special Notes
- Not specified
Facility Details
Name: Health Alliance Plan
Description: Health Alliance Plan (HAP) is looking to grow our Medical Appeals Team with an experienced Registered Nurse.
Specialties:
- Not specified
Mission: Not Specified
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
12/08/2025
Posted:
09/08/2025
