Temporary - RN Appeals Care Coordinator- Remote (AK, AZ, FL, ID, OR, TX, WA)

Let’s do great things, together

Founded in Oregon in 1955, ODS, now Moda, is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

The Temporary RN Appeals Care Coordinator is responsible for providing accurate and appropriate documentation, research and resolution of written and verbal complaints and appeals filed by members, providers, and external agencies.
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• ​​​​https://j.brt.mv/ATS/jb.do?reqGK=27698737&refresh=true

Benefits:

• Medical, Dental, Vision, & Pharmacy
• Employee Assistance Program
• PTO and Company Paid Holidays

Schedule:

• PST

Requirements:

• Current license as a registered nurse in the state of Oregon.
• 5 years of clinical nursing experience with preference given to experience in utilization review, discharge planning and/or managed care.
• Type a minimum of 35 wpm on a computer keyboard and be proficient with Microsoft Office applications.
• Strong analytical, problem solving, memory retention, organizational and detail-oriented skills.
• Excellent communication skills with the ability to interact with all levels of staff, members and providers as needed.
• Ability to be a self-starter and proactively identify opportunities for improvement
• Ability to defuse difficult/angry calls and work towards a positive resolution.
• Ability to maintain confidentiality and project a professional business image.

• Resolve clinical member appeals for all lines of business in accordance with state and federal guidelines.
• Regularly respond to all hearing, appeals, CTM (complaints filed with CMS), grievance, and external review requests within the stipulated timelines and following the review processes outlined in the Managed Care Manuals, Standard Operating Procedures and CMS best practices.
• Represent Moda Health in administrative law judge hearings (ALJs) as required and give testimony on behalf of the plan.
• Maintain accurate and timely documentation of all communication, as outlined in the department policies and procedures.
• Provide oversight of delegated appeals activities to ensure compliance with regulatory and accrediting requirements.
• Develop professional relationships with internal departments, including effectively communicating with support staff and customer service staff.
• Contribute to the ongoing efforts of the department to foster a collaborative and team approach to case load.
• Provide clinical guidance to non-clinical Appeals Team members.
• Performs other duties as assigned.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis via our humanresources@modahealth.com email.