Nurse Appeals Associate

Elevance Health•Nashville, TN

5d•Remote

About The Position

The Nurse Appeals Associate is responsible for supporting the development and implementation of quality improvement interventions and audits. This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Requirements

Requires an LVN/LPN and minimum of 1 year of related experience; or any combination of education and experience, which would require an equivalent background.
Current unrestricted LPN/LVN license in applicable state(s) required.

Nice To Haves

Strong computer literacy skills is preferred.

Responsibilities

Researches, collects data, and submits and resolves administrative appeals.
Contributes to external reviews site visit preparations by the State, accreditation review and Quality Management Committee; conducts internal monitoring and audits timeline compliance standards.
Processes, tracks, trends, and reports complaint and grievances issues.
Prepares complaint and grievance files for Fair Hearings and serves as a subject matter expert on complaints and grievances for non-clinical staff.
Participates in quarterly Plan HIPAA audits.