Nurse Appeals Associate

Elevance Health • Nashville, TN

4d • Hybrid

About The Position

Nurse Appeals Associate Location: 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. Work Schedule: Monday - Friday; 10:00a 7:00p CST The Nurse Appeals Associate is responsible for supporting the development and implementation of quality improvement interventions and audits. How you will make an impact: 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.

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.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed