Legal Operations Coordinator at Mistplay managing corporate records and supporting legal technology initiatives. Overseeing contract management processes while leveraging technology for legal efficiencies.
About the role
- Nurse Appeals responsible for investigating medical necessity appeals requests at Elevance Health. Collaborating with legal and management teams while providing high-quality support.
Responsibilities
- Responsible for investigating and processing medical necessity appeals requests
- Supports legal, management, and executive leadership
- Acts as a resource for clinical and non-clinical teams
- Conducts thorough investigations and reviews of medical necessity appeals
- Documents and logs appeal information
- Generates written correspondence with members, providers, and regulatory entities
- Serves as a subject matter expert for appeals, grievances, and quality of care issues
- Liaises with internal and external attorneys on regulatory cases
Requirements
- Requires a HS diploma or equivalent
- Minimum of 2 years of experience in a managed care healthcare setting
- Current active unrestricted RN license
- AS or BS in Nursing preferred
- Background or exposure in litigation, legal proceedings, and/or paralegal experience is strongly desired
- Understanding of the grievance and appeals process is strongly preferred
- Basic knowledge of Medicare and Medicaid guidelines is preferred
- Proficiency in Microsoft Suite Products (e.g. Outlook, Excel, and Word)
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short term disability benefits
- Long term disability benefits
- 401(k) +match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
UC
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