Denials and Appeals Coordinator

Benbrook, TX

Category: Utilization Review Job Number: 2380

Job Description

Denials and Appeals Registered Nurse- Fort Worth TX
  • Location: Remote -Direct Hire 
  • Schedule: Mon -Fri - 8:00am - 5:00pm 


Summary
CornerStone Medical is looking for a qualified Denials and Appeals RN Coordinator for a premiere healthcare company in Fort Worth, TX. The Registered Nurse is responsible for working with Medical Directors/Physician reviewers, network providers and network facilities to ensure consistent clinical evaluation and processing of prior authorization requests not meeting medical necessity criteria or those being appeal for reasons of medical necessity decisions.

-This includes investigating and processing medical necessity appeal requests as well as acting as the subject-matter expert for all Adverse Benefit Determinations (medical necessity denial), and administrative/ technical denials as governed by the appropriate regulatory agency for a Member’s benefit plan.  Process denials and appeals for medication, behavioral health, PT, OT, Speech, DME, and other outpatient services

Education & Experience:
  • Associates degree in nursing required, Bachelor’s degree preferred.
  • 3 – 5 years utilization review/case management experience
  • Minimum of five (5) years clinical experience. 
  • Minimum of 1 year experience in a Medicaid, 
  • Experience with managed care Utilization Management or similar role, Denial/Appeal, EMR, State fair hearing preferred.

Quick Apply Online or Text Tez at 972-525-5539
 
#CSM
#ZR

Meet Your Recruiter

Tez Williams
Clinical Recruitment Manager

Tez has been with CornerStone Medical since November 2017. He has spent ten years in the healthcare industry, the last two years as a healthcare recruiter. He developed skills for recruiting, training and managing pipelines of 10-50 clinicians at a time while working for Fortune 500 companies. He also gained experience working multiple verticals within the healthcare industry such as allied health, clinical and non-clinical.

As the Clinical Recruitment Manager, his main objective is to locate talented clinicians who are amazing at what they do and match them with their dream jobs. He serves his candidates to the best of his ability, always going the extra mile to locate the best career opportunities in the marketplace. He once even brought a can of gas to a travel nurse stuck on the side of the road on the FIRST day of her assignment!

Tez graduated from Northwestern State University in Louisiana with a Bachelor of Science.

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