Nurse Appeals Associate – Remote Full‑Time

About the role

The Nurse Appeals Associate supports quality improvement initiatives and audit processes within a virtual, full‑time environment. Working Monday‑Friday, 10:00 a.m. – 7:00 p.m. CST, the role blends data‑driven analysis with hands‑on grievance management to ensure compliance and enhance member experience.

Key responsibilities

• Research, collect, and resolve administrative appeals.
• Prepare complaint and grievance files for Fair Hearings and act as subject‑matter expert for non‑clinical staff.
• Support external review preparations, including state site visits and accreditation reviews.
• Conduct internal monitoring, audits, and quarterly HIPAA plan audits.
• Track, trend, and report complaint and grievance issues.

Required profile

• Current, unrestricted LVN/LPN license in the applicable state.
• Minimum of 1 year of related experience or equivalent education/experience.
• Ability to work remotely with occasional in‑person training sessions.

Required skills

• Computer literacy.

What we offer

• Competitive total rewards including merit increases, paid holidays, PTO, and incentive bonuses.
• Medical, dental, vision, short‑ and long‑term disability, 401(k) match, stock purchase plan, and life insurance.
• Wellness programs and financial education resources.