Description

Job Title: Appeals Nurse (Job Code: 210989) Request ID: 176519-1 Location: Remote (Preferred: Iowa | Open nationally) Schedule: Monday – Friday, 8:00 AM – 5:00 PM CST (No OT) Start Date: May 18, 2026 (Flexible) Duration: 10 months (Potential to extend or convert) Openings: 2 Position Summary We are seeking experienced Appeals Nurses to support a high-performing, fully remote team focused on reviewing and processing Iowa Medicaid Member Appeals. Due to increased case volume, this role is critical to ensuring timely and compliant resolution of appeals within required regulatory timeframes. Key Responsibilities Manage member appeals from intake through final resolution Conduct clinical reviews of cases and supporting documentation Perform outreach to members and providers as needed Collaborate with physicians and specialty reviewers Prepare and issue determination letters Ensure all appeals are completed within required timelines: 30 calendar days for standard cases 3 business days for acknowledgment of receipt Maintain accurate documentation and case tracking in internal systems Required Qualifications Education: Associate’s Degree License: Active LPN (RN preferred) Experience: Minimum 2 years of nursing experience Utilization Management (UM) experience is a plus Top Required Skills Strong customer service skills Excellent time management and prioritization Computer proficiency and ability to learn new systems quickly Ideal Candidate Profile Thrives in a fast-paced, high-volume environment Strong organizational and multitasking abilities Adaptable to changing priorities and workloads Detail-oriented with strong accountability Key Responsibilities Manage member appeals from intake through final resolution Conduct clinical reviews of cases and supporting documentation Perform outreach to members and providers as needed Collaborate with physicians and specialty reviewers Prepare and issue determination letters Ensure all appeals are completed within required timelines: 30 calendar days for standard cases 3 business days for acknowledgment of receipt Maintain accurate documentation and case tracking in internal systems