Elevance Health
Nurse Appeals – Litigation & Legal Support
Elevance Health, Greensboro, North Carolina, us, 27497
Anticipated End Date: 2025-11-22
Position Title Nurse Appeals – Litigation & Legal Support
Location North Carolina. Candidates must be residents of North Carolina to be considered.
In Office Expectation This role is
Virtual . Associates can work virtually full-time, with exception of required in‑person training sessions. This approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face onboarding and skill development. Candidates not within reasonable commuting distance will not be considered unless an accommodation is required by law.
Schedule Monday – Friday, 8:00 AM – 5:00 PM Eastern Time. Some flexibility in hours may be necessary depending on court hearing schedules.
Responsibilities
Supports legal, management, and executive leadership by managing State Fair Hearing and External Medical Review requests.
Acts as a resource for clinical and non‑clinical teams by investigating and reviewing medical necessity appeals from members and providers in preparation for litigation.
Documents and logs appeal information in relevant tracking systems; prepares written correspondence with members, providers, and regulatory entities.
Serves as subject matter expert for appeals, grievances, and quality of care issues.
Works with internal and external attorneys on regulatory cases, ensuring accurate entry, investigation, and analysis of state appeals, summarizing medical information for review by medical directors and consultants, and preparing recommendations to uphold or deny appeals within regulatory timeframes.
Minimum Requirements
High school diploma or equivalent and minimum 2 years of experience in a managed care healthcare setting or equivalent combination of education and experience.
Current active unrestricted RN license to practice in applicable state(s).
Preferred Skills, Capabilities, & Experiences
AS or BS in Nursing preferred.
Experience in litigation, legal proceedings, or paralegal work.
Understanding of grievance and appeals process.
Basic knowledge of Medicare and Medicaid guidelines.
Ability to work with internal and external legal counsel, medical directors, judges, and other leadership.
Proficiency in Microsoft Office (Outlook, Excel, Word).
Strong oral, written, and interpersonal communication skills; problem‑solving, organization, and execution with minimal supervision.
Job Level Non‑Management Exempt
EEO Statement Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment regardless of age, citizenship status, color, creed, disability, ethnicity, genetic information, gender identity, gender expression, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status protected by law.
Applicants requiring accommodation may contact elevancehealthjobssupport@elevancehealth.com.
#J-18808-Ljbffr
Position Title Nurse Appeals – Litigation & Legal Support
Location North Carolina. Candidates must be residents of North Carolina to be considered.
In Office Expectation This role is
Virtual . Associates can work virtually full-time, with exception of required in‑person training sessions. This approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face onboarding and skill development. Candidates not within reasonable commuting distance will not be considered unless an accommodation is required by law.
Schedule Monday – Friday, 8:00 AM – 5:00 PM Eastern Time. Some flexibility in hours may be necessary depending on court hearing schedules.
Responsibilities
Supports legal, management, and executive leadership by managing State Fair Hearing and External Medical Review requests.
Acts as a resource for clinical and non‑clinical teams by investigating and reviewing medical necessity appeals from members and providers in preparation for litigation.
Documents and logs appeal information in relevant tracking systems; prepares written correspondence with members, providers, and regulatory entities.
Serves as subject matter expert for appeals, grievances, and quality of care issues.
Works with internal and external attorneys on regulatory cases, ensuring accurate entry, investigation, and analysis of state appeals, summarizing medical information for review by medical directors and consultants, and preparing recommendations to uphold or deny appeals within regulatory timeframes.
Minimum Requirements
High school diploma or equivalent and minimum 2 years of experience in a managed care healthcare setting or equivalent combination of education and experience.
Current active unrestricted RN license to practice in applicable state(s).
Preferred Skills, Capabilities, & Experiences
AS or BS in Nursing preferred.
Experience in litigation, legal proceedings, or paralegal work.
Understanding of grievance and appeals process.
Basic knowledge of Medicare and Medicaid guidelines.
Ability to work with internal and external legal counsel, medical directors, judges, and other leadership.
Proficiency in Microsoft Office (Outlook, Excel, Word).
Strong oral, written, and interpersonal communication skills; problem‑solving, organization, and execution with minimal supervision.
Job Level Non‑Management Exempt
EEO Statement Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment regardless of age, citizenship status, color, creed, disability, ethnicity, genetic information, gender identity, gender expression, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status protected by law.
Applicants requiring accommodation may contact elevancehealthjobssupport@elevancehealth.com.
#J-18808-Ljbffr