California Licensed Clinical Appeals RN

Job Summary

A company is looking for a Clinical Appeals RN to provide expertise in clinical appeals and grievances.

Key Responsibilities

• Review medical records to verify if requested services meet criteria
• Analyze pre-service appeals for clinical eligibility for coverage
• Document determinations accurately and adhere to confidentiality regulations

Required Qualifications

• Active, unrestricted RN license in state of residence
• 2+ years of clinical experience as an RN in an acute, inpatient hospital setting
• Proficiency in Microsoft Office applications
• Available M-F, 8:00-4:30 in their time zone and alternating Saturdays