California Licensed Clinical Appeals RN

Job Summary

A company is looking for a Clinical Appeals RN, responsible for managing clinical appeals and grievances in a remote setting.

Key Responsibilities

• Review medical records and verify service criteria compliance
• Analyze pre-service appeals for clinical eligibility based on Plan benefits
• Coordinate reviews with the Medical Director and document determinations accurately

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
• Availability for M-F, 8:00-4:30 and alternating Saturdays