California Licensed Clinical Appeals RN

Job Summary

Providing expertise in clinical appeals and grievances, the full-time California Licensed Clinical Appeals RN will analyze, review, and evaluate appeals and grievances while working remotely with a schedule of M-F and alternating Saturdays.

Key responsibilities:

• Review medical records to verify if requested services meet criteria
• Analyze pre-service appeals for clinical eligibility based on Plan benefits
• Document determinations accurately while adhering 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, including Word and Outlook
• Availability for M-F, 8:00-4:30 in their time zone and alternating Saturdays