California Licensed Clinical Appeals RN
Job Summary
Providing expertise in clinical appeals and grievances, the remote California Licensed Clinical Appeals RN will review medical records, analyze appeals, and coordinate with Medical Directors while working a schedule of M-F with alternating Saturdays.
Key responsibilities:
- Review medical records to verify service eligibility and compliance with criteria
- Analyze pre-service appeals and interpret Plan language for coverage determinations
- Document determinations accurately and maintain adherence to confidentiality regulations
Required qualifications:
- Active, unrestricted RN license in the state of residence
- 2+ years of clinical experience as an RN in an acute, inpatient hospital setting
- Proficiency in Microsoft Office, Word, Outlook, and Internet applications
- Availability for M-F, 8:00-4:30 in their time zone and alternating Saturdays
Complete Job Description
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