California Licensed Clinical Appeals RN
Job Summary
Providing expertise in clinical appeals and grievances, the part-time California Licensed Clinical Appeals RN will review medical records, analyze appeals, and serve as a Clinical Interface Liaison while working remotely on a schedule of M-F with alternating Saturdays.
Key responsibilities:
- Review medical records and verify if requested services meet criteria
- 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 the state of residence
- 2+ years of clinical experience as an RN, including 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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