RN Appeals Analyst - SC/GA Licensed
Job Summary
Working remotely in a full-time capacity, the RN Appeals Analyst - SC/GA Licensed will research complex appeal requests, conduct clinical reviews to assess medical necessity, and document decisions in compliance with regulations.
Key responsibilities
- Document the basis of appeals and retrospective reviews accurately and timely according to regulations
- Conduct thorough research on service appeals using clinical documentation and contractual requirements
- Perform appeal and retrospective reviews, identifying key issues related to policies and clinical information
Required qualifications
- Associate's degree in a job-related field or graduate of an accredited school of nursing
- 2 years of clinical experience plus 1 year in utilization/medical review, quality assurance, or home health, or 3 years of clinical experience
- Active, unrestricted RN license in the state of hire or an active compact multistate RN license
- Working knowledge of managed care and health care delivery systems
- Proficiency in Microsoft Office applications
Complete Job Description
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