South Carolina Licensed Appeals Analyst
Job Summary
Researching complex appeal requests, the full-time South Carolina Licensed Appeals Analyst will conduct thorough clinical reviews and benefit analyses to determine medical necessity, working remotely during regular business hours.
Key responsibilities
- Document the basis of appeals and retrospective reviews accurately and timely, adhering to regulations
- Conduct comprehensive research on service appeals based on clinical documentation and contractual requirements
- Perform special projects to identify quality of care issues through clinical information reviews
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 or quality assurance, or 3 years of clinical experience
- An active, unrestricted RN license from the United States or a compact multistate unrestricted RN license
- Working knowledge of managed care and various healthcare delivery systems
- Proficiency in Microsoft Office software
Complete Job Description
The complete job description is available to members. Premium membership includes:
Full access to 41,964 remote jobs from human-vetted companies, updated daily
Resume Builder - AI-powered tool to craft, enhance, and tailor your resume to a specific job
Twice-monthly live group coaching and the full Remote Career Center
20% member discount on Career Services
Backed by a 30-day money-back guarantee
Company Company Name
Headquarters Headquarters
Founded Founded
Website
Wikipedia Wikipedia URL
The company description is available to members. Go Premium for full access to every job and company profile in our remote jobs database, backed by a 30-day money-back guarantee.
