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, all while working remotely within standard business hours.
Key responsibilities
- Document the basis of appeals and retrospective reviews accurately and in a timely manner
- Perform detailed research on service appeals based on clinical documentation and regulatory requirements
- Conduct appeal and retrospective reviews, identifying key issues related to policies and clinical information
Required qualifications
- Associate's degree in a job-related field or graduation from an accredited School of Nursing
- Two years of clinical experience plus two years in utilization/medical review or quality assurance, or a total of four years in related fields
- An active, unrestricted RN license in South Carolina or a compact multistate RN license
- Strong clinical experience in home health, rehabilitation, or broad medical surgical settings
- Proficiency in Microsoft Office software
Complete Job Description
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