South Carolina Licensed Appeals Analyst
Job Summary
Researching complex appeal requests, the full-time South Carolina Licensed Appeals Analyst will perform clinical reviews and benefit analyses to determine medical necessity, working remotely Monday through Friday from 8:00 AM to 5:00 PM.
Key responsibilities
- Documents appeal decisions accurately and within mandated timeframes in compliance with regulations
- Conducts thorough research on service appeals based on clinical documentation and governing policies
- Performs special projects to identify quality of care issues through clinical information reviews
Required qualifications
- Associate's degree in a job-related field or a graduate of an accredited School of Nursing
- Active, unrestricted RN license in the state of hire or a compact multistate unrestricted RN license
- Working knowledge of managed care and various health care delivery systems
- Strong clinical experience in home health, rehabilitation, or broad medical surgical settings
- Proficiency in Microsoft Office applications
Complete Job Description
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