South Carolina Licensed RN Appeals Analyst

Job Summary

A company is looking for an RN Appeals Analyst to perform clinical reviews and benefit analyses for appeal requests.

Key Responsibilities

• Document the basis of appeals and retrospective reviews accurately and timely
• Conduct thorough research on service appeals based on clinical documentation and policies
• Perform appeal reviews to determine the application of policies to clinical information

Required Qualifications, Training, and Education

• Associate's degree in a job-related field
• Graduate of an accredited school of nursing
• 2 years of clinical experience plus 1 year in utilization/medical review, quality assurance, or home health
• An active, unrestricted RN license from the United States or a compact multistate RN license
• Working knowledge of Microsoft Office and managed care systems