South Carolina Licensed RN Appeals Analyst

Job Summary

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

Key Responsibilities

• Document appeal or retrospective review decisions accurately and timely in compliance with regulations
• Research service appeals based on clinical documentation and governing policies while maintaining confidentiality
• Conduct special projects to identify quality of care issues through clinical information reviews

Required Qualifications, Training, and Education

• Associate Degree in Nursing or Graduate of an Accredited School of Nursing
• Two years of clinical experience plus one year in utilization/medical review or quality assurance, or three years of clinical experience
• Active, unrestricted RN license from the United States or a compact multistate RN license
• Working knowledge of managed care and healthcare delivery systems
• Strong clinical experience, including home health and rehabilitation