South Carolina Licensed RN Appeals Analyst
Job Summary
Researching complex appeal requests, the full-time South Carolina Licensed RN Appeals Analyst will perform clinical reviews and benefit analyses to determine medical necessity, all while working remotely and adhering to regulatory standards.
Key responsibilities
- Documents appeal and retrospective review findings accurately and timely in compliance with regulations
- Conducts thorough research on service appeals based on clinical documentation and contractual requirements
- Performs special projects to identify quality of care issues through clinical information reviews
Required qualifications
- Associate degree in Nursing or graduate of an accredited School of Nursing
- Two years of clinical experience plus two years in utilization/medical review or quality assurance, totaling four years of relevant experience
- An active, unrestricted RN license in the state of hire or an active compact multistate unrestricted RN license
- Working knowledge of managed care and healthcare delivery systems
- Proficiency in Microsoft Office applications
Complete Job Description
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