South Carolina Licensed RN Appeals Analyst
Job Summary
Researching complex appeal requests, the full-time South Carolina Licensed RN Appeals Analyst will conduct clinical reviews and benefit analyses to determine medical necessity, working remotely Monday through Friday during standard business hours.
Key responsibilities
- Documents appeal decisions accurately and within mandated timeframes, adhering to applicable regulations
- Conducts thorough research of service appeals based on clinical documentation and governing policies while maintaining confidentiality
- Performs retrospective reviews to assess the application of policies and procedures to clinical information
Required qualifications
- Associate Degree in Nursing or graduation from an accredited School of Nursing
- Two years of clinical experience plus one year in utilization/medical review, quality assurance, or home health, or three years of clinical experience
- Active, unrestricted RN license in the state of hire or compact multistate unrestricted RN license
- Working knowledge of managed care and various health care delivery systems
- Strong clinical experience, including home health, rehabilitation, and/or medical-surgical settings
Complete Job Description
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