South Carolina Licensed RN Appeals Analyst
Job Summary
To support a growing team, the full-time South Carolina Licensed RN Appeals Analyst will perform thorough clinical reviews and benefit analyses of complex appeal requests, working remotely during standard business hours.
Key responsibilities
- Documents the basis of appeals and retrospective reviews in compliance with applicable regulations and standards
- Conducts detailed research on service appeals based on clinical documentation and governing agency policies
- Performs special projects to identify quality of care issues through clinical information reviews
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
- An active, unrestricted RN license from the United States and in the state of hire, or an active compact multistate unrestricted RN license
- Working knowledge of managed care and various healthcare delivery systems
- Strong clinical experience in home health, rehabilitation, and/or broad medical-surgical settings
Complete Job Description
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