South Carolina RN Appeals Analyst

Job Summary

A company is looking for a RN Appeals Analyst (W@H Anywhere).

Key Responsibilities

• Conduct thorough clinical reviews and benefit analyses for appeal requests to determine medical necessity
• Document appeal decisions accurately and within mandated timeframes, adhering to regulations
• Perform special projects to identify quality of care issues based on clinical information reviews

Required Qualifications, Training, and Education

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