South Carolina 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

• Research and document the basis of appeal and retrospective review requests in compliance with regulations
• Perform thorough reviews of service appeals based on clinical documentation and contractual requirements
• Conduct special projects to identify quality of care issues through clinical information reviews

Required Qualifications, Training, and Education

• Associate Degree in Nursing or graduation from an accredited school of nursing
• Two years of clinical experience plus one year in utilization/medical review, or three years of clinical experience
• Active, unrestricted RN license from the United States or a compact multistate unrestricted RN license
• Working knowledge of managed care and various healthcare delivery systems
• Strong clinical experience, including home health and broad medical-surgical experience