South Carolina RN Appeals Analyst

Job Summary

A company is looking for an RN Appeals Analyst.

Key Responsibilities

• Researches and documents complex appeal or retrospective review requests in compliance with regulations
• Conducts thorough reviews of service appeals based on clinical documentation and policies
• Performs special projects to identify quality of care issues

Required Qualifications, Training, and Education

• Associate's degree in a job-related field or graduate of an accredited School of Nursing
• 2 years of clinical experience plus 1 year in utilization/medical review, quality assurance, or home health, or 3 years of clinical experience
• An active, unrestricted RN license from the United States or a compact multistate unrestricted RN license
• Working knowledge of Microsoft Office and managed care systems
• Strong clinical experience in home health, rehabilitation, or broad medical surgical settings