South Carolina RN Appeals Analyst

Job Summary

Working remotely in a full-time capacity, the South Carolina RN Appeals Analyst will research complex appeal requests, perform clinical reviews to assess medical necessity, and document decisions in compliance with regulations.

Key responsibilities

• Document the basis of appeals and retrospective reviews accurately and timely, adhering to regulations
• Conduct thorough research on service appeals using clinical documentation and contractual requirements
• Perform appeal reviews to determine the application of policies and procedures to clinical information

Required qualifications

• Associates degree in a job-related field or equivalent from an accredited nursing school
• 2 years of clinical experience plus 1 year in utilization/medical review or quality assurance, or 3 years of clinical experience
• An active, unrestricted RN license in the state of hire or a compact multistate RN license
• Working knowledge of Microsoft Office and ability to manage confidential information
• Strong clinical experience, including home health or rehabilitation