Tennessee Licensed Nurse Analyst

Job Summary

Working remotely on a full-time basis, the Tennessee Licensed Nurse Analyst will review and process member and provider appeals, ensuring compliance with CMS, Medicare, and TennCare guidelines while managing multiple priorities and turnaround times.

Key responsibilities

• Ensure timely and quality resolution of appeals and grievances per regulations and guidelines
• Evaluate medical necessity documentation and prepare detailed case files for review by the Medical Director
• Collaborate with clinical and non-clinical staff to resolve appeals and quality of care cases effectively

Required qualifications

• 3 years of clinical nursing experience required
• Active Registered Nurse (RN) license in Tennessee or a participating state in the Nurse Licensure Compact Law
• Proficiency in Microsoft Office (Outlook, Word, Excel, PowerPoint)
• Experience with appeals and grievance processes and knowledge of Medicare, CMS, and TennCare regulations
• Strong analytical skills and attention to detail