Tennessee Licensed RN Appeals Analyst

Job Summary

Working remotely or on-site in Nashville, Tennessee, the full-time Tennessee Licensed RN Appeals Analyst will manage complex appeal requests, conduct clinical reviews for medical necessity, and document decisions in compliance with regulations.

Key responsibilities

• Document the basis of appeals and retrospective reviews accurately and timely
• Research service appeals based on clinical documentation and contractual requirements while adhering to confidentiality regulations
• Perform appeal and retrospective reviews, defining pertinent issues in relation to policies and clinical information

Required qualifications

• Associate's degree in a job-related field
• Graduate of an accredited school of nursing
• 2 years of clinical experience plus 1 year in utilization/medical review or quality assurance, or 3 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 healthcare delivery systems