Tennessee Licensed RN Appeals Analyst

Job Summary

Working remotely in a full-time capacity, the Tennessee Licensed RN Appeals Analyst will conduct thorough clinical reviews of appeal requests, ensuring compliance with medical necessity guidelines and documenting decisions within mandated timeframes.

Key responsibilities

• Document the basis of appeals and retrospective reviews accurately and timely in accordance with regulations
• Research service appeals based on clinical documentation and contractual requirements while maintaining confidentiality
• Perform special projects to identify quality of care issues through clinical information reviews

Required qualifications

• Associate's degree in a job-related field or equivalent from an accredited nursing school
• Active, unrestricted RN license in the state of hire or a compact multistate RN license
• 2 years of clinical experience plus 1 year in utilization/medical review, quality assurance, or home health, or 3 years of clinical experience
• Working knowledge of Microsoft Office software
• Ability to prioritize tasks and make sound decisions independently