Working remotely in a full-time capacity, the RN Appeals Analyst - SC/GA Licensed will research complex appeal requests, conduct 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 according to regulations Conduct thorough research on service appeals using clinical documentation and contractual requirements Perform appeal and retrospective reviews, identifying key issues related to policies and clinical information Required qualifications 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 Active, unrestricted RN license in the state of hire or an active compact multistate RN license Working knowledge of managed care and health care delivery systems Proficiency in Microsoft Office applications
RN Appeals Analyst - SC/GA Licensed in workfromhome at Unknown Company
This position is listed as contract and able to be worked remotely.