Researching complex appeal requests, the full-time South Carolina Licensed RN Appeals Analyst will perform clinical reviews and benefit analyses to determine medical necessity, all while working remotely and adhering to regulatory standards. Key responsibilities Documents appeal and retrospective review findings accurately and timely in compliance with regulations Conducts thorough research on service appeals based on clinical documentation and contractual requirements Performs special projects to identify quality of care issues through clinical information reviews Required qualifications Associate degree in Nursing or graduate of an accredited School of Nursing Two years of clinical experience plus two years in utilization/medical review or quality assurance, totaling four years of relevant experience An active, unrestricted RN license in the state of hire or an active compact multistate unrestricted RN license Working knowledge of managed care and healthcare delivery systems Proficiency in Microsoft Office applications
South Carolina Licensed RN Appeals Analyst in workfromhome at Unknown Company
- Typical pay
- $71,760–$120,640
For context, most registered nurses earn between $71,760–$120,640 a year according to Bureau of Labor Statistics wage data. What this particular role pays is set by the employer — check the description above.
This position is listed as contract and able to be worked remotely.