Researching complex appeal requests, the full-time South Carolina Licensed RN Appeals Analyst will conduct clinical reviews and benefit analyses to determine medical necessity, working remotely Monday through Friday during standard business hours. Key responsibilities Documents appeal decisions accurately and within mandated timeframes, adhering to applicable regulations Conducts thorough research of service appeals based on clinical documentation and governing policies while maintaining confidentiality Performs retrospective reviews to assess the application of policies and procedures to clinical information Required qualifications Associate Degree in Nursing or graduation from an accredited School of Nursing Two years of clinical experience plus one year in utilization/medical review, quality assurance, or home health, or three years of clinical experience Active, unrestricted RN license in the state of hire or compact multistate unrestricted RN license Working knowledge of managed care and various health care delivery systems Strong clinical experience, including home health, rehabilitation, and/or medical-surgical settings
South Carolina Licensed RN Appeals Analyst in workfromhome at Unknown Company
- Typical pay
- $84,500–$135,200
For context, most registered nurses earn between $84,500–$135,200 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 full time and able to be worked remotely.