Working remotely in a full-time capacity, the South Carolina RN Appeals Analyst will research complex appeal requests, perform 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, adhering to regulations Conduct thorough research on service appeals using clinical documentation and contractual requirements Perform appeal reviews to determine the application of policies and procedures to clinical information Required qualifications Associates degree in a job-related field or equivalent from an accredited nursing school 2 years of clinical experience plus 1 year in utilization/medical review or quality assurance, or 3 years of clinical experience An active, unrestricted RN license in the state of hire or a compact multistate RN license Working knowledge of Microsoft Office and ability to manage confidential information Strong clinical experience, including home health or rehabilitation
South Carolina RN Appeals Analyst in workfromhome at Unknown Company
- Typical pay
- $71,760–$113,550
For context, most registered nurses earn between $71,760–$113,550 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.