South Carolina Licensed Appeals Analyst

A company is looking for an Appeals Analyst (RN). Key Responsibilities Researches and documents complex appeal or retrospective review requests in compliance with regulations Conducts thorough reviews of service appeals based on clinical documentation and policies Performs special projects to identify quality of care issues through clinical information reviews Required Qualifications, Training, and Education Associate Degree in Nursing or Graduate of an Accredited School of Nursing Two years of clinical experience plus one year in utilization/medical review or quality assurance, or three years of clinical experience Active, unrestricted RN license from the United States and in the state of hire, or active compact multistate unrestricted RN license Working knowledge of managed care and various health care delivery systems Strong clinical experience in home health, rehabilitation, and/or broad medical surgical fields

Apr 4, 2025 - 16:05

A company is looking for an Appeals Analyst (RN). Key Responsibilities Researches and documents complex appeal or retrospective review requests in compliance with regulations Conducts thorough reviews of service appeals based on clinical documentation and policies Performs special projects to identify quality of care issues through clinical information reviews Required Qualifications, Training, and Education Associate Degree in Nursing or Graduate of an Accredited School of Nursing Two years of clinical experience plus one year in utilization/medical review or quality assurance, or three years of clinical experience Active, unrestricted RN license from the United States and in the state of hire, or active compact multistate unrestricted RN license Working knowledge of managed care and various health care delivery systems Strong clinical experience in home health, rehabilitation, and/or broad medical surgical fields