South Carolina RN Appeals Analyst

A company is looking for a RN Appeals Analyst (W@H Anywhere). Key Responsibilities Conduct thorough clinical reviews and benefit analyses for appeal requests to determine medical necessity Document appeal decisions accurately and within mandated timeframes, adhering to regulations Perform special projects to identify quality of care issues based on clinical information reviews Required Qualifications, Training, and Education Associate's degree in a job-related field or a graduate of an accredited School of Nursing 2 years of clinical experience plus 1 year of utilization/medical review, quality assurance, or home health experience An active, unrestricted RN license from the United States or a compact multistate unrestricted RN license Working knowledge of managed care and various health care delivery systems Experience with Microsoft Office software

Jun 11, 2025 - 21:30

A company is looking for a RN Appeals Analyst (W@H Anywhere). Key Responsibilities Conduct thorough clinical reviews and benefit analyses for appeal requests to determine medical necessity Document appeal decisions accurately and within mandated timeframes, adhering to regulations Perform special projects to identify quality of care issues based on clinical information reviews Required Qualifications, Training, and Education Associate's degree in a job-related field or a graduate of an accredited School of Nursing 2 years of clinical experience plus 1 year of utilization/medical review, quality assurance, or home health experience An active, unrestricted RN license from the United States or a compact multistate unrestricted RN license Working knowledge of managed care and various health care delivery systems Experience with Microsoft Office software