Tennessee Licensed RN Appeals Analyst

A company is looking for an RN Appeals Analyst. Key Responsibilities Conducts thorough research and clinical reviews of appeal requests to determine medical necessity Documents decisions accurately and in compliance with regulations within mandated timeframes Performs special projects to identify quality of care issues based on clinical information Required Qualifications Associate degree in Nursing or Graduate of 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 from the United States or a compact multistate unrestricted RN license Working knowledge of managed care and health care delivery systems Strong clinical experience, including home health, rehabilitation, or broad medical surgical experience

Apr 2, 2025 - 15:14

A company is looking for an RN Appeals Analyst. Key Responsibilities Conducts thorough research and clinical reviews of appeal requests to determine medical necessity Documents decisions accurately and in compliance with regulations within mandated timeframes Performs special projects to identify quality of care issues based on clinical information Required Qualifications Associate degree in Nursing or Graduate of 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 from the United States or a compact multistate unrestricted RN license Working knowledge of managed care and health care delivery systems Strong clinical experience, including home health, rehabilitation, or broad medical surgical experience