South Carolina RN Appeals Analyst - Salinas California

Company: VirtualVocations
Location: Salinas, California
Posted On: 01/28/2025

A company is looking for an Appeals Analyst (RN).



Key Responsibilities

Research and document complex appeal or retrospective review requests in compliance with regulations
Conduct thorough reviews of service appeals based on clinical documentation and contractual requirements
Perform 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 two years in utilization/medical review or related fields
Active, unrestricted RN license from the United States or a compact multistate RN license
Working knowledge of Microsoft Office and managed care systems
Strong clinical experience in home health, rehabilitation, or medical-surgical settings More...

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