California Licensed Clinical Appeals RN

Job Summary

A company is looking for a Clinical Appeals RN to work remotely, responsible for clinical appeals and grievances.

Key Responsibilities

• Review medical records and verify requested services meet criteria
• Analyze pre-service appeals for clinical eligibility and interpret Plan language
• Document determinations accurately and coordinate reviews with the Medical Director

Required Qualifications

• Active, unrestricted RN license in state of residence
• 2+ years of clinical experience as an RN in an acute, inpatient hospital setting
• Proficiency in Microsoft Office, Word, Outlook, and Internet
• Availability for a 5-day work week, including some weekends