California Licensed Clinical Appeals RN

Job Summary

A company is looking for a Clinical Appeals RN - Remote (M-F working alternating Saturdays).

Key Responsibilities

• Review medical records and verify if the requested service meets criteria
• Review pre-service appeals for clinical eligibility for coverage as prescribed by the Plan benefits
• Coordinate reviews with the Medical Director and accurately document determinations

Required Qualifications

• Active, unrestricted RN license in state of residence
• 2+ years of clinical experience as an RN, including in an acute, inpatient hospital setting
• Proficiency in Microsoft Office, Word, Outlook, and Internet
• Available M-F, 8:00-4:30 in their time zone and alternating Saturdays