Job Summary
A company is looking for a Clinical Appeals RN to work remotely during Pacific Standard Time hours.
Key Responsibilities:
- Address and process Standard and Expedited appeals cases
- Maintain compliance with turnaround times for appeals, completing standard cases within 25-30 days and expedited cases within 24-72 hours
- Communicate with members, medical groups, and internal departments regarding appeals
Required Qualifications:
- Current, unrestricted RN license in the state of residency, with ability to obtain a CA RN license
- 3+ years of clinical experience in a hospital or acute care setting
- Experience navigating a Windows-based environment with exceptional typing skills
- Ability to evaluate and interpret medical records across all specialties
- Availability to work 8:00am - 5:00pm PST
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