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California Licensed Clinical Appeals RN

7/11/2025

Remote

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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