California Licensed Clinical Appeals RN

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