California Licensed Clinical Appeals RN

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

Key Responsibilities

Review medical records to verify service criteria compliance

Analyze pre-service appeals for clinical eligibility based on Plan benefits

Document determinations accurately while adhering to confidentiality regulations

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, including Word and Outlook

Availability M-F, 8 : 00-4 : 30 in their time zone and alternating Saturdays