California Licensed Clinical Appeals RN

A company is looking for a Clinical Appeals RN, fully remote, requiring 4 or 5 workdays per week with weekends required.

Key Responsibilities

Review medical records and verify if requested services meet criteria

Analyze and evaluate pre-service appeals for clinical eligibility for coverage

Document determinations accurately and coordinate reviews with the Medical Director

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 applications

Availability for 5-day work weeks, including weekends