California Licensed Clinical Appeals RN

A company is looking for a Clinical Appeals RN - Fully Remote.

Key Responsibilities

Review medical records to verify service criteria and clinical eligibility for coverage

Coordinate reviews with the Medical Director and document determinations accurately

Adhere to confidentiality regulations while interpreting Plan language

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 for 5-day work weeks, including weekdays and alternating weekends