South Carolina Licensed RN Appeals Analyst

A company is looking for an RN Appeals Analyst to conduct clinical reviews and benefit analyses for appeal requests. Key Responsibilities Document appeal or retrospective review decisions accurately and timely in compliance with regulations Research service appeals based on clinical documentation and governing policies while maintaining confidentiality Conduct special projects to identify quality of care issues through clinical information reviews Required Qualifications, Training, and Education Associate Degree in Nursing or Graduate of an Accredited School of Nursing Two years of clinical experience plus one year in utilization/medical review or quality assurance, or three years of clinical experience Active, unrestricted RN license from the United States or a compact multistate RN license Working knowledge of managed care and healthcare delivery systems Strong clinical experience, including home health and rehabilitation

Created: 2026-03-05