Remote Appeals Analyst – RN Utilization Review
Southcarolinablues
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Benefits offered by this job
Job summary
BlueCross BlueShield of South Carolina is seeking a remote RN reviewer for complex appeal and retrospective review requests. You will research clinical documentation, apply medical necessity guidelines, and document decisions within regulatory timelines. Must hold an RN license in the US or a multi-state compact license and have strong analytical and communication skills.
The role is full-time, remote, Monday–Friday with 8:00am–5:00pm shifts. Sponsorship is not available.
Qualifications
- Associate's in a related field required or equivalent.
- RN license in US or compact multi-state license required.
Responsibilities
- Document the basis of appeal or retrospective review accurately and timely.
- Research clinical substance of service appeals across documentation and policies.
- Perform reviews to determine precedence and applicability of policy provisions.
- Participate in special projects reviewing clinical information for quality of care.
Skills
Education
Tools
Job description
BlueCross BlueShield of South Carolina is seeking a remote RN reviewer for complex appeal and retrospective review requests. You will research clinical documentation, apply medical necessity guidelines, and document decisions within regulatory timelines. Must hold an RN license in the US or a multi-state compact license and have strong analytical and communication skills.
The role is full-time, remote, Monday–Friday with 8:00am–5:00pm shifts. Sponsorship is not available.
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