Remote RN Appeals & Grievance Analyst

bcbst; Chattanooga (TN); Remote; USD 65,000 - 95,000; Full time

Job summary

BCBST BlueCross BlueShield of Tennessee, Inc. is hiring an Appeals & Grievance Nurse Analyst to review and process member and provider appeals, ensuring timely and compliant resolutions under CMS, Medicare, and TennCare guidelines.

The role emphasizes case evaluation, documentation, and collaboration with Medical Directors. Ideal candidates bring at least 3 years of clinical nursing experience, Tennessee RN licensure, and strong data entry and communication skills.

Qualifications

• 3 years of clinical nursing experience
• RN license in Tennessee or eligible for licensure in residence state
• Strong analytical and documentation skills

Responsibilities

• Review and process member and provider appeals per CMS, Medicare and TennCare guidelines
• Summarize clinical records and prepare case files for Medical Director review
• Research and document medical necessity with accurate, timely information
• Draft individualized appeal and QOC grievance response letters with accuracy and compliance
• Collaborate with clinical and non-clinical teams to resolve appeals and quality of care cases

Skills

Independent work

MS Office

Communication skills

Team player

Job description

BCBST BlueCross BlueShield of Tennessee, Inc. is hiring an Appeals & Grievance Nurse Analyst to review and process member and provider appeals, ensuring timely and compliant resolutions under CMS, Medicare, and TennCare guidelines.

The role emphasizes case evaluation, documentation, and collaboration with Medical Directors. Ideal candidates bring at least 3 years of clinical nursing experience, Tennessee RN licensure, and strong data entry and communication skills.