Ourhrconnect
RN Appeals Analyst
US · W@H South Carolina · Remote · Full-time · Mid
需在美东时间周一至周五8:00am-5:00pm工作
Salary not stated
AI summary
About the company
蓝十字蓝盾南卡罗来纳州公司，成立超70年，是南卡最大保险公司、美国领先的政府合同管理方，拥有东南部先进数据处理中心，业务多元。
Role overview
该岗位为蓝十字蓝盾南卡罗来纳州公司的全职远程岗位，隶属于Palmetto GBA子公司，主要负责医疗服务申诉与回顾性审查，需依据医疗必要性准则提供临床或福利分析，按规定时限完成合规文档，工作时间为美东时间周一至周五8:00am-5:00pm。
Responsibilities
- 研究复杂申诉及回顾性审查请求，提供临床或福利分析
- 按规定时限完成合规的申诉决策文档
- 依据多维度信息开展申诉研究，遵守隐私法规
- 处理特殊项目，识别医疗质量问题
Requirements
- 相关领域副学士学位或注册护士学校毕业
- 2年临床经验加2年医疗审查等经验，或总计4年相关经验
- 持有美国有效无限制RN执照或NLC多州RN执照
- 熟练使用微软办公软件
- 具备独立工作、决策及沟通等能力
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Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in…
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