Opportunity Description
Overview
Job Title: Registered Nurse – Claims & Appeals Review
Location: Remote (Anywhere in Florida)
Duration: 06 Months/Can be Extended
Working hours: Day Shift
Job Type: Subcon
Pay Rate: Negotiable
Position Description
The Quality Analyst is responsible for ensuring the accuracy, compliance, and timeliness of appeal reviews through both manual and automated reporting mechanisms. This role supports continuous improvement in clinical operations by identifying quality gaps, performing root cause analysis, and recommending corrective actions.
Key Responsibilities
- Review appeal cases and supporting documentation to ensure completeness and compliance with InterQual and contractual guidelines.
- Conduct manual audits and reporting to assess quality of appeal decisions and documentation.
- Analyze operational data ...
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