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 ...