RN Appeals Analyst
BlueCross BlueShield of South Carolina
Posted: 10/21/2026
Senior Grid & Interconnection Analyst
Solar Provider Group
Posted: 10/21/2026PythonRTOSSQL
Revenue Analyst
Pancreatic Cancer Action Network
Posted: 10/21/2026ERP
Mortgage Licensing Analyst
eLEND Solutions
Posted: 10/21/2026
Application Analyst I – Full Time – Days – Cupid, Radiant
Cape Fear Valley Health
Posted: 10/21/2026
Credit Analyst
Uline
Posted: 10/21/2026Credit Analyst
Uline
Posted: 10/21/2026
Senior Quantitative Analytics & Model Development Analyst
PNC
Posted: 10/21/2026PythonSQL
RMF/ISSO Analyst
DecisionPoint Corporation
Posted: 10/21/2026Cyber Security
Senior Vulnerability Management, ACAS Response Analyst
DecisionPoint Corporation
Posted: 10/21/2026CloudCyber SecurityServiceNow
Service Performance, SLA Analyst – Journeyman
DecisionPoint Corporation
Posted: 10/21/2026ITSMServiceNowSQLTableau
Vulnerability Management, ACAS Analyst – Journeyman
DecisionPoint Corporation
Posted: 10/21/2026Cyber SecurityServiceNow
Digital Commerce Analyst
WD-40 Company
Posted: 10/21/2026
Demand Planning Analyst
Sonoco
Posted: 10/21/2026Oracle
Program Cost and Schedule Control Analyst
Northrop Grumman
Posted: 10/21/2026
Software Asset Analyst
SAIC
Posted: 10/21/2026ITSMServiceNowSQL
Epic Medical Device Integration Application Analyst II
Mosaic Life Care
Posted: 10/21/2026
Acquisition Analyst
Apogee Engineering, LLC
Posted: 10/21/2026TypeScript
Program Controls Analyst II
Honeywell Aerospace Technologies
Posted: 10/21/2026Program Controls Analyst II
Honeywell Aerospace Technologies
Posted: 10/21/2026
Implementation Analyst – 2nd Shift
GXO Logistics, Inc.
Posted: 10/21/2026RN Appeals Analyst
BlueCross BlueShield of South CarolinaPosted 10/21/2026full-timeRemote • South Carolina • United StatesMid-LevelSenior💰 $53,462 - $102,258 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates strong clinical expertise in nursing with a focus on utilization review and quality assurance, while ensuring compliance with medical necessity guidelines and confidentiality standards. Proficient in analyzing clinical documentation and making informed decisions based on established policies and procedures.
Highest-signal resume keywords
Active RN LicenseUtilization Review ExperienceClinical Experience in Home HealthKnowledge of Managed Care SystemsAnalytical Thinking Skills
About the role
Key responsibilities & impact- Research complex appeal or retrospective review requests, including pre-pay and post-payment review appeals
- Conduct thorough clinical reviews or benefit analyses to determine whether requested services meet medical necessity guidelines
- Document appeal and retrospective review decisions accurately, within mandated timeframes, and in compliance with regulations or standards
- Research member and provider service appeals using clinical documentation, contractual requirements, governing agencies, policies, and procedures
- Maintain confidentiality when handling protected health information
- Define and determine precedence of pertinent issues when applying policies, procedures, clinical information, benefit provisions, or policy provisions
- Perform special projects, including reviewing clinical information to identify quality-of-care issues
Requirements
What you’ll need- Associate degree - Nursing or Graduate of Accredited School of Nursing
- Two years clinical experience plus one year utilization/medical review, quality assurance, or home health, OR 3 years clinical
- Working knowledge of word processing software
- Ability to work independently, prioritize effectively, and make sound decisions
- Working knowledge of managed care and various forms of health care delivery systems
- Strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience
- Knowledge of specific criteria/protocol sets and the use of the same
- Good judgment skills
- Demonstrated customer service, organizational, oral and written communication skills
- Ability to persuade, negotiate, or influence others
- Analytical or critical thinking skills
- Ability to handle confidential or sensitive information with discretion
- An active, unrestricted RN license from the United States and in the state of hire, OR active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
- CMS residency requirement for certain divisions: lived in the US for at least three out of the last five years
- Preferred: three years utilization/medical review, quality assurance, or home health, plus five years clinical
- Preferred: Bachelor's degree in Nursing
- Preferred knowledge of Administrative Law Judge (ALJ) process, statistical principles, NCQA, URAC, SCDOI, US DOL and HIPAA standards/regulations, claims systems, and presentation skills
Benefits
Comp & perks- 401(k) retirement savings plan with company match
- Subsidized health plans and free vision coverage
- Life insurance
- Paid annual leave – the longer you work here, the more you earn
- Nine paid holidays
- On-site cafeterias and fitness centers in major locations
- Wellness programs and healthy lifestyle premium discount
- Tuition assistance
- Service recognition
- Incentive Plan
- Merit Plan
- Continuing education funds for additional certifications and certification renewal
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ReviewBenefit AnalysisMedical Necessity GuidelinesQuality AssuranceDocumentation ComplianceContractual RequirementsClinical Information AnalysisStatistical PrinciplesAdministrative Law Judge ProcessClaims Systems
Soft Skills
Good Judgment SkillsCustomer Service SkillsOrganizational SkillsOral Communication SkillsWritten Communication SkillsPersuasion SkillsNegotiation SkillsCritical Thinking Skills
Tools & Technologies
Word Processing Software
Certifications & Qualifications
Associate Degree in NursingBachelor's Degree in Nursing (Preferred)Active Compact Multistate RN License (Preferred)
Industry Keywords
HIPAA StandardsNCQAURACSCDOIUS DOLHealthcare Delivery SystemsClinical DocumentationProtected Health Information