Florida Licensed Clinical Appeals Nurse

Job Summary

Supporting revenue cycle operations, the remote Florida Licensed Clinical Appeals Nurse will review denied claims for clinical accuracy and medical necessity, develop evidence-based appeal strategies, and draft payer-ready appeal documentation.

Key Responsibilities

• Review medical records and payer denial rationale to determine appeal opportunities
• Draft clear, concise, and evidence-based appeal letters for multiple levels of appeal
• Collaborate with coding, CDI, denial recovery, and operations teams to strengthen appeal strategy

Required Qualifications

• Active Registered Nurse (RN) license in the United States
• Minimum 3-5 years of clinical nursing experience
• Strong understanding of medical necessity criteria and payer review processes
• Experience reviewing medical records and clinical documentation
• Excellent written communication skills for translating clinical information into persuasive appeal narratives