Florida Licensed Clinical Nurse Specialist

Job Summary

To support revenue recovery efforts, the full-time Florida Licensed Clinical Nurse Specialist will resolve complex clinical denials by analyzing medical records and developing evidence-based appeal arguments while working remotely from Delray Beach, FL.

Key responsibilities

• Review and analyze medical records and denial rationale to develop clinically supported appeal arguments
• Identify denial trends and escalate insights to support prevention strategies and process improvement
• Serve as a clinical subject matter expert, providing training and support to clinical staff and cross-functional partners

Required qualifications

• Active LPN or RN license in Florida
• 1+ year experience in utilization review, case management, or clinical denials
• Knowledge of utilization management and medical necessity criteria (e.g., InterQual, Milliman)
• Strong written communication skills for persuasive clinical appeals
• Proficiency with EMRs and healthcare systems