Registered Nurse Clinical Appeals

Location: Remote

Compensation: Salary

Reviewed: Thu, Apr 16, 2026

This job expires in: 16 days

Job Category: Healthcare

Weekly Hours: Full Time

Employment Status: Permanent

Employer Type: Employer

Career Level: Experienced

Education Level: Bachelors, Masters

Job Summary

A company is looking for a Clinical Denials and Appeals RN.

Key Responsibilities

Conduct pre and post service medical necessity reviews and retrospective medical record reviews
Identify denial root causes, determine appeal viability, and prepare clinical appeals
Collaborate with various teams to resolve denials and track outcomes for process improvement

Required Qualifications

Current unrestricted Registered Nurse license in the state of residence
University degree with 4-6 years of relevant acute care clinical experience
Prior experience in clinical denials, utilization review, case management, or appeals
Bachelor of Science in Nursing or higher preferred
Experience with InterQual and/or Milliman Care Guidelines is advantageous

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