Remote Clinical Financial Case Manager RN

Job Summary

Providing advanced clinical appeal services, the full-time Remote Clinical Financial Case Manager RN will manage complex patient account denials, conduct clinical reviews, and assist in developing denial prevention strategies while supporting the clinical appeals team.

Key responsibilities

• Oversee the review and escalation of complex patient account denials and monitor payer denial trends
• Assist in evaluating workflows for effectiveness and support the adoption of new tools and systems
• Provide actionable quality assurance insights and monitor productivity and performance trends within the clinical appeals team

Required qualifications

• Bachelor's Degree in Nursing (BSN) from an accredited nursing program
• Current, unrestricted Registered Nurse (RN) license in the applicable state of practice
• Minimum of 2 years of experience in claim denial escalation processes
• Minimum of five (5) years of experience in clinical appeals and relevant professional nursing experience
• Demonstrated working knowledge of medical necessity criteria and payer requirements