Remote Clinical Review Nurse

Job Summary

To support healthcare revenue solutions, the full-time Remote Clinical Review Nurse will analyze denied insurance claims, draft persuasive appeal letters, and collaborate with legal teams to optimize patient care revenue without direct patient interaction.

Key Responsibilities

• Analyze denied insurance claims and complete medical records
• Draft persuasive, medically sound appeal letters to support treatment or service needs
• Collaborate with the legal team to ensure appeals are compelling and complete

Required Qualifications

• RN License (required)
• 5+ years of acute hospital experience (required)
• Knowledge of national clinical criteria such as InterQual and Milliman standards
• Experience in medical record chart review and appealing managed care denials (preferred)
• Certification in Case Management, Legal Nurse Consulting, or Coding is a plus