Virginia Licensed Integrated Care Manager RN

Job Summary

Managing inpatient and outpatient provider appeals, the full-time Virginia Licensed Integrated Care Manager RN will review clinical denials, identify root causes, and perform post-claim analysis to support appeal submissions in a remote setting.

Key responsibilities

• Manage appeals for inpatient and outpatient services across various payer types
• Review clinical denials and conduct root cause analysis for appeal submissions
• Perform post-claim analysis to support the appeal process

Required qualifications

• Registered Nurse (RN) License (Compact or Virginia) preferred
• 3 years of nursing experience required
• Experience in Revenue Cycle, Utilization Review, and Case Management preferred
• Provider appeals experience is a plus
• Strong proficiency in Excel