Virginia Licensed Nurse Case Manager

Job Summary

A company is looking for an Integrated Nurse Case Manager/Registered Nurse (RN) for Inpatient and Outpatient Clinical Appeals.

Key Responsibilities

• Manage inpatient and outpatient provider appeals across all payer types
• Review clinical denials, identify root causes, and perform post-claim analysis
• Support appeal submissions based on clinical review findings

Required Qualifications, Training, and Education

• RN-Diploma (Non-degree) required; Bachelor's Degree in Nursing preferred
• Registered Nurse (RN) License (Compact or Virginia) preferred
• 3 years of experience in Nursing required
• Experience/knowledge in Revenue Cycle, Utilization Review, and Case Management preferred
• Proficiency in Excel is essential