Virginia Licensed Nurse Case Manager

Job Summary

Managing inpatient and outpatient provider appeals, the full-time Virginia Licensed Nurse Case Manager will review clinical denials, identify root causes, and perform post-claim analysis while working remotely in Virginia.

Key responsibilities

• Manage provider appeals across various payer types, including government and commercial insurance
• Review clinical denials and conduct post-claim analysis to support appeal submissions
• Collaborate with healthcare teams to ensure compliance and improve appeal processes

Required qualifications

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