122 appeals nurse jobs at 83 companies in United States
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Appeals Nurse Consultant
Ohio or Mississippi or Texas or North Carolina or Alabama or Florida or South Carolina or Pennsylvania or New Jersey
$61k-$130k/yr RemoteFull Time
3+ YOEActive unrestricted RN license, willingness to obtain a compact RN license within 3 months, 3+ years of Medicare/Medicaid appeals experience, and an associate degree or nursing diploma.
Microsoft Teams, Microsoft Outlook, Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Google Workspace, VPN, EHR
1mo
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Denials Management Appeals Nurse (Anesthesia)
United States or Tampa
$81k-$121k/yr RemoteFull Time
5+ YOECurrent RN license in state of employment, 5+ years clinical hospital experience with 3 years anesthesia experience, experience in third-party payor appeals/revenue cycle and utilization review; familiarity with medical necessity criteria and claims appeals.
Epic, Craneware, Waystar, InterQual
6d
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Appeals Registered Nurse
Madison or Colorado or Florida or Georgia or Illinois or Indiana or Iowa or Michigan or Minnesota or Missouri or Nebraska or New Jersey or North Carolina or Ohio or South Carolina or Texas or Virginia or Wisconsin
$66k-$68k/yr RemoteFull Time
1+ YOERequires ASN or BSN, active RN license, 1+ year clinical experience, medical review knowledge, strong communication and organizational skills, and proficiency with Microsoft Office systems.
Microsoft Outlook, Microsoft Teams, Microsoft OneNote, Microsoft Word, Microsoft Excel, Centers for Medicare & Medicaid Services (CMS)
1mo
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Clinical Appeals Nurse (Remote | Must have California LVN / RN License)
United States or California
$78k-$117k/yr RemoteFull Time
2+ YOEActive California LVN or RN license, minimum 2 years clinical nursing experience, 1 year utilization management/appeals experience preferred, knowledge of clinical criteria and coding (ICD-10, CPT), proficiency with Milliman/InterQual/Apollo, EMR, Word, Excel, and Outlook.
Milliman, InterQual, Apollo, ICD-10, CPT, Word, Microsoft Excel, Microsoft Outlook, Access Express, N-coder, EHR
2d
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Appeals RN - Care Management Per Diem - REMOTE
Torrance, California, United States
$57-$89/hr RemotePart Time
4+ YOEAssociate's degree in nursing, California RN license, four years of acute hospital patient care and case management experience; case management certification and appeals experience preferred.
1mo
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MARKET APPEALS SPECIALIST- CENTRAL APPEALS OFFICE
Chicago or King of Prussia
RemoteFull Time
3+ YOEBachelor's degree required (Master's preferred). RN license or master's-level clinician required. 3+ years related experience. Knowledge of utilization management, appeals, payer engagement, and medical necessity. Proficient in Microsoft Excel, Teams, and Word.
Cerner, Microsoft Excel, Microsoft Teams, Microsoft Word
1mo
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Appeals Coordinator
Philadelphia, Pennsylvania, United States
OnsiteFull Time
Graduate of accredited nursing school; active PA and multi-state compact RN license required; knowledge of InterQual, Milliman, ICD-10-CM; APC coding preferred.
InterQual, Milliman, ICD-10-CM, APC coding
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Clinical Appeals Coord
Philadelphia, Pennsylvania, United States
RemoteFull Time
5+ YOEActive unrestricted RN license, 5+ years clinical healthcare experience, experience with utilization management/appeals, strong written communication, audit readiness, and proficiency with Microsoft Office and clinical systems.
InterQual, MCG, Microsoft Office, Microsoft Authenticator
1mo
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Clinical Appeals Coordinator
Monongalia County, West Virginia, United States
RemoteFull Time
3+ YOECurrent RN or LPN license (or multi-state via eNLC), 3+ years clinical claims and appeals experience, 2 years customer service, proficiency with InterQual and/or Milliman Care Guidelines and Microsoft Office.
InterQual, Milliman Care Guidelines, Microsoft Office
1mo
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Clinical Appeals Coordinator
Monongalia County or United States
RemoteFull Time
3+ YOECurrent RN or LPN licensure (or multi-state compact), 3+ years clinical claims and appeals experience, 2+ years customer service, proficiency with InterQual/Milliman Care Guidelines and Microsoft Office, strong communication and problem-solving.
InterQual, Milliman Care Guidelines, Microsoft Office
1w
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Clinical Appeals Coord in Work From Home
Philadelphia, Pennsylvania, United States
RemoteFull Time
5+ YOEActive unrestricted RN license, 5+ years clinical nursing experience, experience with utilization management/appeals, knowledge of NCQA/state/federal appeal requirements, strong communication and analytical skills.
Microsoft Office, Microsoft Authenticator, InterQual, MCG, CMS
1mo
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Appeals & Grievances Nurse
Sacramento, California, United States
$95k-$115k/yr HybridFull Time
3+ YOEBSN and active CA RN license, 3+ years utilization/case management or appeals & grievances experience in managed care, certification in utilization management or case management preferred, intermediate Microsoft Excel/Word, strong clinical assessment and communication skills.
Microsoft Excel, Microsoft Word
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IBR Clinical Appeals Analyst - Remote
United States
$35-$63/hr RemoteFull Time
2+ YOEActive RN with undergraduate nursing degree, 2+ years appeals/coding or auditing experience, CPT-4/NCCI/ICD-10 knowledge, strong writing and critical thinking, Microsoft Excel proficiency.
Microsoft Excel, Word, Adobe
1mo
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Clinical Appeals Nurse - Full Time Remote - Jefferson Health
Philadelphia, Pennsylvania, United States
RemoteFull Time
10+ YOEActive PA RN license, bachelor’s in nursing or specialized diploma, 10 years clinical or case management/utilization review, knowledge of Interqual/medical policy, coding, and payor rules, Epic and Excel experience, RCE training.
Epic, Microsoft Excel, Microsoft Word
6d
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Senior Grievance & Appeals Specialist, Clinical
New York City, New York, United States
$93k-$117k/yr OnsiteFull Time
3+ YOENew York RN license required; 3 years healthcare experience, including 2 years in grievance and appeals or medical/utilization management. Requires Microsoft Office proficiency; nursing bachelor's or master's degree preferred.
Microsoft Office, Microsoft Word, Microsoft Excel
3d
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Clinical Appeals Coordinator
Oregon or Kansas or Wisconsin or Arizona or South Dakota or North Dakota or Washington or Nevada or Montana or Idaho or New Mexico or Utah or Iowa or Wyoming or Colorado or Missouri or Texas or Minnesota
$34-$61/hr RemoteFull Time
4+ YOERN with 4+ years of clinical nursing or case management experience, or LPN/LVN with 5+ years; applicable state license required. Managed care or utilization review experience preferred.
NCQA
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Appeals Professional III (Monday - Friday)
Austin, Texas, United States
RemoteFull Time
3+ YOEAssociate's degree (or 60+ credits) in healthcare or equivalent experience, 3 years medical appeals/medical review/clinical experience, healthcare professional background (nursing, PT, RT, OT), demonstrated medical necessity decision writing, US residency 3 of last 5 years.
2mo
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Manager, Clinician Appeals (Active RN License REQ'D)
United States or New Jersey
RemoteFull Time
8+ YOE5+ MgmtActive unrestricted RN (or MD/DO) license required, 8+ years clinical experience with 5+ years leadership in appeals/UM/CDI/RCM, mandatory DRG Downgrade experience, QA and team management skills, payer appeals and documentation expertise.
6d
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Clinical Appeals RN - FT - Day - Revenue Integrity & Denials Mgmt Lawrenceville NJ
Lawrenceville, New Jersey, United States
$92k-$121k/yr OnsiteFull Time
3+ YOENJ RN license, BLS, 3 years of clinical nursing experience, and experience in utilization review, case management, clinical appeals, CDI, or denial management. Requires MCG and payer-policy knowledge.
MCG, Microsoft Office, hospital information systems
1mo
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Clinical Denials and Appeals Specialist
United States
RemoteFull Time
5+ YOEActive RN license, 5+ years clinical nursing, 3–5 years denials/appeals experience, strong clinical review and persuasive writing, knowledge of medical necessity, DRG, ICD-10, CPT/HCPCS, Medicare/Medicaid, and payer policies.
InterQual, MCG, Microsoft Word, Epic
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