Utilization Mgmt Nurse (RN)
Remote
USD 40-40 / hour
Utilization Management Appeals Nurse
Remote | $40/hour | Monday-Friday, Business Hours
Our client is seeking a Utilization Management Appeals Nurse to join a dynamic team responsible for developing well-supported, defensible clinical appeals on behalf of provider clients. This role utilizes strong clinical judgment, medical record review expertise, and exceptional writing skills to analyze denial cases and develop evidence-based appeal letters. The Appeals Nurse works collaboratively with physicians, operations, intake teams, leadership, and other stakeholders while maintaining quality, accuracy, and productivity standards in a fast-paced remote environment.
Key Responsibilities:
- Review and analyze patient medical records and denial documentation
- Extract pertinent clinical information and develop strong, defensible appeal letters
- Utilize medical necessity criteria, national guidelines, and supporting clinical literature
- Ensure appeals are well-written, accurate, and completed within established turnaround times
- Use appeal tools, templates, and department-approved processes
- Collaborate with interdisciplinary teams to support successful appeal outcomes
- Adhere to company policies, procedures, scheduling, and productivity expectations
Requirements:
- Active RN license
- 3+ years of bedside nursing experience in Adult ED, Telemetry, ICU, or CCU settings
- Strong clinical assessment and critical thinking skills
- Excellent written communication and documentation abilities
- Proficiency with Microsoft Word and electronic medical records
- Ability to work independently in a fast-paced remote environment
Preferred Qualifications:
- Utilization Management experience
- Appeals and denials management experience
- Familiarity with MCG and InterQual (IQ) guidelines
- Experience reviewing medical necessity determinations
Compensation & Schedule:
- $40.00/hour
- Fully remote
- Monday-Friday
- 8-hour shifts scheduled between 6:00 AM and 6:00 PM EST
If you are an experienced acute care RN with strong clinical documentation and writing skills, this is an excellent opportunity to transition your expertise into a specialized utilization management and appeals role.