Integrated Care Manager/Registered Nurse (RN) for Inpatient and Outpatient Clinical Appeals- Remote in Virginia

City/State

Work Shift

• Manage inpatient and outpatient provider appeals across all payer types, including government and commercial insurance
• Review clinical denials (non-billing related), identify root causes, and perform post-claim analysis to support appeal submissions

• N-3YR - RN-Diploma (Non-degree) REQUIRED; Bachelors Degree in Nursing preferred

• Registered Nurse (RN) License (Compact or Virginia) preferred

• 3 years experience in Nursing REQUIRED
• Experience/knowledge in Rev Cycle, Utilization Review (UR) and Case Management preferred
• Provider appeals experience is a plus
• Strong proficiency in Excel

Talroo – Nursing

Managed Care, MCO, Health Plan, Healthcare, Health Insurance, Nursing, RN, Registered Nurse, Appeals, Inpatient, Outpatient, Denial, Provider, Case management, clinical, Utilization Review, Claims, Revenue Cycle

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.