Clinical Appeals Nurse (PRN)

NetSmart Technologies; United States; Remote; USD 60,000 - 80,000; Part time

Job summary

A healthcare consulting firm is seeking a detail-oriented PRN nurse for clinical writing and advocacy. This remote position allows for flexible scheduling and involves preparing clinical appeals for managed care denials. Ideal candidates will have a BSN, RN license, and significant clinical experience in acute care settings. Strong communication and analytical skills are essential.

Qualifications

• At least 5 years of clinical experience in acute care settings.
• Current and unrestricted RN license.
• At least 3 years of experience in case management or clinical appeals.

Responsibilities

• Prepare and submit clinical appeals in response to denials from managed care organizations.
• Participate in ALJ Hearings, presenting oral arguments to support Medicare denials.
• Analyze denial patterns to help reduce future denials.

Skills

Exceptional written and verbal communication skills

Strong analytical and problem-solving skills

Proficiency with MS Office suite

Education

Bachelor's of Science in Nursing (BSN)

Job description

Are you a registered nurse with a passion for clinical writing and advocacy? Join our Clinical Appeals team as a PRN nurse and help us overturn denied claims through evidence-based appeal writing. This part-time, remote position is ideal for experienced nurses who are detail-oriented, self-motivated, and passionate about using their clinical knowledge to make a difference behind the scenes. As a PRN team member, you'll have the flexibility to set your own schedule while meeting a minimum weekly commitment.

Responsibilities

• Prepare and submit clinical appeals in response to denials from managed care organizations, governmental entities, and Recovery Audit Contractors (RACs) for hospital clients
• Review medical records and utilize industry guidelines, Medicare policies, and best practice standards to support appeal arguments
• Participate in Administrative Law Judge (ALJ) Hearings, presenting oral arguments to support the reversal of Medicare denials
• Analyze denial patterns and contribute insights to help reduce future denials
• Collaborate with the appeals team and hospital clients to provide updates on appeal statuses and outcomes
• Maintain current knowledge of healthcare regulations, coding guidelines, and payer policies relevant to the appeals process

Qualifications

Required

• Bachelor's of Science in Nursing (BSN) or equivalent degree
• Current and unrestricted RN license
• At least 5 years of clinical experience in acute care settings
• At least 3 years of experience in case management, utilization review, or clinical appeals
• Exceptional written and verbal communication skills
• Proficiency with MS Office suite, particularly Word and Excel
• Strong analytical and problem-solving skills with attention to detail

Preferred

• Experience with payer-side case management or medical director-level review

Expectations

• Comfortable with remote work arrangements and virtual collaboration tools
• May require occasional travel for conferences, client meetings, or in-person hearings
• Physical demands include extended periods of sitting, computer use, and telephone communication

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.