Hospital Appeal UR Nurse

Medix; New Jersey; Hybrid; USD 69,000 - 83,000; Full time

Job summary

Medix is seeking an experienced Hospital Appeal UR Nurse in Morristown, NJ to support a hospital-based denials and appeals initiative. The role reviews denied or underpaid claims, evaluates clinical documentation, and develops evidence-based appeals to support reimbursement.

The ideal candidate will have UR/UM, CDI, or clinical auditing experience, with strong written communication. Hybrid schedule: onsite 4 days, 1 day remote, with potential shift to 3 onsite/2 remote; contract to hire; expects

Qualifications

• 3–5+ years of clinical nursing experience in acute care.
• Experience in Case Management, Clinical Documentation Improvement, Denials & Appeals.
• Ability to interpret medical records and billing information.
• Knowledge of CMS, MCG/InterQual criteria.

Responsibilities

• Review denied or underpaid claims and develop evidence-based appeals.
• Perform chart reviews and clinical documentation assessment.
• Track denials and assist in prevention strategies.
• Collaborate with Physician Advisors and PEER-to-peer reviews.

Skills

Utilization Review

Utilization Management

Case Management

Clinical Documentation Improvement

Clinical Auditing

Written Communication

EPIC experience

Education

RN License

Tools

EPIC

Job description

Hospital Appeal UR Nurse (258724) Morris, New Jersey

Salary: USD50 - USD60 per hour

Hospital Appeal UR Nurse

Location: Morristown, NJ
Schedule: Monday–Friday | 7:00 AM–3:00 PM or 8:00 AM–4:00 PM
Work Arrangement: Hybrid — 4 days onsite / 1 day remote; Potential future schedule of3 days onsite / 2 days remotefollowing conversion
Pay Rate: $50–$60/hour
Employment Type: Contract to hire
No equipment is provided; candidates should be prepared to work within the organization's onsite technology environment.

About the Role

We are seeking an experiencedHospital Appeal UR Nurseto support a hospital-based denials and appeals initiative. This role will review denied or underpaid claims, evaluate clinical documentation, and develop evidence-based appeals to support appropriate reimbursement.

The ideal candidate will have a strong background inUtilization Review, Utilization Management, Case Management, Clinical Documentation Improvement, or clinical auditing, along with excellent clinical judgment and written communication skills.

This position will also support anAI-driven denials and appeals initiative, including chart review, documentation validation, clinical criteria assessment, and appeal letter review.

Key Responsibilities

• Denial Review & Clinical Analysis
• Documentation & Audit Review
• Denial Tracking & Prevention

Qualifications

• 3–5+ years of clinical nursing experience, preferably in an acute-care/hospital setting.

Experience in one or more of the following:

• Case Management
• Clinical Documentation Improvement
• Clinical Auditing
• Denials & Appeals
• Revenue Cycle
• Strong clinical assessment and critical-thinking skills.
• Excellent written communication and documentation skills.
• Ability to interpret complex medical records and billing information.
• Knowledge ofMCG and/or InterQual medical necessity criteria.
• Understanding ofDRG/APR-DRG reimbursement.
• Familiarity with payer policies and multi-level appeal processes.li>
• Knowledge of CMS regulations and commercial payer requirements.

Preferred Qualifications

• Hospital or acute-care nursing experience.
• Clinical auditing/review experience.
• EPIC experience strongly preferred.
• Experience working with Physician Advisors and Peer-to-Peer reviews.
• Experience handling medical necessity, level-of-care, authorization, or DRG denial appeals.