Hybrid UR Nurse - Denials & Appeals Specialist

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

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