Remote Clinical Nurse Specialist: Complex Care & Appeals

Devoted; Northern (KY); Hybrid; USD 90,000 - 114,000; Full time

Benefits offered by this job

Health, dental and vision coverage

Generous paid time off

$100 monthly mobile stipend

Stock options

Bonus eligibility

Parental leave

401K

Job summary

Devoted Health is seeking a Clinical Nurse Specialist to join its remote US team. Under the guidance of the Manager of Clinical Services and Escalations, you will review complex medical records, apply CMS and InterQual criteria, and provide clinical recommendations across UM, appeals, and provider disputes, collaborating with multiple departments.

This full-time CNS role requires 5+ years nursing experience, an unrestricted RN license, and strong analytical and communication skills.

Qualifications

• Minimum of 5 years of clinical nursing experience with complex records.
• 2+ years in utilization management or related managed-care role.
• Experience applying CMS, Medicare Advantage, and medical necessity criteria.

Responsibilities

• Perform complex clinical reviews across pre-service, concurrent, post-service and appeals.
• Review appeals and provider disputes with clear clinical recommendations.
• Interpret InterQual and CMS criteria for clinical decision-making.
• Document determinations with services, codes, care levels and dates.
• Identify system issues and suggest process improvements.

Skills

Clinical nursing experience

Utilization management experience

Analytical & communication skills

Independent worker

Education

Registered Nurse (RN) license

Tools

InterQual criteria

Job description

Devoted Health is seeking a Clinical Nurse Specialist to join its remote US team. Under the guidance of the Manager of Clinical Services and Escalations, you will review complex medical records, apply CMS and InterQual criteria, and provide clinical recommendations across UM, appeals, and provider disputes, collaborating with multiple departments.

This full-time CNS role requires 5+ years nursing experience, an unrestricted RN license, and strong analytical and communication skills.