Remote Medicare Appeals RN – Fast-Paced, Impactful Review

Medasource; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

Medasource is seeking an experienced Clinical Appeals Registered Nurse (RN) to support the Medicare appeals team for a leading healthcare insurance client. This fully remote opportunity focuses on reviewing clinical appeals, evaluating medical necessity, and ensuring timely determinations per Medicare guidelines.

The ideal candidate has direct Medicare clinical appeals experience, strong utilization review knowledge, and can work independently in a fast-paced environment.

Qualifications

• Active RN license required.
• Direct Medicare clinical appeals experience required.
• Associate degree in Nursing or equivalent.
• Experience with medical necessity reviews and appeal determinations.
• Inpatient/outpatient appeals experience preferred.
• Payer-side Medicare/Medicaid/commercial experience preferred.

Responsibilities

• Review Medicare clinical appeals submitted by members and providers within required timeframes.
• Evaluate denied claims and medical necessity criteria to support accurate determinations.
• Handle inpatient and outpatient appeals, including expedited requests, radiology, and DME denials.
• Apply Medicare regulations, medical policies, and clinical review guidelines to ensure compliance.
• Prepare appeal determinations, notification letters, and supporting documentation.
• Collaborate with medical directors and internal teams to maintain accuracy and productivity.

Skills

Active RN license

Direct Medicare appeals experience

Independent work

Education

Associate degree in Nursing

Tools

MCG

InterQual

CMS guidelines

Facets

Job description

Medasource is seeking an experienced Clinical Appeals Registered Nurse (RN) to support the Medicare appeals team for a leading healthcare insurance client. This fully remote opportunity focuses on reviewing clinical appeals, evaluating medical necessity, and ensuring timely determinations per Medicare guidelines.

The ideal candidate has direct Medicare clinical appeals experience, strong utilization review knowledge, and can work independently in a fast-paced environment.