Handle all Iowa Medicaid appeals except behavioral health Requirements: * Education: Associates degree required * Licensure: LPN required * Minimum 2 years of nursing experience * Utilization ...
Handle all Iowa Medicaid appeals except behavioral health Requirements: * Education: Associates degree required * Licensure: LPN required * Minimum 2 years of nursing experience * Utilization ...
Denial and Appeals RN / Clinical Resource Management
Rocky Hill, CT · On-site
$21 - $26/hr
Denial And Appeals Rn / Clinical Resource Management Work where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: pride in what ...
New
Denial and Appeals RN / Clinical Resource Management
Rocky Hill, CT · On-site
$21 - $26/hr
Denial And Appeals Rn / Clinical Resource Management Work where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: pride in what ...
New
Clinical Appeals Nurse We are seeking an experienced Clinical Appeals Nurse to support the appeal and grievance processes by analyzing and responding to adverse coverage decisions. This role involves ...
Clinical Appeals Nurse We are seeking an experienced Clinical Appeals Nurse to support the appeal and grievance processes by analyzing and responding to adverse coverage decisions. This role involves ...
We are currently seeking a highly skilled Clinical Appeals Nurse to play a crucial role in managing medical denials by providing clinical expertise in the appeals process. This position is ideal for ...
We are currently seeking a highly skilled Clinical Appeals Nurse to play a crucial role in managing medical denials by providing clinical expertise in the appeals process. This position is ideal for ...
APPEALS COORDINATOR
Prince Frederick, MD · On-site
$23 - $28.75/hr
The RN Clinical Appeals Nurse will actively manage, maintain and communicate denial/appeal activity to appropriate stakeholders, and report suspected or emerging trends related to payer denials.
APPEALS COORDINATOR
Prince Frederick, MD · On-site
$23 - $28.75/hr
The RN Clinical Appeals Nurse will actively manage, maintain and communicate denial/appeal activity to appropriate stakeholders, and report suspected or emerging trends related to payer denials.
Investigate, interpret, analyze and prioritize appeal requests using nursing expert knowledge and all available clinical information for both medical and behavioral health conditions, as well as ...
Investigate, interpret, analyze and prioritize appeal requests using nursing expert knowledge and all available clinical information for both medical and behavioral health conditions, as well as ...
Clinical Appeals Nurse
Cooper City, FL · On-site
We are currently seeking a highly skilled Clinical Appeals Nurse to play a crucial role in managing medical denials by providing clinical expertise in the appeals process. This position is ideal for ...
Clinical Appeals Nurse
Cooper City, FL · On-site
We are currently seeking a highly skilled Clinical Appeals Nurse to play a crucial role in managing medical denials by providing clinical expertise in the appeals process. This position is ideal for ...
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Clinical Appeals Nurse (Remote)
$67K - $133K/yr
The Clinical Appeals Nurse completes research, basic analysis, and evaluation of members and provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes ...
Clinical Appeals Nurse (Remote)
$67K - $133K/yr
The Clinical Appeals Nurse completes research, basic analysis, and evaluation of members and provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes ...
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Appeals Nurse Consultant
$60K - $129K/yr
Utilization management or appeals experience Education * Associate's Degree in Nursing OR Nursing Diploma (REQUIRED) * Bachelor's Degree (PREFERRED) License * Active and unrestricted Registered Nurse ...
Appeals Nurse Consultant
$60K - $129K/yr
Utilization management or appeals experience Education * Associate's Degree in Nursing OR Nursing Diploma (REQUIRED) * Bachelor's Degree (PREFERRED) License * Active and unrestricted Registered Nurse ...
The Clinical Appeals Nurse completes research, basic analysis, and evaluation of members and provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes ...
The Clinical Appeals Nurse completes research, basic analysis, and evaluation of members and provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes ...
Appeals Nurse Consultant
Homer, AK · Remote
$60K - $129K/yr
Utilization management or appeals experience Education * Associate's Degree in Nursing OR Nursing Diploma (REQUIRED) * Bachelor's Degree (PREFERRED) License * Active and unrestricted Registered Nurse ...
Appeals Nurse Consultant
Homer, AK · Remote
$60K - $129K/yr
Utilization management or appeals experience Education * Associate's Degree in Nursing OR Nursing Diploma (REQUIRED) * Bachelor's Degree (PREFERRED) License * Active and unrestricted Registered Nurse ...
Denials Management Appeals Nurse (Anesthesia)
$80K - $121K/yr
The Denials Management Appeals Nurse (Anesthesia) is responsible for managing our medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is ...
Denials Management Appeals Nurse (Anesthesia)
$80K - $121K/yr
The Denials Management Appeals Nurse (Anesthesia) is responsible for managing our medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is ...
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Clinical Appeals Coordinator
$22.50 - $28/hr
The Appeals Nurse will investigate and process medical necessity requests from both members and providers. The Clinical Appeals Coordinator is a collaborative member of the Medical Management team.
Grievance and Appeals Nurse
Sacramento, CA · On-site
$27.02 - $48.55/hr
Experience with utilization or appeals review preferred. Knowledge of InterQual criteria preferred. License/Certification: Current state's RN, LPN, or LVN license. Must be licensed in California.
Grievance and Appeals Nurse
Sacramento, CA · On-site
$27.02 - $48.55/hr
Experience with utilization or appeals review preferred. Knowledge of InterQual criteria preferred. License/Certification: Current state's RN, LPN, or LVN license. Must be licensed in California.
Appeals Nurse Consultant
$60K - $129K/yr
Utilization management or appeals experience Education * Associate's Degree in Nursing OR Nursing Diploma (REQUIRED) * Bachelor's Degree (PREFERRED) License * Active and unrestricted Registered Nurse ...
Appeals Nurse Consultant
$60K - $129K/yr
Utilization management or appeals experience Education * Associate's Degree in Nursing OR Nursing Diploma (REQUIRED) * Bachelor's Degree (PREFERRED) License * Active and unrestricted Registered Nurse ...
Denials Management Appeals Nurse (Anesthesia)
$80K - $121K/yr
The Denials Management Appeals Nurse (Anesthesia) is responsible for managing our medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is ...
Denials Management Appeals Nurse (Anesthesia)
$80K - $121K/yr
The Denials Management Appeals Nurse (Anesthesia) is responsible for managing our medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is ...
Utilization Review Medical Appeals Nurse - USRN NTT DATA Services is currently seeking a Utilization Review Medical Appeals Nurse - USRN to join our team in Manila, Quezon (PH-QUE), Philippines (PH)
Utilization Review Medical Appeals Nurse - USRN NTT DATA Services is currently seeking a Utilization Review Medical Appeals Nurse - USRN to join our team in Manila, Quezon (PH-QUE), Philippines (PH)
Appeals Nurse information
See salary details
$30.5K - $38.2K
5% of jobs
$38.2K - $46K
5% of jobs
$46K - $53.7K
7% of jobs
$53.7K - $61.4K
4% of jobs
$66.7K is the 25th percentile. Wages below this are outliers.
$61.4K - $69.1K
4% of jobs
$69.1K - $76.9K
2% of jobs
$76.9K - $84.6K
1% of jobs
$84.6K - $92.3K
0% of jobs
The median wage is $94.6K / yr.
$92.3K - $100K
68% of jobs
$100K - $107.8K
0% of jobs
$107.8K - $115.5K
2% of jobs
$30.5K
$86.5K
$115.5K
How much do appeals nurse jobs pay per year?
As of Aug 24, 2026, the average yearly pay for appeals nurse in the United States is $86,480.00, according to ZipRecruiter salary data. Most workers in this role earn between $66,500.00 and $98,500.00 per year, depending on experience, location, and employer.
What is an appeals nurse?
An Appeals Nurse is a registered nurse who reviews medical claims that have been denied by insurance companies to determine if the denial was justified. They analyze medical records, insurance policies, and clinical guidelines to prepare written appeals or recommend approval of coverage. Appeals Nurses act as a liaison between healthcare providers, patients, and insurance companies, ensuring that patients receive appropriate care and coverage according to established standards. Their work helps resolve disputes and ensures that medical decisions are based on accurate clinical information.
What does an appeals nurse do?
As an appeals nurse, your duties involve analyzing the denials of insurance claims or of coverage for medical treatments or procedures at a healthcare facility. In this position, you review medical code data and records to determine whether the denial was warranted or whether to move forward with an appeal. You also weigh other factors such as health care regulations, input from medical staff involved in the patient's diagnosis, and the pre-existing conditions of the patient. Your responsibilities include generating a report that notifies the parties involved of your decisions. You must provide evidence to support your determination.
What are the key skills and qualifications needed to thrive as an appeals nurse, and why are they important?
To thrive as an Appeals Nurse, you need a solid clinical background, active RN licensure, and experience with medical review processes. Familiarity with utilization management systems, insurance guidelines, and electronic health records is typically required, along with certifications like CCM or URAC being advantageous. Exceptional written communication, analytical thinking, and attention to detail are crucial soft skills for effectively reviewing cases and writing persuasive appeals. These skills ensure accurate, evidence-based appeal decisions, optimize patient outcomes, and help healthcare organizations navigate complex insurance regulations.
What are some common challenges appeals nurses face when reviewing denied claims, and how can they effectively address them?
Appeals Nurses often encounter challenges such as incomplete medical documentation, tight deadlines, and complex insurance policies. To effectively address these issues, it's crucial to maintain strong communication with healthcare providers to clarify and obtain missing information, stay organized to manage multiple case files simultaneously, and keep up-to-date with the latest payer guidelines. Collaborating closely with physicians, case managers, and insurance representatives also helps ensure accurate and persuasive appeal letters, increasing the likelihood of overturning denials.
What is the difference between Appeals Nurse vs Case Manager?
| Aspect | Appeals Nurse | Case Manager |
|---|---|---|
| Credentials | RN license, certifications in case management or appeals | RN license, certifications in case management |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Hospitals, insurance companies, community health |
| Employer & Industry | Insurance providers, healthcare organizations | Insurance providers, healthcare organizations |
| Primary Focus | Handling appeals, reviewing denied claims | Coordinating patient care, managing cases |
Appeals Nurses primarily focus on reviewing and contesting denied insurance claims, ensuring patients receive coverage. Case Managers coordinate patient care and manage treatment plans. While both roles require nursing credentials and work within healthcare or insurance settings, Appeals Nurses specialize in appeals processes, whereas Case Managers focus on ongoing patient care management.
How much do appeals nurses make?
Appeals nurses in Texas typically earn between $70,000 and $90,000 annually, depending on experience, certifications, and the healthcare facility. Salaries can vary based on location, workload, and whether the nurse works full-time or part-time, with some positions offering additional benefits or overtime pay.
More about Appeals Nurse jobs
What cities are hiring for Appeals Nurse jobs?
Cities with the most Appeals Nurse job openings:
What are the most commonly searched types of Appeals Nurse jobs?
The most popular types of Appeals Nurse jobs are:
What states have the most Appeals Nurse jobs?
States with the most job openings for Appeals Nurse jobs include:
What job categories do people searching Appeals Nurse jobs look for?
The top searched job categories for Appeals Nurse jobs are:
- Utilization Review Nurse Lvn
- Volunteer Rn Utilization Review Nurse
- Rn Utilization Review Nurse
- Per Diem Optum Utilization Review
- Utilization Management Review Nurse
- Per Diem Chart Review Nurse Practitioner
- Therapy Utilization Review
- International Utilization Review Nurse
- Internship Rn Utilization Review Nurse
- International Utilization Review Rn
Job description
Job Title
Summary:
Work Mode: 100% Remote, possible on-site if hired full-time
Location: Preferred Iowa Candidates
Duration: 10 months, contract to hire possible
Shift: 8 am to 5 pm CST, no overtime
Responsibilities:- Review and process Iowa Medicaid Member Appeals
- Manage the entire appeal process from start to finish
- Conduct outreach to members/providers
- Complete clinical reviews and send cases to specialty review/MD
- Write determination letters and close cases
- Complete standard cases within 30 calendar days
- Acknowledge receipt of cases within 3 business days
- Handle all Iowa Medicaid appeals except behavioral health
- Education: Associates degree required
- Licensure: LPN required
- Minimum 2 years of nursing experience
- Utilization Management (UM) experience helpful
- RN licensure preferred
- Ability to thrive in a fast-paced environment with frequently changing workloads
- Strong prioritization, organization, and adaptability
- Customer service skills
- Time management skills
- Computer skills and ability to learn new systems
About Axelon
Sourced by ZipRecruiter
Axelon is a leading staffing and recruiting firm headquartered in New York, NY, US. Rooted within the staffing solutions industry, it was established with a mission to connect and leverage talent worldwide. Its official website is axelon.com. Axelon provides a range of services from staffing solutions to consulting services. With decades of service delivery experience under their belt, they possess an unrivaled ability to deliver global talent across all industries and professions, including information technology, administrative, engineering, professional, and scientific sectors. Axelon places strong emphasis on collaborative values, tirelessly working to build strong relationships with clients, candidates, employees, and vendors alike.
Industry
Recruiting and staffing services
Company size
501 - 1,000 Employees
Headquarters location
New York, NY, US
Year founded
1977