ZipRecruiter

Log In

1

Clinical Appeal Manager Jobs (NOW HIRING)

Ageatia Global Solutions

Nurse, Clinical Appeals

Evaluate medical and behavioral health appeal requests using clinical expertise * Interpret ... Experience with Medical Review, Utilization Management, or Case Management at a Managed Care ...

Ageatia Global Solutions

Clinical Appeals Nurse

Organizes the appeal case for physician review by compiling clinical, contractual, medical policy ... Preferred Qualifications: * 2 years' experience in Medical Review, Utilization Management or Case ...

Centene

Clinical Appeals Coordinator

OR · On-site +1

$33.71 - $60.67/hr

Responsible for ensuring that all appeal letters generated comply with both State and NCQA ... Managed care or utilization review experience preferred. License/Certification: LPN, LVN, or RN ...

MedReview

Appeals Specialist

Manhattan, NY · Remote

Provide clear, thorough, and accurate appeal responses * Coordinate and communicate with Clinical ... Ability to manage tasks, and prioritize work in an effective way * High attention to detail and ...

CareFirst

Clinical Appeals Nurse (Remote)

Baltimore, MD · Remote

Organizes the appeal case for physician review by compiling clinical, contractual, medical policy ... CCM - Certified Case Manager Upon Hire Preferred. * LNCC - Legal Nurse Consultant Certified Upon ...

MedReview

Appeals Specialist

Manhattan, NY · On-site +1

$50K/yr

Provide clear, thorough, and accurate appeal responses * Coordinate and communicate with Clinical ... Ability to manage tasks, and prioritize work in an effective way * High attention to detail and ...

previous pagenext page

Showing results 21-40

All JobsClinical Appeal JobsClinical Appeal Manager Jobs

Clinical Appeal Manager information

See salary details

$40K

$79.3K

$123K

How much do clinical appeal manager jobs pay per year?

As of Sep 10, 2026, the average yearly pay for clinical appeal manager in the United States is $79,349.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,000.00 and $88,500.00 per year, depending on experience, location, and employer.

What are popular job titles related to Clinical Appeal Manager jobs?

For Clinical Appeal Manager jobs, the most frequently searched job titles are:

Infographic showing various Clinical Appeal Manager job openings in the United States as of August 2026, with employment types broken down into 88% Full Time, 11% Part Time, and 1% Contract. Highlights an 85% Physical, 2% Hybrid, and 13% Remote job distribution, with an average salary of $79,349 per year, or $38.1 per hour.

Clinical Appeals Nurse

Cooper City, FL • On-site

Health Business Solutions LLC
Health Care and Social Assistance • 51 - 200 employees
Learn more about Health Business Solutions LLCexternal

Full-time

Medical, PTO

Re-posted 18 days ago

Job description

Join our dedicated team at HBiz where we strive to provide outstanding care and service excellence. 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 those who excel in analytical thinking and have a strong background in clinical practice and health information management.


**** Salaries from 60,000 to 90,000 PhP per month depending on experience******

Key Responsibilities:

  1. Review and analyze clinical documentation, utilization records, and insurance denial rationales to formulate well-constructed appeal cases.
  2. Engage in the appeals process for denied claims, ensuring that all appeals are submitted in a timely manner according to regulatory and insurer-specific requirements.
  3. Utilize clinical experience and knowledge in accordance with established Milliman or Interqual guidelines to substantiate medical necessity and appropriate level of care.
  4. Collaborate with healthcare providers, case managers, and insurance companies to gather additional information and advocate for proper patient services and reimbursement.
  5. Interpret and apply ICD-10 coding in the review of medical records to support appeal submissions.
  6. Maintain accurate and detailed records of all appeals processes, outcomes, and communications.
  7. Educate clinical staff on best practices, changes in payer requirements, and implications of clinical documentation and coding standards.
  8. Stay abreast of changes in healthcare regulations, payer policies, and clinical criteria guiding medical necessity.

Required Qualifications:

  • Active Registered Nurse (RN) license in the Philippines, US licensed preferred
  • Minimum of two years of bedside clinical experience in a hospital setting.
  • At least one year of experience in clinical appeals or utilization management.
  • Bachelor’s Degree in Nursing (BSN) preferred; minimum of an Associate Degree in Nursing (ADN) required.
  • Proficiency with Milliman or Interqual clinical guidelines.
  • Strong understanding of ICD-10 coding principles.
  • Excellent written communication skills, with the ability to articulate complex clinical information in a clear and professional manner for appeal justifications.
  • Strong organizational skills and the ability to manage multiple cases simultaneously.

Desired Skills:

  • Exceptional critical thinking and problem-solving skills.
  • Demonstrated ability to work independently as well as part of a team.
  • Commitment to ethical medical practices and compliance with all federal and state regulations.

What We Offer:

  • Competitive salary and benefits package including health and paid time off.
  • Opportunities for professional growth and continuing education.
  • Supportive work environment focused on teamwork and positive outcomes.
  • HBiz is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
  • We look forward to considering your application and hopefully welcoming you to our team!