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Clinical Appeal Review Rn Coder Jobs (NOW HIRING)

NTT DATA Services

BPO Clinical Review Specialist

FL · On-site

$76K/yr

Clinical Reviewer Specialist (RN) Position Summary The Clinical Reviewer Specialist is responsible ... appeal resolution. Education & Licensure * Active Registered Nurse (RN) license required. (Not ...

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · On-site

Where applicable, the Auditor will support appeal and fraud investigation activities. This position ... Working knowledge of medical terminology and claim coding with familiarity of CPT-4, HCPCs and ICD ...

Independence Blue Cross

Clinical Appeals Coord

$22.50 - $28/hr

Position Summary The Clinical Appeals Coordinator, RN is responsible for supporting the end-to-end ... The role supports case development, documentation review, matched-specialty coordination, member ...

Actalent

Clinical Review Clinician - Appeals

$30 - $40/hr

RN Clinical Review Nurse (Utilization Review Nurse) The Clinical Review Clinician for Appeals is responsible for performing clinical reviews to resolve and process appeals by examining medical ...

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How much do clinical appeal review rn coder jobs pay per year?

As of Sep 10, 2026, the average yearly pay for clinical appeal review rn coder in the United States is $94,545.00, according to ZipRecruiter salary data. Most workers in this role earn between $71,000.00 and $101,500.00 per year, depending on experience, location, and employer.

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Infographic showing various Clinical Appeal Review Rn Coder job openings in the United States as of September 2026, with employment types broken down into 89% Full Time, and 11% Contract. Highlights an 94% In-person, and 6% Remote job distribution, with an average salary of $94,545 per year, or $45.5 per hour.

Clinical Appeals-RN

Syracuse, NY • On-site

Healthcare Support Staffing
Recruiting and Staffing Services • 201 - 500 employees
Learn more about Healthcare Support Staffingexternal

Full-time

Medical

Re-posted 4 days ago

Job description

Company Description

DESCRIPTION: 

                                        Universal American is a Fortune 500 company with offices throughout the United States. The company offers health insurance, and also deals in Medicare managed care plans, and Medicare prescription drug benefits.

Universal American has been on the cutting edge of healthcare for over 2 decades, pioneering innovative collaborations between patients/doctors to produce healthy outcomes. Universal built their business model around the concept that PCP's are the in the best position to drive significant improvements in cost and quality of healthcare. As a company, Universal enables them by providing a structure that offers appropriate incentives for such improvements and actionable information that helps them achieve goals. This concept underlies their long term success in serving the needs of people with Medicare and/or Medicaid. 

Job Description

Day to Day Responsibilities:

The Clinical Appeals RN performs the clinical appeals in accordance with internal policy and procedures, as well as regulations and timeframes set forth by the New York State Medicaid Contract.

The Clinical Appeals RN is responsible for timely assembly of the materials used for decision making from the Plan's prior payment or service denial, and the thorough evaluation of those records and any new appeal information or documentation that was submitted with the appeal according to Medicaid coverage guidelines and other acceptable medical criterion.

 Additionally, the Clinical Appeals RN is responsible for preparing clinical information and other supportive coverage guidelines to present to the Medical Director or external Physician Reviewer for their reconsideration (appeal) determination.

Exhibits a thorough understanding of Medicaid Contract and Managed Care Legislation in regard to appeals processing guidelines.

Thoroughly reviews all supporting information and requests additional information and/or medical records as required. 

Applies contract language, benefits and covered services in researching and deciding the outcome of appeals. 

Analyzes cases and identifies those which require escalating or expedited review, and adheres to associated timeframes for timely completion of the appeal review process. 

Evaluates the necessity, appropriateness of medical services and procedures requested; then forwards all appeal cases with supportive criteria, guidelines, and protocols to an internal or external Physician Reviewer in the appropriate specialty for final determination. 

IF IS JOB OPPORTUNITY IS FOR YOU, GIVE ME A CALL AT 321-574-6926 ASAP! 


Qualifications

Active RN license in NY

Familiar with Medicaid contract and Managed Care Legislation in regard to appeals processing guidelines

2+ years as a Clinical Appeals RN


Additional Information

Please reach out to me at 321-574-6538 


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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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