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Clinical Appeals Rn Jobs (NOW HIRING)

MVP Health Care

Clinical Appeals RN

Schenectady, NY · On-site

About the Opportunity As a Clinical Appeals RN, you play a vital role in ensuring fair, accurate, and timely review of healthcare service and coverage denials. In this position, you will evaluate ...

Mvphealthcare

Clinical Appeals RN

Schenectady, NY · Hybrid

About the Opportunity As a Clinical Appeals RN, you play a vital role in ensuring fair, accurate, and timely review of healthcare service and coverage denials. In this position, you will evaluate ...

Mvphealthcare

Clinical Appeals RN

Rochester, NY · Hybrid

About the Opportunity As a Clinical Appeals RN, you play a vital role in ensuring fair, accurate, and timely review of healthcare service and coverage denials. In this position, you will evaluate ...

Mvphealthcare

Clinical Appeals RN

Tarrytown, NY · Hybrid

About the Opportunity As a Clinical Appeals RN, you play a vital role in ensuring fair, accurate, and timely review of healthcare service and coverage denials. In this position, you will evaluate ...

Colorwave Inc

Appeals RN

Boston, MA · On-site

$75K - $150K/yr

Appeals RN Hospitals on Incredible Health are actively hiring and accepting applications in the ... Clinical pathway, Navigator, or Utilization Review. Shifts available: day shift Job types available ...

Colorwave Inc

Appeals RN

Palmdale, CA · On-site

$76K - $125K/yr

Appeals RN Hospitals on Incredible Health are actively hiring and accepting applications in the ... Clinical Pathway, Navigator, or Utilization Review. Shift(s) available: day shift Job types ...

Ageatia Global Solutions

Clinical Appeals Nurse

Clinical Appeals Specialist The Clinical Appeals Specialist completes research, basic analysis, and ... Licenses/Certifications: * RN - Registered Nurse - State Licensure And/or Compact State Licensure ...

New

WVU Medicine

Clinical Appeals Coordinator

$22.50 - $28/hr

The Clinical Appeals Coordinator is a collaborative member of the Medical Management team. MINIMUM ... EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Current Registered Nurse license issued by the state ...

Peak Health

Clinical Appeals Coordinator

$22.50 - $28/hr

The Clinical Appeals Coordinator is a collaborative member of the Medical Management team. MINIMUM ... EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Current Registered Nurse license issued by the state ...

Guidehouse

Supervisor Clinical Appeals/UM

$77K - $129K/yr

The Clinical Appeals/UM RN Supervisor is responsible for overseeing a team of Registered Nurses conducting clinical denials management, appeal reviews, and payer dispute resolution activities. This ...

Guidehouse

Clinical Denials and Appeals RN

$68K - $113K/yr

Clinical Appeals Nurse Travel Required: None Clearance Required: None What You Will Do: * Conduct ... Current unrestricted Registered Nurse license in the state you reside * Bachelor's degree and 4-6 ...

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Clinical Appeals Rn information

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How much do clinical appeals rn jobs pay per hour?

As of Jul 14, 2026, the average hourly pay for clinical appeals rn in the United States is $38.55, according to ZipRecruiter salary data. Most workers in this role earn between $31.25 and $43.27 per hour, depending on experience, location, and employer.

What is a Clinical Appeals RN job?

A Clinical Appeals RN is a registered nurse who reviews denied medical claims and submits appeals to insurance companies to ensure appropriate reimbursement. They analyze medical records, insurance policies, and clinical guidelines to justify the necessity of treatments or procedures. This role requires strong knowledge of healthcare regulations, excellent critical thinking skills, and experience in case management or utilization review.

What does a typical day look like for a Clinical Appeals RN?

A typical day for a Clinical Appeals RN involves reviewing denied insurance claims, gathering and evaluating clinical documentation, composing argument letters, and communicating with healthcare providers and payers to support appeal cases. You may participate in multidisciplinary meetings to discuss complicated cases and must often manage multiple appeals at different stages of the process. The work is largely independent, though collaboration with physicians, case managers, and insurance representatives is common. Strong organization and time management skills are important to keep up with deadlines and ensure the best possible outcomes for patients.

What are the key skills and qualifications needed to thrive in the Clinical Appeals Rn position, and why are they important?

A Clinical Appeals RN requires current RN licensure, comprehensive clinical knowledge, and experience with utilization review or case management. Familiarity with healthcare claims, appeals processes, and specialized systems such as InterQual or Milliman, as well as strong documentation skills, are often essential. Excellent critical thinking, persuasive writing, and collaboration skills set top candidates apart. These skills ensure accurate, timely, and effective advocacy in the appeals process, leading to favorable outcomes for patients and healthcare organizations.

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What cities are hiring for Clinical Appeals Rn jobs? Cities with the most Clinical Appeals Rn job openings:
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Clinical Appeals Rn jobs near you
Infographic showing various Clinical Appeals Rn job openings in the United States as of July 2026, with employment types broken down into 90% Full Time, 8% Part Time, and 2% Contract. Highlights an 79% Physical, 5% Hybrid, and 16% Remote job distribution, with an average salary of $80,174 per year, or $38.5 per hour.
Clinical Appeals-RN

Clinical Appeals-RN

Healthcare Support Staffing

Syracuse, NY

Other

Medical

Re-posted 6 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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