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Supervisor of Appeals and Grievances RN

Los Angeles, CA · On-site

$49.12 - $63.85/hr

The Supervisor of Appeals and Grievances RN oversees the daily clinical operations of the Appeals and Grievances department and provides leadership, guidance, and support to the A&G RN team. This ...

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How much do clinical appeals rn jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for clinical appeals rn in California is $38.04, according to ZipRecruiter salary data. Most workers in this role earn between $30.82 and $42.69 per hour, depending on experience, location, and employer.

What is a Clinical Appeals RN?

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.

How to get into clinical appeals in nursing?

To become a Clinical Appeals RN, gain experience in medical-surgical or case management nursing, develop strong knowledge of insurance policies and medical documentation, and obtain relevant certifications such as Certified Case Manager (CCM) or Nurse Case Manager (CCM). Familiarity with electronic health records and strong communication skills are also important for handling appeals effectively.

What does a Clinical Appeals RN do?

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 as a Clinical Appeals RN?

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.

What are popular job titles related to Clinical Appeals Rn jobs in California? For Clinical Appeals Rn jobs in California, the most frequently searched job titles are:
What job categories do people searching Clinical Appeals Rn jobs in California look for? The top searched job categories for Clinical Appeals Rn jobs in California are:
Clinical Appeals Rn jobs near you
Infographic showing various Clinical Appeals Rn job openings in California as of August 2026, with employment types broken down into 86% Full Time, and 14% Contract. Highlights an 71% In-person, and 29% Remote job distribution, with an average salary of $79,124 per year, or $38 per hour.

Clinical Appeals and Medical Necessity Manager

Montefiore Einstein

Boulevard, CA • On-site

Full-time

Posted 4 days ago

Montefiore Einstein rating

8.4

Company rating: 8.4 out of 10

Based on 75 frontline employees who took The Breakroom Quiz

25th of 887 rated healthcare providers

Job description

City/State:
Yonkers, New York
Grant Funded:
No
Department:
REV - Utilization Management
Work Shift:
Day
Work Days:
MON-FRI
Scheduled Hours:
8:30 AM-5 PM
Scheduled Daily Hours:
7.5 HOURS
Pay Range:
$80,000.00-$100,000.00
Job Summary
This position directly manages the appeals process at the Wakefield Division of Montefiore Medical Center. This RN/PA/FMG/MD/HIM Professional responds to third party clinical denials, interfaces with health plans, works closely with Finance and Contracting regarding utilization management health plan issues, and advises the Director of denial trends. S/he analyzes Wakefield Division denials and acts accordingly to minimize the financial impact of third party payer denials. S/he ensures the Wakefield Division denials and appeals are documented properly in the designated automated tracking application. S/he performs first level review for FFS Medicare elective and emergent hospital admissions. S/he also acts as a resource regarding medical necessity to other associates of the department and to departments that interface with Utilization Management. S/he exhibits expertise in the knowledge of rules, mandates and regulations related to denials and appeals and educates and mentors Case Managers/CTCC's and related staff to ensure compliance with these. S/he will interface with the Case Managers/CTCC's in order to clarify clinical scenarios when medical record documentation is insufficient to do so and the Case Manager/CTCC's was involved with a case on a concurrent basis. CTCC's performing appeals activity report to this associate.
Qualifications:
  • Bachelors degree in health care or related field required - Masters preferred
  • RN/Physician Assistant/Foreign Medical Graduate/HIM Professional preferred
  • Analytical skills required
  • Knowledge of Medical Terminology required
  • Experience in Managed Care/Utilization Management Required
  • Excellent verbal and written communication and interpersonal skills required
  • Excellent organizational skills required

Montefiore Medical Center is an equal employment opportunity employer. Montefiore Medical Center will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.

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