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Clinical Appeals Rn Jobs in Texas (NOW HIRING)

Integral Care

Registered Nurse - Clinical

Austin, TX · On-site

$39.38 - $52.72/hr

Registered Nurse - Clinical Job Number: 26-11168 Job Summary: The primary purpose of the RN position is to provide general health care, training, and education to clients in a clinical environment.

US Renal Care

Clinical RN

Laredo, TX · On-site

The Clinical RN acts as a patient teacher and advocate, assisting the patient in seeking information, assuring the patient has the opportunity for informed consent for treatment decisions, and ...

Satellite Healthcare

Clinical RN

Laredo, TX · On-site

The Clinical RN acts as a patient teacher and advocate, assisting the patient in seeking information, assuring the patient has the opportunity for informed consent for treatment decisions, and ...

Satellite Healthcare, Inc

Clinical RN

Austin, TX · On-site

WHAT YOU WILL DO The Clinical RN will discover and learn how to function as a SHC coordinator of patient care, collaborating with other care providers and health team members to provide the required ...

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How much do clinical appeals rn jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for clinical appeals rn in Texas is $35.91, according to ZipRecruiter salary data. Most workers in this role earn between $29.13 and $40.29 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 Texas? For Clinical Appeals Rn jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Clinical Appeals Rn jobs in Texas look for? The top searched job categories for Clinical Appeals Rn jobs in Texas are:
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Clinical Appeals Rn jobs near you
Infographic showing various Clinical Appeals Rn job openings in Texas as of August 2026, with employment types broken down into 87% Full Time, and 13% Contract. Highlights an 70% In-person, and 30% Remote job distribution, with an average salary of $74,694 per year, or $35.9 per hour.

Medicare Clinical Appeals Reviewer III

St. George Tanaq Corporation

Austin, TX • On-site

Other

Posted 17 days ago

Job description

Medicare Clinical Appeals Reviewer III

Fully Remote•United States

Job Type

Full-time

Description

Overview

Tanaq Support Services (TSS) delivers professional, scientific, and technical services and information technology (IT) solutions to federal agencies in health, agriculture, technology, and other government services. TSS is a subsidiary of the St. George Tanaq Corporation, an Alaskan Native Corporation (ANC) committed to serving Federal customers while also giving back to the Tanaq native community and shareholders.

About the Role

We are seeking a Medicare Clinical Appeals Reviewer III (Dispute Resolution Reviewer III) to support our federal client. The Medicare Clinical Appeals Reviewer III is a licensed clinician who independently evaluates complex Medicare appeals and dispute cases, reviews clinical documentation, interprets federal regulations, and issues appeal determinations supported by medical evidence and policy.

They will also provide independent second-level determinations and dispute resolutions based on documentation, facts, laws, regulations, and applicable guidelines. This role works under general supervision with moderate latitude for initiative and independent judgment.

This is a remote position. Candidates must be based in the United States and able to work Eastern, Central, or Mountain Time Zone business hours with availability to work on a rotating schedule on weekends and holidays.

Required: Active, unrestricted license in good standing as an RN, PT, RT, OT, or other qualifying licensed healthcare professional. Licenses with restrictions or encumbrances are not eligible.

Responsibilities

  • Review the medical records/case file, write a reconsideration/dispute resolution decision that is clear, concise, and impartial, supports the determination made, and documents the review.

  • Make fair, impartial, and independent decisions based on current medical evidence, statutes, regulations, rulings, policies, and procedures.

  • Respond to and ensure that all appeal/dispute issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.

  • Conduct research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other related resources to make an accurate, well-supported decision.

  • Stay abreast of changes in regulations, medical and healthcare practices, policies, and procedures.

  • Participate in case-specific verbal discussions.

  • Conduct reviews of appeals/disputes involving multiple beneficiaries/services in a single case.

  • Plan responses to statistical analysis challenges with assistance from statisticians.

  • Attend meetings and participate in workgroups at management's direction.

  • Serve as a subject matter expert.

  • Mentors and/or trains staff.

  • Conduct quality reviews and audits, as needed.

  • Participate in special projects and perform other duties as assigned.

Requirements

Required Experience and Skills

  • Must have 2-3 years of experience in medical dispute resolution, Medicare appeals, medical review, clinical review, or a related healthcare setting.

  • Must have Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience. Licensed candidates with closely related clinical or medical experience may be considered.

  • Demonstrated experience writing or making appeal or payment determinations

  • Experience using Microsoft 365, including Excel and Word.

  • Must be able to pass Federal and state criminal background checks, as required by client.

  • Must be able to pass education, certification and license verification, as well as other professional background checks, as required by client.

  • Must be able to pass drug screen, as required by client.

  • Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.

Preferred Qualifications

  • Medicare appeals, medical review, healthcare compliance review, or independent dispute resolution.

  • Experience making determinations on appeals, payments, billing, or dispute resolution.

  • Experience working with or supporting a federal public health agency environment.

  • Patient-Provider Dispute Resolution or Independent Dispute Resolution experience.

  • Coding certification.

Education and Training

  • Must be an actively licensed healthcare professional with Nursing, Physical Therapy, Respiratory Therapy, Occupational Therapy, or closely related clinical experience.

Physical Requirements

  • Prolonged periods of sitting at a desk and working on a computer. May need to lift 25 pounds occasionally.

Who We Are

Tanaq Support Services (TSS) is a public health contractor and certified 8(a) business owned by St. George Tanaq Corporation, an Alaska Native Corporation (ANC). We listen to our stakeholders and leverage our science, technology, communication, and program expertise to develop effective solutions.

Our commitment to non-discrimination

Tanaq Support Services is an Equal Employment Opportunity Employer. All qualified applicants will receive consideration for employment without regard to disability, protected veteran status, or any other status protected by applicable federal, state, or local law. Tanaq complies with the Drug-Free Workplace Act of 1988 and participates in E-Verify.

If you are an individual with a disability and need assistance completing any part of the application process, please email accommodation@tanaq.com to request a reasonable accommodation. This email is for accommodation requests only and cannot be used to inquire about the status of applications.

Notice on candidate AI usage

Tanaq is committed to ensuring a fair and competitive interview process for all candidates based on their experience, skills, and education. To protect the integrity of the interview process, candidates may not use artificial intelligence (AI) tools to generate or assist with responses during phone, in-person, or virtual interviews. Candidates who require a reasonable accommodation that may involve AI must contact us before their interview at accommodation@tanaq.com.

To view this and all our job postings, visit us at:

https://recruiting.paylocity.com/recruiting/jobs/All/a4712c9f-f074-40e8-9a14-bee06660bd81/Tanaq-Support-Services-LLC

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