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Clinical Appeals Rn Jobs in Washington (NOW HIRING)

HHA Home Care LLC

Clinical Nurse (RN)

Rockville, MD · On-site

$80K - $90K/yr

On-Site Clinical Nurse (RN) - Home Care Position Summary The Clinical Nurse Manager (RN) is a salaried leadership role responsible for overseeing clinical quality, caregiver supervision, and client ...

SmithLife Homecare

Clinical Nurse (RN)

Rockville, MD · On-site

On-Site Clinical Nurse (RN) - Home Care Position Summary The Clinical Nurse Manager (RN) is a salaried leadership role responsible for overseeing clinical quality, caregiver supervision, and client ...

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Clinical Appeals Rn information

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$25

$43

$65

How much do clinical appeals rn jobs pay per hour?

As of Jul 29, 2026, the average hourly pay for clinical appeals rn in Washington is $43.66, according to ZipRecruiter salary data. Most workers in this role earn between $35.38 and $48.99 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.

What are popular job titles related to Clinical Appeals Rn jobs in Washington? For Clinical Appeals Rn jobs in Washington, the most frequently searched job titles are:
What job categories do people searching Clinical Appeals Rn jobs in Washington look for? The top searched job categories for Clinical Appeals Rn jobs in Washington are:
Clinical Appeals Rn jobs near you
Infographic showing various Clinical Appeals Rn job openings in Washington as of July 2026, with employment types broken down into 49% Full Time, 38% Part Time, and 13% Contract. Highlights an 100% In-person job distribution, with an average salary of $90,804 per year, or $43.7 per hour.

RN Manager Grievances & Appeals

MedStar Health

Columbia, MD • On-site

$102K - $196K/yr

Full-time

Posted 12 days ago

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 238 frontline employees who took The Breakroom Quiz

131st of 890 rated healthcare providers

Job description

About the Job
General Summary of Position
Responsible for day to day oversight and management of Intake Clinical Appeals Claims Appeals Complaints Grievances and Intake functions. The Manager of Appeals Complaints and Grievances will be dedicated to delivering service and operational excellence through a focus on continuous improvement in the areas of contribution competencies and performance of the Intake Appeals Complaints and Grievances team. This role will be tasked with overseeing intake the development and operational execution of all appeals (clinical and non-clinical) complaints and grievance processes in line with regulatory standards while enhancing quality and effectiveness. Additionally the role will need to utilize advanced technical knowledge to resolve complex issues. This involves setting objectives creating policies and procedures determining approaches allocating resources and managing inventory.
Primary Duties and Responsibilities
  • Oversees and provides direction for Intake Appeals (Clinical and Claims) Retrospective Review Emergency Room Review and Customer Service/Complaints/Grievances for all lines of business.
  • Oversees and analyzes critical data and reporting as required by MedStar Family Choice for areas of responsibility. Ensures appropriate data collection and timely submission.
  • Develops and contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Ensures compliance with hospital/facility policies and procedures and governmental/accreditation regulations.
  • Actively participates with annual strategic planning objectives for MedStar Family Choice. Initiates innovative ideas and programs to improve quality while maintaining or reducing medical expense.
  • Provides oversight to ensure that retrospective events appeals and complaints/grievances timeframes are in compliance with NCQA EQRO State of Maryland District of Columbia Federal and any other applicable standards.
  • Maintains working knowledge of MFC authorization rules for MD and DC and facilitates appropriate training to ensure that MFC associates practitioners facilities and vendors are aware of authorization rules.
  • Acts as the clinical liaison with IT and subject matter expert for Appeals Grievances and Customer Service with respect to the clinical software system. Maintains close affiliation with the support service team to ensure the system operations meet departmental functions troubleshoots issuers coordinates testing for system upgrades and coordinates appropriate training for associates. Acts as a resource to staff using the software.
  • Oversees the selection orientation training program and assignment of new and current associates. Maintains up to date training manuals for assigned departments.
  • Develops standards of performance evaluates performance and conducts performance management planning. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with subordinates to review programs provide feedback discuss new developments and exchanges information.
  • Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.
  • Performs other duties as assigned.
    • Minimal Qualifications
    Education
    • Bachelor's degree in Nursing required
    Experience
    • 3-4 years Utilization management experience required and
    • 5-7 years Diverse clinical experience in a hospital or medical setting required and
    • 1-2 years 2 years supervisory experience required
    • Additional experience with appeals and grievances preferred
    Licenses and Certifications
    • RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the State of Maryland upon hire and valid RN licensure in the District of Columbia (DC) prior to start date in position. Upon Hire required and
    • CCM - Certified Case Manager Active Certified Case Manager (CCM) or CCM certification within 1 Year required
    Knowledge Skills and Abilities
    • Excellent verbal and written communication skills.
    • Proficient in Microsoft Word Excel and PowerPoint.

    This position has a hiring range of
    USD $102,606.00 - USD $196,996.00 /Yr.

    What Medstar Health employees say

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    Hours and flexibility

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    Get the full story on Breakroom

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    About Medstar Health

    Sourced by ZipRecruiter

    MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

    Industry

    Health care and social assistance

    Company size

    10,000+ Employees

    Headquarters location

    Columbia, MD, US

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