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Denials Management Nurse Jobs (NOW HIRING)

Shriners Children's Hospital

$60 - $80/hr

The Denials Management Analyst is responsible for analyzing denials data, creating payor metrics ... We're always looking for driven, compassionate professionals to join our team as nurses, physical ...

DHR Health

Clerk, Denials Management

Edinburg, TX · On-site

Ability to communicate clearly and concisely with all levels of nursing, administration, and ... with Denials on report discrepancy. • Establishes, maintains and revises record keeping and ...

DHR Health

Clerk, Denials Management

Edinburg, TX · On-site

Ability to communicate clearly and concisely with all levels of nursing, administration, and ... with Denials on report discrepancy. • Establishes, maintains and revises record keeping and ...

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Denials Management Nurse information

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How much do denials management nurse jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for denials management nurse in the United States is $23.50, according to ZipRecruiter salary data. Most workers in this role earn between $17.55 and $25.72 per hour, depending on experience, location, and employer.

What is a denials management nurse?

A Denials Management Nurse is a registered nurse who specializes in analyzing and managing insurance claim denials within healthcare organizations. They review denied claims, determine the reasons for denial, and work to overturn these decisions by providing additional clinical documentation or appealing to insurance companies. Their goal is to ensure that healthcare providers receive appropriate reimbursement for patient care. Denials Management Nurses also identify trends in denials and recommend process improvements to reduce future claim rejections.

How does a denials management nurse typically collaborate with other departments to resolve claim denials?

Denials Management Nurses work closely with billing teams, physicians, and utilization review staff to gather medical documentation and clarify clinical justifications for services rendered. They often act as liaisons, communicating between healthcare providers and insurance companies to appeal denied claims effectively. Regular interdisciplinary meetings and case reviews are common, ensuring that all parties understand the reasons for denials and can contribute to a successful resolution. This collaborative approach helps streamline the appeals process and improves overall reimbursement outcomes.

What are the key skills and qualifications needed to thrive as a denials management nurse, and why are they important?

To thrive as a Denials Management Nurse, you need a solid background in clinical nursing, strong knowledge of medical coding and billing, and often an RN license with experience in utilization review or case management. Familiarity with electronic health records (EHRs), claims management systems, and knowledge of payer policies and denial appeal processes are typically required. Attention to detail, critical thinking, and effective written and verbal communication are crucial soft skills for this role. These competencies help ensure appropriate reimbursement, reduce claim denials, and improve overall financial and patient care outcomes for healthcare organizations.

What is the difference between Denials Management Nurse vs Utilization Review Nurse?

AspectDenials Management NurseUtilization Review Nurse
CertificationsRN license, possibly Certified Denials ManagementRN license, often Certified Utilization Review
Work EnvironmentInsurance companies, hospital billing departmentsHospitals, insurance companies, healthcare facilities
Primary FocusAppealing denied claims, reducing denialsAssessing medical necessity, authorization reviews
Industry UsageCommon in billing and claims managementCommon in case management and care coordination

While both roles involve healthcare and require RN licensure, the Denials Management Nurse primarily focuses on appealing denied claims and reducing denials, whereas the Utilization Review Nurse concentrates on evaluating medical necessity for approvals. Both roles are vital in healthcare reimbursement but differ in their specific responsibilities and work settings.

What are popular job titles related to Denials Management Nurse jobs?

For Denials Management Nurse jobs, the most frequently searched job titles are:

Denials Management Appeals Nurse (Anesthesia)

Remote

Shriners Children's
Hospitality Services • 10K+ employees
Learn more about Shriners Children'sexternal

$80K - $121K/yr

Full-time

Re-posted 11 days ago

Shriners Children's rating

8.0

Company rating: 8.0 out of 10

Based on 45 frontline employees who took The Breakroom Quiz

139th of 1,066 rated hospitals

Job description

Company Overview
Shriners Children's is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.
With 20+ hospitals, outpatient clinics, ambulatory care centers and outreach locations across the globe, we provide excellent care to children up to age 18 regardless of their family's ability to pay or insurance status. Please click here to learn more about our locations.
Job Description
The Denials Management Appeals Nurse (Anesthesia) is responsible for managing our medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Denials Management Appeals Nurse (Anesthesia) will utilize their clinical background to address the clinical denials, as well as write sound, compelling factual arguments for appealing denials.
The Denials Management Appeals Nurse (Anesthesia) is also responsible for maintaining a detailed knowledge of Third Party Payors and Governmental Payors clinical/medical necessity criteria, as well as filing compliant appeals in accordance with Third party and governmental contracts
Key Responsibilities:
  • Performs a review of assigned cases comparing the bill to the medical record.
  • Performs a detailed comparison of charges to documentation to ensure services documented have been captured through the charge process
  • Performs a detailed comparison of charges to documentation to ensure services not documented are not charged.
  • Reviews documentation to ensure that services typically performed with specific procedures are being documented so that charge capture may occur
  • Review findings with the hospital representatives and obtains an agreement on the discrepancies.
  • Demonstrates tact and understanding in handling problems, has a good rapport with hospital and corporate staffs.
  • Follows up on appeals in a timely fashion to ensure that cases are completed.
  • Re-checks mathematical computations before finalizing letter and report.
  • Updates status of all cases assigned on minimum weekly basis
  • Informs supervisor of any changes, problems, or concerns that arise at a facility.
  • In the event of a dispute with the requesting party's audit findings, files an appeal with the third party or governmental payor
  • Analyzes and interprets all medical necessity/clinical denials from third party payors or governmental payors.
  • Files appeals based on medical documentation and interpretation of medical necessity guidelines or InterQual criteria.

Required Qualifications:
  • 5 years of clinical healthcare/hospital experience
  • 3 years of related Anesthesia experience
  • Third Party Payor Appeals/Revenue Cycle experience
  • Current RN license in State of employment
  • Working experience with Utilization Review activities and general knowledge of TJC, PRO, and other regulatory bodies.
  • High School Diploma/GED

Preferred Qualifications:
  • Bachelor's degree - BSN highly desired
  • Case Management certification
  • Experience reviewing hospital and professional claims, denials and EOB's, appealing claims and working on claims in an audit
  • Experience with Epic, Craneware, Waystar, software and applications

The pay range for this position is $80,912.00 - $121,388.80. Compensation is determined based on years of relevant experience and departmental equity.

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