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Rn Clinical Denial Management Jobs (NOW HIRING)

Carle Health

RN -UM/Clinical Denial Mgmt

Champaign, IL · On-site

$35.87 - $58.37/hr

Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional ... Send clinical documentation to insurance companies per their request. Communicate with physicians ...

Carle Health

RN -UM/Clinical Denial Mgmt

Champaign, IL · On-site

$35.87 - $58.37/hr

Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional ... Send clinical documentation to insurance companies per their request. Communicate with physicians ...

Firstsource

Clinical Denials Specialist

Clinical Denial Specialist Schedule: M - F 8 AM - 4:30 PM EST GENERAL SUMMARY: * The goal of the ... Registered Nurse (RN) Certification with experience in care management, utilization review, prior ...

Deaconess

Clinical Denial Analyst (RN)

Evansville, IN · On-site

$28.71 - $40.19/hr

Minimum of two (2) years performing utilization review, charge audit, case management or similar ... Three (3) to five (5) years of clinical experience as a Registered Nurse in an acute care or ...

Healthrise

Clinical Denials Specialist

Farmington Hills, MI · On-site

$17.75 - $23.50/hr

Clinical designated nurse, RN credentials (denials/CDI) * Minimum of 2-3 years of experience in healthcare revenue cycle management, medical billing, claims processing, or denial management. Physical ...

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How much do rn clinical denial management jobs pay per year?

As of Aug 31, 2026, the average yearly pay for rn clinical denial management in the United States is $89,949.00, according to ZipRecruiter salary data. Most workers in this role earn between $71,000.00 and $104,500.00 per year, depending on experience, location, and employer.

What is an RN Clinical Denial Management?

An RN Clinical Denial Management job involves reviewing denied insurance claims, analyzing medical records, and appealing denials to ensure appropriate reimbursement for healthcare services. These nurses collaborate with physicians, coders, and insurance companies to identify trends in denials and develop strategies to improve claims approval rates. They also ensure that documentation supports medical necessity and compliance with payer guidelines. This role requires strong clinical judgment, knowledge of insurance policies, and expertise in reimbursement processes to prevent revenue loss for healthcare organizations.

What are the typical daily responsibilities of an RN Clinical Denial Management?

An RN Clinical Denial Management specialist spends much of their day reviewing denied insurance claims, analyzing medical documentation, and preparing appeal letters with supporting clinical evidence. They often collaborate closely with physicians, case managers, and coding staff to clarify documentation and support appeals. Regular tasks include submitting and tracking appeals, staying updated on payer policies, and communicating outcomes to internal teams. This role is fast-paced and detail-oriented, requiring the specialist to balance multiple cases while ensuring accuracy and compliance throughout the claims management process.

What are the key skills and qualifications needed to thrive in RN Clinical Denial Management?

To excel as an RN Clinical Denial Management professional, you need a current RN license, in-depth knowledge of clinical care guidelines, and expertise in medical record review. Familiarity with electronic health records (EHR), insurance portals, coding systems like ICD-10, and reimbursement processes is highly valuable, as are certifications such as CCM or related case management credentials. Exceptional analytical skills, attention to detail, strong written communication, and the ability to collaborate with providers and payers set outstanding candidates apart. These skills are crucial for successfully overturning denied claims, ensuring appropriate reimbursement, and maintaining compliance with regulatory and payer requirements.

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Rn Clinical Denial Management jobs near you
Infographic showing various Rn Clinical Denial Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $89,949 per year, or $43.2 per hour.

RN Clinical Reimbursement Specialist

INTEGRIS Health

Oklahoma City, OK • On-site

Full-time

Medical, PTO

Posted 11 days ago

Integris Health rating

6.6

Company rating: 6.6 out of 10

Based on 180 frontline employees who took The Breakroom Quiz

573rd of 895 rated healthcare providers

Job description

Join our team as a RN Clinical Reimbursement Specialist at INTEGRIS Health in Oklahoma City, OK.

Get to Know Your Team

  • INTEGRIS Health, Oklahoma's largest not-for-profit health system, is seeking a dedicated caregiver to join us in our mission to partner with people to live healthier lives.

  • Benefits of being an INTEGRIS Health caregiver include front-loaded PTO, medical benefits through the extensive INTEGRIS Health network, financial assistance for continued education, 24/7 mental health support and more.

  • Take your first step toward growing your career by joining us.

INTEGRIS Health mission: Partnering with people to live healthier lives.

To our patients, that means we will partner to provide unprecedented access to quality and compassionate health care. To you, it means some of the state's best career and development opportunities. With INTEGRIS Health, you will have a genuine chance to make a difference in your life and your career.

INTEGRIS Health is the state's largest Oklahoma-owned health system with hospitals, rehabilitation centers, physician clinics, mental health facilities and home health agencies throughout much of the state.

* Current licensure as a Licensed Practical Nurse (LPN) or Registered Nurse (RN) in the State of Oklahoma or current multistate license from a Nurse Licensure Compact (eNLC) member state and 8 years' experience working with healthcare facilities, health insurance or managed care companies, and 10 years demonstrated experience working with healthcare facilities, health insurance or managed care companies 

* 6 years of direct managed care or case management experience 

* Knowledge and proficiencies with government rules and regulations, managed care contracts, provider relations, pre-certification, reimbursement, financial analysis, and patient accounting 

* Knowledge of legal documents, collection agency procedures, and contract documents 

* Must be able to communicate effectively in English (Verbal/Written)

INTEGRIS Health is an Equal Opportunity Employer. All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status.

The RN Clinical Reimbursement Specialist is responsible for identifying and preparing clinical appeals for government, managed care organizations, and various other payors. Provides assistance and guidance in the maintenance of the charge description master for the INTEGRIS Health system.

The RN Clinical Reimbursement Specialist responsibilities include, but are not limited to, the following:

  • Assists the Director of Revenue Recovery in the training and development of all INTEGRIS recovery staff related to clinical and non-clinical payment issues
  • Oversees and manages the INTEGRIS System clinical denial management process
  • Identifies inaccurate and/or problematic denial and payment trends and assists with the development of a plan to insure facilities receive maximum reimbursement
  • Participates in Utilization Management Committee for all INTEGRIS facilities to report denial issues and develop preventive strategies in collaboration with the physicians
  • Analyzes, prepares and distributes monthly denial reports to Vice Presidents, Directors and Managers of specified hospital departments
  • Responds to utilization management clinical denials issued by government contracted vendors for the Medicare and Medicaid programs
  • Supports Case Management and other hospital departments with clinical expertise in regards to both payor and patient clinical denial inquiries
  • Assists the Chargemaster Consultant in the development, implementation, maintenance and audit functions related to the chargemaster description master.
  • Analyzes denial trends for documentation or charging issue opportunities and facilitates cross-departmental collaboration to improve processes and develop best practices.
  • Identifies charging, coding or clinical documentation issues and works with ancillary departments to resolve issues and notify appropriate leadership.
  • Educates and maintains effective and practical knowledge of government and managed care payer rules, regulations and requirements.
  •  

Reports to assigned Corporate Manager. This position may have additional or varied physical demand and/or respiratory fit test requirements. Please consult the Physical Demands Project SharePoint site or contact Risk Management/Employee Health for additional information. Minimal. 

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