Clinical Appeals Review Nurse

Clinical Appeals Review Nurse

Remote | Full-Time | $38-42 per hour

Work Remotely. Grow Professionally. Feel Valued.

For more than 30 years, Managed Resources, Inc. has partnered with healthcare organizations nationwide to improve performance, strengthen revenue cycle operations, support compliance, and help providers focus on delivering quality patient care.

We’re proud of the work we do, but we’re equally proud of the workplace we’ve built.

At Managed Resources, you’ll find the stability and reputation of an established healthcare consulting firm combined with the accessibility, collaboration, and growth opportunities of a smaller organization. Here, your contributions are visible, your ideas are welcomed, and your work makes a meaningful impact.

Compensation

Salary Range: $38 - $42 per hour

Actual compensation will be determined based on factors including experience, qualifications, specialized skills, geographic location, and internal equity considerations.

Quick Facts

• Remote
• Full-Time
• Competitive Compensation
• Phone & Internet Stipend
• Medical, Dental, and Vision Benefits (Full-Time Employees)
• 401(k) Retirement Plan with Company Match
• Paid Time Off, Seven Company Holidays, and Two Floating Holidays (Full-Time Employees)
• Professional Development Opportunities
• Employee Recognition Programs

Why Join Managed Resources?

Your Voice Matters

At Managed Resources, employee feedback isn’t collected and forgotten; it helps drive meaningful change.

Employee feedback has contributed to enhancements in employee recognition programs, professional development opportunities, communication initiatives, employee experience improvements, and technology investments. We believe the people closest to the work often have the best ideas.

Feeling Valued Matters

We believe great work deserves recognition.

Throughout the year, we celebrate employee contributions through appreciation initiatives, recognition programs, milestone celebrations, and professional observances such as Nurses Week and Coding Week. We intentionally create opportunities for employees to feel seen, valued, and appreciated.

A Remote Team That Stays Connected

Remote work shouldn’t mean feeling disconnected.

We foster connection through virtual team events, company celebrations, employee appreciation activities, holiday gatherings, and opportunities for collaboration across teams. Our employees enjoy the flexibility of remote work while remaining part of an engaged and supportive culture.

Opportunities to Learn and Grow

Whether you’re looking to deepen your expertise, expand your skill set, or take the next step in your career, Managed Resources supports continuous learning and professional growth.

Our leaders are accessible, collaborative, and invested in helping employees succeed.

The Best of Both Worlds

As an established organization with more than three decades of success, we offer stability, industry expertise, and long-standing client relationships.

As a smaller organization, employees have the opportunity to build meaningful relationships, gain visibility with leadership, contribute ideas, influence change, and make a measurable impact on the organization.

Your work matters here.

About the Opportunity

Managed Resources is seeking a detail-oriented and experienced Clinical Appeals Review Nurse to join our Clinical Appeals team. In this role, you will review denied medical claims, evaluate clinical documentation, and develop well-supported appeal letters to pursue reconsideration of denied services. Using your clinical expertise, critical thinking, and knowledge of medical necessity criteria, you will help ensure appeals are accurate, thorough, and submitted in a timely manner.

Why This Role Matters

What You’ll Gain

• Flexibility of a remote work environment
• Visibility and access to leadership
• Opportunity to contribute ideas and influence change
• Professional development and career growth opportunities
• Meaningful work supporting healthcare organizations nationwide
• A collaborative culture that values employee success, recognition, and work-life balance

What You’ll Do

• Conduct secondary quality reviews of clinical appeal letters to ensure accuracy, clinical soundness, and compliance with coding, payer, and regulatory requirements prior to submission.
• Review denied claims for potential provider appeals
• Evaluate medical records and supporting clinical documentation.
• Assess medical necessity using established clinical criteria.
• Apply clinical judgment to determine appeal eligibility.
• Develop clear, accurate, and clinically supported appeal letters.
• Reference medical literature, healthcare regulations, and clinical guidelines as appropriate.
• Evaluate diagnoses, treatments, and services against accepted medical standards.
• Assess clinical factors, including severity of illness, treatment frequency, and duration of care.
• Ensure appeals are objective, professional, and evidence-based.
• Submit completed appeal letters for management review and approval.
• Maintain accurate appeal logs and documentation.
• Complete assigned reviews accurately and within established timelines.
• Prepare required payer reports and support appeal follow-up activities

What You’ll Bring

• Registered Nurse (BSN preferred)
• Certification in Case Management, Legal Nurse Consulting, or Coding a plus.
• Five years of acute hospital experience is mandatory.
• Possess knowledge and experience with national clinical criteria applied in case management including InterQual and Milliman standards.
• Working knowledge of billing codes, Revenue Codes, CPT’s, etc. Experience with case management software such as Midas preferred.
• Experience and knowledge of managed care contracts, account receivables and revenue cycle functions.
• Working knowledge of provider billing guidelines, payer reimbursement policies, and related industry-based standards.
• Experience and success in appealing managed care denials and underpayment decisions.
• Ability to examine financial and clinical data trends and provide recommended action steps to resolve.

Benefits & Perks

Full-Time Employees

• Medical, Dental, and Vision Insurance
• Phone and Internet Stipend
• Company-Paid Life Insurance
• 401(k) Retirement Plan with Company Match
• Paid Time Off
• Seven Company-Observed Holidays
• Two Floating Holidays for Personal Observance
• Professional Development Opportunities
• Employee Recognition Programs
• Remote Work Environment

Ready to Join Us?

If you’re looking for a company where your expertise is respected, your contributions are recognized, and your work has a meaningful impact, we’d love to hear from you.

Join a team that combines the stability of an established healthcare consulting organization with the culture, connection, and growth opportunities of a smaller company.

Apply today and build your career with Managed Resources.

Managed Resources, Inc. is an Equal Opportunity Employer and is committed to creating an inclusive workplace where all employees can thrive.