Contractor Contract Clinical Appeals RN
Sutherland is hiring a remote Contractor Contract Clinical Appeals RN. The career level for this job opening is Experienced and is accepting Houston, TX based applicants remotely. Read complete job description before applying.
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Sutherland
Job Title
Contract Clinical Appeals RN
Posted
Career Level
Contractor
Career Level
Experienced
Locations Accepted
Houston, TX
Salary
HOUR $25 - $50
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Job Details
The Appeals Nurse will review medical records to construct compelling clinical appeals in order to overturn managed care denials based upon clinical nursing judgment and the medical necessity of services delivered.
Duties and Responsibilities:
- Review of medical records to evaluate the validity of 3rd party denials.
- Assess strength of completed appeal to predict favorable outcomes.
- Ability to detect issues resulting in denials and constructively report on issue to assist in resolution.
- Construct 1st and 2nd level appeals by applying clinical rationale.
- Manage assigned workload of accounts so appeals are submitted timely in accordance with payer timeframes.
Requirements:
- Licensed RN.
- 5 years experience working in acute hospital setting.
- Knowledge of managed care and utilization review process.
- Knowledge of Interqual criteria and/or Milliman Guidelines.
- Knowledge of DRGs.
- Excellent written skills.
- Proficient computer skills including Microsoft Office, with access to high-speed internet.
- Experience as a Case Manager or UR nurse who has written appeals is required.
Compensation:
- Payment is a 1099 paid bi-weekly upon Reviews.
- We will pay $50 per Appeal, and $25 per Review if cannot be appealed.
- You will also be paid $25/hour for any IT/ Compliance trainings that require completion of your time.
Skills
FAQs
What is the last date for applying to the job?
The deadline to apply for Contractor Contract Clinical Appeals RN at Sutherland is
29th of November 2025
. We consider jobs older than one month to have expired.
Which countries are accepted for this remote job?
This job accepts [
Houston, TX
] applicants. .
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