Clinical Appeals Nurse, PRN

🔥 15 hours ago

🇺🇸 United States – Remote

⏱ Part Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Netsmart

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1973

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

Netsmart is a leading provider of comprehensive EHR solutions tailored for a wide range of care settings, especially in behavioral health, addiction treatment, autism, geriatrics, and intellectual and developmental disabilities. The company offers a range of software products that streamline operations, enhance care coordination, and promote value-based care across healthcare communities. In addition to EHRs, Netsmart provides technology solutions for care coordination, telehealth, population health management, and revenue cycle management, aiming to support the delivery of integrated and person-centered care. Their solutions are used in a variety of sectors including human services, post-acute care, and public health, making Netsmart a significant player in the healthcare technology industry.

📋 Description

• Prepare and submit clinical appeals responding to denials from managed care organizations, governmental entities, and Recovery Audit Contractors (RACs) for hospital clients • Review medical records and apply industry guidelines, Medicare policies, and best practice standards to support appeal arguments • Participate in Administrative Law Judge (ALJ) Hearings and present oral arguments supporting reversal of Medicare denials • Analyze denial patterns and contribute insights to reduce future denials • Collaborate with the appeals team and hospital clients on appeal statuses and outcomes • Maintain current knowledge of healthcare regulations, coding guidelines, and payer policies relevant to the appeals process

🎯 Requirements

• Bachelor's of Science in Nursing (BSN) or equivalent degree • Current and unrestricted RN license • At least 5 years of clinical experience in acute care settings • At least 3 years of experience in case management, utilization review, or clinical appeals • Exceptional written and verbal communication skills • Proficiency with MS Office suite, particularly Word and Excel • Strong analytical and problem-solving skills with attention to detail • All applicants must be legally authorized to work in the United States • Netsmart does not provide work visa sponsorship for this position • Successful completion of a pre-employment background check, including a drug screen • Preferred: Experience with payer-side case management or medical director-level review

🏖️ Benefits

• Part-time employment • Remote work arrangements • Virtual collaboration tools • Occasional travel for conferences, client meetings, or in-person hearings • Pre-employment background check and drug screen provided at Netsmart’s sole expense