Clinical Appeals Nurse

We are seeking a qualified Clinical Appeals Nurse to join our revenue cycle in a new position within Regions Hospital. The Clinical Appeals Nurse will play a crucial role in ensuring that our patients receive the appropriate level of care by managing and appealing denied insurance claims. The ideal candidate will have a strong background in nursing, a thorough understanding of insurance policies and regulations, and excellent communication skills.

The Clinical Appeals Nurse completes retrospective clinical appeals for full or partially denied claims for managed care, government, non-government, and commercial payors, writing comprehensive factual arguments to present to third party payors, medical review boards, or other responsible parties applying clinical criteria to establish medical necessity. Beyond addressing claims after they are denied, the Clinical Appeals Nurse will also work to prevent denials, utilizing clinical expertise to conduct trainings, provide relevant feedback, and complete root cause analysis for claims denials.

This role is highly visible within the organization, and will forge partnerships within the broader HealthPartners organization, working closely with utilization management, coding, revenue cycle, care management, social work, and other areas within Regions and HealthPartners. The incumbent will have the opportunity to help shape the work and scope of this role, aligning revenue cycle best practices on an enterprise level.

This position is eligible to work remotely following onsite training in Saint Paul, MN, with occasional onsite meetings depending on business needs. Employees must reside in Minnesota, Wisconsin, Iowa, North Dakota, or South Dakota, and have a reliable internet connection and a quiet place to work free from interruptions.

Work Schedule:

• Monday-Friday, 7:00 a.m.-3:30 p.m., hybrid remote.

Required Qualifications:

• Associate degree in nursing from an accredited college or university.
• Current licensure as an RN in the State of Minnesota.
• One year of experience as an RN in a clinical setting performing utilization review, case management or discharge planning, care improvement, and/or quality improvement.
• Strong understanding of insurance policies and regulations.
• Reside in Minnesota, Wisconsin, Iowa, North Dakota, or South Dakota, and have a reliable internet connection and a quiet place to work free from interruptions.

Preferred Qualifications:

• Bachelor's or Master's degree in nursing.
• Three years of experience as an RN in a clinical setting performing utilization review, case management or discharge planning, care improvement, and/or quality improvement.
• Working knowledge of Epic and/or Allscripts software.

Additional Information:

This is a non-union 1.0 FTE (80 hours per pay period) day shift position. The full salary range for this position is $77,542.40-$120,182.40 annually, based on experience and internal equity. This position is exempt under the Fair Labor Standards Act, and eligible for benefits. Our benefits include medical and dental insurance (which begin on day one of employment), 401k with match, disability insurance, tuition reimbursement, educational reimbursement toward continuing education, and we are a qualified non-profit employer under the federal Public Service Loan Forgiveness program. We offer an onsite employee fitness center and an onsite employee clinic to make it more convenient for our staff to get the care they need. We also have a Center for Employee Resilience that provides support and evidence-based practices to bring relief and build resiliency. Regions is also proud to be a Yellow Ribbon Company.

At HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.
We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.
At HealthPartners, everyone is welcome, included and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
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