Hospital Appeal UR Nurse

Job Description

Job Description

Hospital Appeal UR Nurse

Location: Morristown, NJ
Schedule: Monday-Friday | 7:00 AM-3:00 PM or 8:00 AM-4:00 PM
Work Arrangement: Hybrid - 4 days onsite / 1 day remote; Potential future schedule of 3 days onsite / 2 days remote following conversion
Pay Rate: $50-$60/hour
Employment Type: Contract to hire
No equipment is provided; candidates should be prepared to work within the organization's onsite technology environment.

About the Role

We are seeking an experienced Hospital Appeal UR Nurse to support a hospital-based denials and appeals initiative. This role will review denied or underpaid claims, evaluate clinical documentation, and develop evidence-based appeals to support appropriate reimbursement.

The ideal candidate will have a strong background in Utilization Review, Utilization Management, Case Management, Clinical Documentation Improvement, or clinical auditing , along with excellent clinical judgment and written communication skills.

This position will also support an AI-driven denials and appeals initiative , including chart review, documentation validation, clinical criteria assessment, and appeal letter review.

Key Responsibilities

• Denial Review & Clinical Analysis
• Appeals Development
• Physician Collaboration
• Documentation & Audit Review
• Denial Tracking & Prevention

Qualifications

• 3-5+ years of clinical nursing experience , preferably in an acute-care/hospital setting.

• Experience in one or more of the following:

• Utilization Review
• Utilization Management
• Case Management
• Clinical Documentation Improvement
• Clinical Auditing
• Denials & Appeals
• Revenue Cycle
• Strong clinical assessment and critical-thinking skills.
• Excellent written communication and documentation skills.
• Ability to interpret complex medical records and billing information.
• Knowledge of MCG and/or InterQual medical necessity criteria .
• Understanding of DRG/APR-DRG reimbursement .
• Familiarity with payer policies and multi-level appeal processes.
• Knowledge of CMS regulations and commercial payer requirements.

Preferred Qualifications

• Hospital or acute-care nursing experience.
• Utilization Review or Utilization Management experience.
• Case Management experience.
• Clinical auditing/review experience.
• EPIC experience strongly preferred.
• Experience working with Physician Advisors and Peer-to-Peer reviews.
• Experience handling medical necessity, level-of-care, authorization, or DRG denial appeals.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

\nCompany Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\n\r\nOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?