Virginia Licensed Nurse Case Manager

Managing inpatient and outpatient provider appeals, the full-time Virginia Licensed Nurse Case Manager will review clinical denials, identify root causes, and perform post-claim analysis while working remotely in Virginia. Key responsibilities Manage provider appeals across various payer types, including government and commercial insurance Review clinical denials and conduct post-claim analysis to support appeal submissions Collaborate with healthcare teams to ensure compliance and improve appeal processes Required qualifications Registered Nurse (RN) License (Compact or Virginia) preferred 3 years of nursing experience required Experience in Revenue Cycle, Utilization Review (UR), and Case Management preferred Knowledge of provider appeals processes is a plus Strong proficiency in Excel