Remote Registered Nurse - Denial/Appeals @ Actalent

Job DescriptionThe Denial and Appeals Management Nurse works remotely Monday through Friday, generally from 7:00 a.m. to 3:30 p.m., with some flexibility as long as an 8-hour shift starts before 9:00 a.m. This role supports the clinical claims denial and appeals process for both inpatient and outpatient services, using clinical expertise, managed care experience, and strong documentation skills to recover appropriate reimbursement. The position is initially a 60-day project with the potential for extension and offers an opportunity to work at the intersection of acute care nursing, managed care, and denials/appeals in a fully remote environment.

Responsibilities

• Review clinical claim denials for inpatient and outpatient services to determine the validity of the denial and identify appeal opportunities.
• Pull and review relevant clinical information from the medical record to support appeals, ensuring completeness and accuracy.
• Draft clear, persuasive appeal letters using Epic-generated documentation and other supporting records.
• Submit completed appeals through payer portals or via fax, following payer-specific processes and requirements.
• Evaluate medical and clinical information to determine the appropriate documentation needed to support medical necessity and other appeal arguments.
• Collaborate closely with the denial and appeals team to manage appeal activity within required timelines and filing deadlines.
• Monitor and prioritize appeal queues to prevent appeals from aging out or missing timely filing limits.
• Apply knowledge of managed care, utilization management, and prior authorization processes to strengthen appeal strategies.
• Use Microsoft Office and Epic to organize information, track work, and document appeal outcomes in a clear and professional manner.
• Communicate effectively with internal stakeholders to clarify clinical details and ensure alignment on appeal strategies.
• Maintain strict confidentiality and adhere to HIPAA and organizational policies when handling protected health information.
• Meet productivity and quality expectations for appeal volume, timeliness, and accuracy with minimal onboarding time.

Essential Skills

• Active Registered Nurse (RN) with graduation from an accredited school of nursing.
• Bachelors degree in Nursing.
• At least 3 years of clinical experience in an acute care setting.
• At least 3 years of managed care experience.
• Demonstrated experience in denials and appeals, utilization management, or prior authorization.
• Proficiency with Microsoft Office applications for documentation, tracking, and communication.
• Ability to work effectively within Epic or similar electronic health record systems to pull clinical documentation and generate appeal packets.
• Ability to maintain a HIPAA-compliant workspace and handle confidential information appropriately.

Additional Skills & Qualifications

• Experience in Utilization Management, including medical necessity reviews and level-of-care determinations.
• Experience in Prior Authorization processes within managed care or health system environments.
• Experience with clinical claims denials and appeals, including understanding payer guidelines and medical necessity criteria.
• Experience in Care Management or Clinical Documentation Improvement (CDI), supporting strong documentation and justification skills.
• Experience working with commercial insurers and understanding of payer utilization review and audit practices.
• Familiarity with Epic electronic health record systems and using Epic to generate appeal documentation.
• Ability to become productive quickly with minimal onboarding, particularly in short-term project environments.
• Comfort working in a high-volume, time-sensitive appeals environment with defined project timelines.

Recruiter: Eisen Hardy - '[email protected]'

Job Type & LocationThis is a Contract position based out of Shaker Heights, OH.

Pay and BenefitsThe pay range for this position is $40.00 - $40.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

Medical, dental & vision

Critical Illness, Accident, and Hospital

401(k) Retirement Plan Pre-tax and Roth post-tax contributions available

Life Insurance (Voluntary Life & AD&D for the employee and dependents)

Short and long-term disability

Health Spending Account (HSA)

Transportation benefits

Employee Assistance Program

Time Off/Leave (PTO, Vacation or Sick Leave)

Application DeadlineThis position is anticipated to close on Nov 24, 2026.

Workplace TypeThis is a fully remote position. About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email [email protected] for other accommodation options.

San Francisco Fair Chance Ordinance

Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI)

We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.