Join Our Team as a Clinical Appeals RN!

We are seeking a Clinical Appeals Nurse to manage and communicate denials and appeals from third-party payers and government entities. You will serve as the primary liaison for clinical denial inquiries, reviewing cases based on MCG, InterQual, and other relevant guidelines. Responsibilities include drafting professional appeal letters based on medical necessity, researching CMS policies, and collaborating with leadership to implement performance improvement initiatives that mitigate revenue loss.

• Associate’s Degree in Nursing (ADN) required.


• Valid RN License (Texas or Compact).


• Proficiency with MCG (Milliman Care Guidelines) or InterQual preferred.


• Strong clinical analytical skills and ability to draft formal medical necessity appeals.