Hospital Appeal UR Nurse

Hospital Appeal UR Nurse (258724) Morris, New Jersey

Salary: USD
50 - USD
60 per hour

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 of3 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.

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.

• Denial Review & Clinical Analysis
• Documentation & Audit Review
• Denial Tracking & Prevention

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

Experience in one or more of the following:

• 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 Inter Qual medical necessity criteria
  .
• Understanding of
  DRG/APR-DRG reimbursement
  .
• Familiarity with payer policies and multi-level appeal processes.li>
• Knowledge of CMS regulations and commercial payer requirements.

• Hospital or acute-care nursing 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.