Clinical Appeals Nurse

3 weeks ago


Boise, Idaho, United States R1 RCM Full time

R1 RCM is seeking a highly skilled Clinical Appeals Nurse to join our team. As a Clinical Appeals Nurse, you will play a critical role in ensuring that our hospital clients receive fair and timely reimbursement for their services.

Key Responsibilities:

  • Conduct thorough reviews of patient medical records and payer denial information to assess the entire hospital stay and clinical course of the patient.
  • Identify risk factors, comorbidities, and adverse events to determine if payer denial was justified for that hospital stay or service using evidence-based guidelines.
  • Review governmental regulations, payer protocols, and/or medical policy to recommend appropriate actions.
  • Apply clinical judgment to support medical necessity appeals reviewing against appropriate coverage guidelines.
  • Leverage proficient writing skills to prepare written appeals and represent clients at telephonic hearings if needed.

Requirements:

  • Active Registered Nurse license
  • Experience in a clinical inpatient environment working with a wide range of patient populations
  • Ability to use sound judgment in reviewing clinical documentation supporting patient care
  • Proficiency in basic computer skills

About R1 RCM:

R1 RCM is a leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are dedicated to providing a workplace free from harassment and equal employment opportunities for all.



  • Boise, Idaho, United States R1 RCM Full time

    Clinical Appeals and Denials ManagerR1 RCM is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are seeking a Clinical Appeals and Denials Manager to join our team.Key Responsibilities:Serve as a leader and mentor to Clinical Appeals...


  • Boise, Idaho, United States R1 RCM Full time

    R1 RCM is a leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups.We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing...


  • Boise, Idaho, United States Wellspring Nurse Source Full time

    Travel ICU Nurse Job OpportunityWellspring Nurse Source is seeking a dedicated and skilled travel ICU nurse to join their team in Boise, Idaho.Job RequirementsSpecialty: ICU - Intensive Care UnitDiscipline: RNShift: 12 hours, nightsEmployment Type: TravelAs a travel ICU nurse with Wellspring Nurse Source, you will have the opportunity to work with a...


  • Boise, Idaho, United States Wellspring Nurse Source Full time

    Wellspring Nurse Source is a nurse-owned and operated company that is committed to helping you find your best job at the best rate. We are 100% dedicated to supporting our clinicians on every step of their travel adventure, assisting with everything from onboarding and payroll to on-the-job clinical support with a dedicated Clinician Success Team. **Job...


  • Boise, Idaho, United States Wellspring Nurse Source Full time

    Wellspring Nurse Source is seeking a travel nurse for a Pediatric Intensive Care position. The job requires a RN with experience in PICU and a strong commitment to patient care.Job DetailsSpecialty: Pediatric Intensive CareDiscipline: RNEmployment Type: TravelShift: 12 hours, nightsHours per week: 36The ideal candidate will have excellent communication...


  • Boise, Idaho, United States St. Luke's Health System Full time

    Job SummaryWe are seeking a skilled Registered Nurse to join our team as a Float Oncology Nurse. This is a full-time position that will support the Medical Oncology Clinic and the Radiation Oncology Clinic.As a Float Oncology Nurse, you will provide patient education, care coordination, and assess and manage immunotherapy/radiation therapy patients. You will...


  • Boise, Idaho, United States Wellspring Nurse Source Full time

    Pediatric Intensive Care RN Travel Nursing OpportunityWellspring Nurse Source is seeking a dedicated and compassionate Registered Nurse (RN) to join our team in a Pediatric Intensive Care (PICU) travel nursing position in Boise, Idaho.Job Requirements:Specialty: Pediatric Intensive CareDiscipline: Registered Nurse (RN)Duration: 13 weeksShift: 12 hours,...


  • Boise, Idaho, United States Aureus Group Full time

    Aureus Medical Group is seeking a Clinical Oncology RN for a travel assignment in Boise, ID. This top-rated facility offers a unique opportunity to enhance your clinical skills, perfect your resume, and build your dream career. As a Clinical Oncology RN, you will be responsible for providing high-quality patient care in a fast-paced oncology setting. Our...


  • Boise, Idaho, United States Wellspring Nurse Source Full time

    Wellspring Nurse Source is a nurse-owned and operated company that is dedicated to helping travel nurses find their best job at the best rate. We are 100% committed to supporting our clinicians on every step of their travel adventure, assisting with everything from onboarding and payroll to on-the-job clinical support with a dedicated Clinician Success Team....


  • Boise, Idaho, United States Wellspring Nurse Source Full time

    Wellspring Nurse Source is seeking a travel nurse RN for a Pediatric Intensive Care position in Idaho.Job DetailsSpecialty: PICU - Pediatric Intensive CareDiscipline: RNDuration: 13 weeks36 hours per weekShift: 12 hours, nightsEmployment Type: TravelWellspring Nurse Source offers a competitive pay package based on 12 hour shifts and 36.0 hours per week, with...


  • Boise, Idaho, United States Wellspring Nurse Source Full time

    Wellspring Nurse Source is seeking a skilled travel nurse for a medical surgical position in a dynamic healthcare setting.Job DetailsSpecialty: Medical SurgicalDiscipline: Registered NurseDuration: 13 weeks36 hours per weekShift: 12 hours, daysEmployment Type: TravelWellspring Nurse Source offers a competitive pay package based on 12 hour shifts and 36.0...


  • Boise, Idaho, United States Wellspring Nurse Source Full time

    Wellspring Nurse Source is seeking a travel nurse for a ICU - Intensive Care Unit position in Idaho.Job DetailsSpecialty: ICU - Intensive Care UnitDiscipline: RNDuration: 26 weeksShift: 12 hours, nightsEmployment Type: TravelThe pay package is based on 12 hour shifts and 36.0 hours per week with a tax-free stipend amount to be determined.About Wellspring...


  • Boise, Idaho, United States St. Luke's Health System Full time

    Job Title: Clinical Nurse SpecialistWe are seeking a highly skilled Clinical Nurse Specialist to join our Patient Blood Management (PBM) program at St. Luke's Health System.About the Role:This is a full-time, exempt position that requires a strong clinical background and a passion for quality improvement. The successful candidate will work closely with our...

  • Travel Nurse RN

    4 weeks ago


    Boise, Idaho, United States Wellspring Nurse Source Full time

    Travel Med Surg Nursing Job OpportunityWellspring Nurse Source is seeking a travel nurse RN Med Surg for a travel nursing job in Boise, Idaho.Job Details: Specialty: Med Surg Discipline: RN Start Date: Not specified Duration: 13 weeks Hours per week: 40 Shift: 10 hours, daysAbout the Job:This travel Med Surg nursing job in Boise, Idaho offers a great...


  • Boise, Idaho, United States Jackson Nurse Professionals Full time

    Job Title: Critical Care Travel NurseJackson Nurse Professionals is seeking a travel nurse to fill a critical care position in a reputable area hospital.Job Requirements:Current state license in good standing with State License Board.12 months MICU experience in an acute care setting within the last 3 years.At minimum, current BLS required (certifications...

  • Nurse Practitioner

    3 weeks ago


    Boise, Idaho, United States St. Luke's Health System Full time

    Job Summary:We are seeking a skilled Registered Nurse to join our Urology Clinic team at St. Luke's Health System. As a Registered Nurse in this role, you will be responsible for providing exceptional patient care and working closely with our medical team to deliver high-quality services.Key Responsibilities:Provide direct patient care, including...


  • Boise, Idaho, United States Wellspring Nurse Source Full time

    Job Title: Travel Nurse RN PACU - Post Anesthesia CareJob Description:We are seeking a skilled Travel Nurse RN to join our team in Boise, Idaho. As a Post Anesthesia Care Unit (PACU) nurse, you will be responsible for providing high-quality patient care in a fast-paced environment.Key Responsibilities:Provide individualized patient care to patients...

  • Travel Nurse ICU RN

    1 month ago


    Boise, Idaho, United States Jackson Nurse Professionals Full time

    Travel ICU Registered Nurse Job OpportunityJackson Nurse Professionals is seeking a highly skilled Travel ICU Registered Nurse to join our team for a 13-week contract at a reputable area hospital.Job Requirements:Current state license in good standing with State License Board.12 months MICU experience in an acute care setting within the last 3 years.At...

  • Clinical Review Nurse

    4 weeks ago


    Boise, Idaho, United States St. Luke's Health System Full time

    At St. Luke's Health System, we're committed to delivering exceptional patient experiences. As a Clinical Review Nurse, you'll play a critical role in evaluating medical necessity for patient hospitalization and acting as an internal resource for patient care.Key Responsibilities:Evaluate medical necessity for patient hospitalizationAct as an internal...

  • Nurse Manager

    3 weeks ago


    Boise, Idaho, United States St. Luke's Health System Full time

    Job Summary:St. Luke's Health System is seeking a skilled Registered Nurse to fill a leadership role in our Clinic. As a Nurse Manager, you will be responsible for evaluating medical necessity for patient hospitalization and acting as an internal resource for patient care. This is a challenging and rewarding opportunity to make a difference in the lives of...