McBee Associates: Clinical Appeals Nurses – Remote

A Clinical Appeals Nurse combines clinical expertise with the critical work of healthcare revenue recovery, using medical knowledge to determine whether denied claims are supported by the patient’s records and applicable coverage standards. This remote opportunity with McBee Associates offers experienced nurses the chance to move beyond traditional bedside care and apply their clinical judgment, medical record review skills, and writing expertise to complex medical necessity denials and DRG reassignments.

In this role, you’ll review detailed medical records and prepare professional clinical appeals for hospital clients, drawing on Medicare guidelines, national and local coverage determinations, industry standards, and evidence-based clinical judgment. The position also includes participating in Administrative Law Judge hearings and presenting oral arguments, making strong written and verbal communication skills essential to helping clients challenge inappropriate claim denials and recover revenue.

Clinical Appeals Nurses provide support to the Denials Management Practice. The Clinical Appeals Nurse reviews medical records and prepares clinical appeals in response to medical necessity denials and DRG reassignments. Successful requests will result in overturning denied claims and recovering revenue for our clients.

About McBee Associates, Inc.

McBee Associates, Inc. is a recognized leader in delivering financial and management consulting services to the healthcare industry. The firm is one of the nation’s largest independent healthcare consulting practices, developing lasting solutions that ensure the financial success of our clients for over 40 years.

McBee Associates provides solutions to resolve the unique financial and operational needs of hospitals, home health agencies, hospice facilities, and other organizations. The firm’s consulting professionals have extensive experience and in-depth knowledge of current health care regulations and policies. Our approach involves using practical solutions and cutting-edge technologies that fit each client’s culture to achieve a healthy bottom line, the most efficient operations, and the best clinical outcomes.

With a client base of more than 3,800 facilities, McBee Associates has earned the trust of providers large and small, including Fortune 500 companies, for-profit and not-for-profit chains, health systems, and community-based agencies. As a national consulting firm serving clients across the country, McBee Associates has established four office locations at strategic points along the Eastern Seaboard:

• Philadelphia, PA – Corporate Office
• New York, NY
• Baltimore, MD/Washington, DC
• Richmond, VA

For 40 years, McBee Associates has focused exclusively on the financial and management needs of health care organizations across the country. McBee Associates has a proven track record of providing solutions designed to increase profitability, improve operations, and ensure the financial health of their clients.

Clinical Appeals Nurses Responsibilities

• Prepare professional, efficient clinical appeals in response to managed care, governmental, or RAC denials for hospital clients.
• Utilize industry guidelines, Medicare Benefit Policy Manual guidelines, national coverage determinations, local coverage determinations, and best practice standards, as well as a broad knowledge base and sound clinical judgment in reviewing medical records and writing appeals.
• Participate in telephonic Administrative Law Judge Hearings and present oral arguments for reversing Medicare denials.

Qualifications of Clinical Appeals Nurses Job

• Bachelor’s degree in nursing
• Current state licensure
• Experience in writing clinical appeal letters is required
• Experience in case management, concurrent review, and utilization management is strongly desired
• Clinical experience in an acute care setting and proficiency in medical record review
• Payer case management experience is a definite plus
• Superior written communication skills
• Proficiency with MS Word is a must

McBee Associates is proud to offer 100% paid health, dental and vision insurance to all of our full-time employees, as well as a comprehensive benefits package!

Job Title: Clinical Appeals Nurses
Location: Remote – USA
Category: Appeals/Denials Management
Group Registered Nurse

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Overall, the Clinical Appeals Nurse position offers an opportunity for experienced nurses to apply their clinical knowledge in a specialized healthcare consulting environment focused on appeals and denials management. With responsibilities spanning medical record analysis, clinical appeal writing, regulatory guidelines, and administrative hearings, the role provides a distinctive career path for nurses with strong clinical judgment and communication skills who want to make an impact beyond direct patient care.