• The Clinical Appeals Nurse is responsible for handling appeals requiring clinical input or interpretation
• Compose clinical appeal letters to send to payers for denial considerations utilizing documentation, contract language, or voice recordings as applicable
• Present a concise medical summary within each appeal based on support from the medical record
• Demonstrate understanding of use of all medical necessity software, including but not limited to InterQual
• Demonstrate the ability to interpret medical payer policy requirements
• Contact appropriate parties (internal and/or external) as needed for additional information to resolve the clinical appeal
• Determine root cause of each denial and apply company specific coding for trending and analysis

Update the patient account record to identify actions taken on the account

• At least 1 year of case management experience required
• Relevant education may substitute experience requirement
• Strong ability to research evidence-based practices and is able to identify trends and process improvements

Currently licensed as a registered nurse (RN) in the state(s) of practice and/or has an active compact license, in accordance with law and regulation

• Parallon offers a total rewards package that supports the health, life, career and retirement of our colleagues
• The available plans and programs include:
• Comprehensive medical coverage that covers many common services at no cost or for a low copay
• Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation

Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more

• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Family support through fertility and family building benefits with Progyny and adoption assistance
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income
• Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location