Denial and Appeals RN / Clinical Resource Management

Job overview

The Denial and Appeals RN / Clinical Resource Management is an onsite, full-time role based in Coventry, CT. Compensation is not specified for this position, which supports the Integrated Care Partners (ICP) network within the Hartford HealthCare Corp. system. This role exists to manage the payer denial and appeals process. The nurse works autonomously to appeal inappropriate denials, partnering with medical directors and physician advisors to compose factually sound appeal letters while ensuring compliance with regulatory and payer timeframes.

What you'll do

• Manage payer denials and appeals.
• Compose factually sound appeal letters.
• Partner with Medical Directors and Physician Advisors.
• Maintain documentation for regulatory compliance.
• Analyze root causes for denials and support performance improvement.

What we're looking for

Skills & competencies

full-time

day shift

coventry ct

registered nurse

denial and appeals

care management

clinical resource management

hartford healthcare

onsite

utilization management

Work arrangement

• Weekend coverage required

Benefits & perks

• Competitive benefits program designed to ensure work/life balance.

Why this role

Physician-led, clinically integrated health care network focused on quality and cost-effective care.

About the employer

Hartford HealthCare Corp. is hiring for this role. Industry: Offices of Physicians (except Mental Health Specialists). Sector: 62.