Denial and Appeals Registered Nurse (RN) - Clinical Resource Management

Job overview

The Denial and Appeals Registered Nurse (RN) is an onsite role based in Hartford, CT, supporting the Clinical Resource Management department within the Hartford HealthCare system. Compensation is not specified for this position, which focuses on managing the payer denial and appeals process to ensure regulatory compliance and financial accuracy. This role exists to manage complex cases across HHC system hospitals by appealing inappropriate denials. The RN will collaborate with medical directors and physician advisors to formulate factually sound appeal letters, analyze denial trends, and provide education to stakeholders to mitigate future denials.

What you'll do

• Manage denials and appeals within regulatory timeframes
• collaborate with internal and external stakeholders
• partner with Medical Directors to compose appeal letters
• maintain accurate appeals documentation
• analyze root causes for denials
• provide education on mitigation strategies
• identify denial trends.

What we're looking for

Skills & competencies

full-time

day shift

registered nurse

rn

hartford ct

hartford healthcare

case management

utilization management

appeals

no weekends

no on-call

no degree required

Work arrangement

• Weekend coverage required

Benefits & perks

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

Why this role

Physician-led, clinically integrated network; focus on high-volume complex case management; autonomous role.

About the employer

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