Utilization Review Nurse Appeal Specialist

Job overview

The Utilization Review Nurse Appeal Specialist role is listed in Pinellas Park, FL, and pays $34–$54 per hour. The specialist works under a Physician Advisor and collaborates with Brundage Group’s Appeal Service Line. The role evaluates payer denials, especially medical-necessity denials, and prepares evidence-based appeals using clinical documentation, payer policies, InterQual or MCG criteria, and CMS guidelines. It helps ensure accurate, well-supported appeals are completed within payer deadlines and contributes to denial trend analysis and process improvement.

What you'll do

• Review medical-necessity denials and records
• author appeal letters
• escalate complex cases to a Physician Advisor
• collaborate on cases requiring physician judgment or peer-to-peer support
• manage review queues and deadlines
• research CMS requirements
• track denial reasons and outcomes
• maintain documentation
• coordinate with case management, utilization management, and clinical documentation staff
• support process and template improvements
• maintain HIPAA compliance.

What we're looking for

Skills & competencies

utilization review nurse appeal specialist

pinellas park fl

brundage medical group

registered nurse

medical necessity appeals

denials management

interqual

mcg criteria

cms guidelines

physician advisor

hipaa

$34–$54/hr

Work arrangement

• Weekend coverage required

Why this role

Requires an RN with at least three years of acute-care hospital experience, three years of utilization review or management experience, and prior medical-necessity appeal-letter writing. CCM, ACM, CHCQM, CMCN, and CMGT-BC credentials are preferred.

About the employer

Brundage Medical Group LLC is hiring for this role. Industry: Offices of Physicians (except Mental Health Specialists). Sector: 62.