Use your clinical background to review medical necessity, analyze denied claims, and help recover lost revenue—all from home. This role is built for sharp, detail-oriented RNs who can assess documentation, apply InterQual® criteria, and write strong clinical appeal support.
About Conifer Health Solutions
Conifer Health Solutions provides revenue cycle expertise to hospitals, health systems, and physician groups across more than 135 regions. With over 30 years of experience, the company helps healthcare organizations improve financial outcomes, strengthen clinical operations, and enhance overall patient experience. Conifer is part of the Tenet and Catholic Health Initiatives family.
Schedule
- Fully remote role
- Requires independent clinical review work with minimal supervision
- May travel up to 10% to facilities or company locations
- Involves retrospective review, documentation analysis, and appeal preparation
What You’ll Do
- Conduct post-service medical necessity reviews to determine clinical appeal potential
- Apply InterQual® criteria and additional clinical evidence to support appeal cases
- Prepare concise, evidence-based clinical summaries for disputed/denied claims
- Use electronic tools such as ACE, nThrive, eCARE, InterQual®, VI, and Microsoft Office
- Research medical records, contracts, EOBs, adjustments, and denials
- Identify payor trends, recommend process improvements, and assist leadership as needed
- Support non-clinical staff with clinical guidance
- Assist Legal as capacity allows, including participation in mediation or litigation prep
What You Need
- Current, valid RN license (required)
- Minimum 3 years of recent acute care experience; med-surg or critical care preferred
- At least 2 years of Utilization Review or Case Management experience preferred
- Strong working knowledge of InterQual® criteria
- Understanding of managed care contracts, reimbursement terms, and denial management
- Excellent writing, communication, and clinical reasoning skills
- Ability to work virtually, multitask, and meet productivity and quality goals
- Research skills related to off-label medication use, State/Federal guidelines, and regulatory requirements
Preferred Certifications:
- CCM, CPUR, CPUM, CPHM, or similar
Benefits
- Pay range: $30.85 – $46.28 per hour (based on experience, location, and qualifications)
- Medical, dental, vision, disability, and life insurance
- PTO and sick leave (minimum 12 days per year)
- 10 paid holidays annually
- 401(k) with up to 6% employer match
- FSA, HSA, and dependent care options
- Employee discount programs and Employee Assistance Program
- Optional benefits including pet insurance, legal, accident, critical illness, and long-term care coverage
A strong match for RNs who want to apply their clinical expertise beyond the bedside while helping recover revenue for healthcare partners.
Take the next step toward a flexible, high-impact remote career.
Happy Hunting,
~Two Chicks…