Registered Nurse – Intake

🚨 Hiring: Registered Nurse – Intake
📍 Location: Remote
💼 Type: Contract
About Smart IT Frame:
At Smart IT Frame, we connect top talent with leading organizations across the USA. With over a decade of staffing excellence, we specialize in IT, healthcare, and professional roles, empowering both clients and candidates to grow together.
Role Summary:
We are looking for a qualified Registered Nurse (RN) – Intake professional to review clinical records, process appeals, and evaluate medical necessity in accordance with healthcare policies and regulatory standards.
🔑 Must-Have Qualifications
Degree from an accredited School of Nursing or a relevant Master’s degree in Behavioral Health / Social Work
2–4 years of related experience
Active RN license or applicable professional license
Clinical Review & Appeals Processing
Medical Necessity Review
Strong Clinical Documentation & Communication Skills
💼 Key Responsibilities
Review medical records and clinical data to evaluate appeals and determine medical necessity.
Prepare case reviews for Medical Directors by analyzing appeal details and applicable clinical criteria.
Ensure timely appeal processing in compliance with State, Federal, and NCQA standards.
Communicate with members, providers, facilities, and internal departments regarding appeals.
Prepare appeal resolution letters, communications, and reports.
Collaborate with leadership and cross-functional teams to improve appeals workflows and clinical processes.
Support quality improvement initiatives and ensure compliance with organizational policies.
⭐ Preferred Skills
Knowledge of NCQA, Medicare, and Medicaid regulations
Utilization Management experience
Clinical Appeals / Medical Necessity Review experience
📋 Accepted Licenses
RN, LCSW, LMHC, LPC, LMFT, or Licensed Psychologist, as applicable to the position.
📩 Interested candidates? Apply today or share profiles at mario.i@smartitframe.com

Work arrangement
Yes