Medicare Advantage Appeals RN
Clearwater, FL · HybridFull-timeSeen todaySeen in employer's feed today
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At a glance
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Requirements
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Job overview
The Medicare Advantage Appeals RN conducts medical necessity and quality-of-care reviews for clinical appeals, grievances, and claim disputes, aligning decisions with Medicare Managed Care and CMS standards. The role supports timely case handling, quality improvement, regulatory compliance, and audit readiness, and collaborates with physicians, providers, vendors, and internal departments to make accurate, fair determinations while maintaining documentation and data integrity.
Skills & qualifications
Skills
Qualifications
Full job description
Why BayCare?
At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.
Summary:
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Conducts medical necessity and quality-of-care reviews for clinical appeals, grievances, and claim disputes to ensure decisions align with Medicare Managed Care and CMS (Centers for Medicare & Medicaid Services) regulatory standards.
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Ensures that all cases meet required state and federal timeframes, supports departmental quality improvement efforts, and contributes to regulatory compliance and audit readiness.
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Collaborates with physicians, providers, vendors, and internal departments to ensure accurate, fair, and timely determinations while maintaining thorough documentation and data integrity.
Minimum Qualifications:
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2 years of experience with clinical appeals within a health plan, Medicare Advantage experience highly preferred
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Registered Nurse
Facility: BayCare Health System, Admin - Non Hospital Related-BHS
Location: Park Place
Status: Full Time, Exempt: Yes
Shift Hours: 8:00a - 5:00p, Monday - Friday
Weekend Work: Every 5th weekend on call
On Call: Yes - Every 5th weekend
How often will this team member be working remotely? Hybrid - occasional in office meetings and residency
Equal Opportunity Employer Veterans/Disabled
Position Medicare Advantage Appeals RN
Location Clearwater:Park Place | Business and Administrative | Full Time
Req ID 183111
How this job compares
Set against the 28,941 open Nurse jobs on Olive Jobs, counted November 12, 2026.
- Pay
- This postingNot listed
- Florida median$71–110K/yr156 salary ranges
- Florida median$32–52/hr797 hourly ranges
- Openings
- Olive Jobs lists 1,952 open Nurse jobs in Florida and 28,941 across the US. Under 1% of them nationwide are listed as remote or flexible.
- Hiring the most in Florida
- AdventHealth491 open
- HCA Healthcare438 open
- Aveanna Healthcare154 open
- Experience
- This posting asks for at least 2 years of experience; Nurse postings that state a minimum ask for 1 year at the median (12,083 postings).
- Education
- 3,184 of the 28,941 open Nurse jobs (11%) ask for a bachelor's degree or higher.
Pay, requirements and demand for Nurse jobs
Counted across the open, public US postings on Olive Jobs on November 12, 2026. Pay medians are the middle values of the low ends and of the high ends of postings that list both ends of a range in the same cadence (a yearly salary or an hourly rate); a range's midpoint is halfway between its ends. Pay and experience figures resting on fewer than 20 postings are left out.
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