Rn Jobs in St Cloud

About The Position

Requirements

• Current RN or LPN license.
• Strong medical knowledge and ability to interpret clinical documentation, diagnostic testing, and physician assessments.
• Excellent written communication skills, including the ability to turn complex medical information into clear, compelling, medically appropriate justifications.
• Strong critical-thinking, analytical, and problem-solving skills.
• Ability to advocate confidently and professionally for patients while maintaining accurate, evidence-based documentation.
• Exceptional attention to detail and organizational skills.
• Ability to manage multiple cases, prioritize deadlines, and follow through on challenging authorization requests.
• Comfort communicating with physicians and other healthcare professionals to obtain additional documentation or clarification.
• Ability to work independently, research unfamiliar medical conditions, and develop appropriate clinical rationale.

Nice To Haves

• Experience with DOL claims, DME authorizations, utilization review, or insurance denials and appeals.
• Experience writing Letters of Medical Necessity, clinical summaries, or medical appeals.
• Familiarity with DME, including mobility equipment, respiratory equipment, hospital beds, lift chairs, and other medically necessary devices.
• Understanding of medical terminology, ICD-10 codes, HCPCS codes, and medical necessity requirements.
• Experience reviewing pulmonary function tests, oxygen studies, mobility assessments, and other objective clinical findings.

Responsibilities

• Review pended and denied DME authorization requests to identify why additional information is required or coverage was denied.
• Analyze medical records, physician office notes, diagnostic testing, and clinical assessments for evidence supporting medical necessity.
• Draft clear, professional, clinically supported Letters of Medical Necessity (LMNs), reconsideration requests, and denial responses for physician review and signature.
• Develop medical justifications explaining how requested DME provides treatment, care, or symptom relief related to DOL-approved medical conditions.
• Research medical literature, clinical guidelines, and DOL policies to strengthen authorization requests.
• Work with physicians, nurses, case managers, and home health agencies to obtain necessary clinical documentation.
• Address DOL concerns regarding medical necessity, comorbid conditions, alternative equipment, and objective supporting evidence.
• Communicate with DOL Medical Benefits Examiners (MBEs) to clarify authorization requirements and resolve outstanding requests.
• Track pending cases, follow up on outstanding documentation, and work toward timely resolutions.
• Identify recurring denial trends and recommend improvements to documentation and authorization processes.