Denials Prevention Specialist, Clinician PRN
Datavant · United States · US
Utilization Review
Remote
physician
Nurse
Demand80
Career growth72
Healthcare fit82
Remote potential75
Salary band
USD 22 – 45
5-year outlook
Stable demand for nurses in utilization review and denials prevention is likely to continue as payers tighten medical necessity reviews. Compensation is typically competitive with clinical nursing, though PRN status may affect benefits and hours; advancement into CDI, utilization management leadership, or revenue cycle can improve earnings.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-03
Intelligence details
Flexible work details
- Side income
- Classified as side-income friendly
- Engagement type
- PRN
- Hours
- Shift-based
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- physician, Nurse
- Rate period
- Hourly
Why this was classified this way
- PRN
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Experienced nurses seeking a flexible, non-clinical PRN role in utilization review and denials prevention should consider this, especially if they have DRG denial or appeal writing experience. New grads or nurses without acute care/UM exposure may find the barrier high.
Who should apply
RNs and LPNs with 3–5 years of acute care experience, ideally in ICU/ER or case management, who are interested in managed care, utilization review, or revenue cycle. Nurses with prior UM/CM/CDI or health plan experience are strongest.
CV angle
Frame acute care experience around medical necessity, DRG downgrade denials, appeal writing, and use of Milliman/Interqual. Highlight any managed care, UM/CM/CDI, CMS/NCQA/URAC, ICD-10/CPT, and payer communication experience. Quantify denial overturn rates, caseloads, or TAT compliance if available.
Skills to highlight
- Utilization Review
- Denials Prevention
- Appeal Writing
- Medical Necessity Criteria (Milliman/Interqual)
- DRG Downgrade Denials
- Managed Care
- ICD-10/CPT
- CMS/NCQA/URAC Compliance
Role summary
A PRN clinician role at Datavant focused on preventing and appealing inpatient denials by applying medical necessity criteria, clinical expertise, and payer guidelines to support utilization review and denial reversals.
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