Experience in health plan operations, Appeals & Grievances, Utilization Management, or Quality
Also asks
Strong clinical judgment and analytical skills
Also asks
Proficiency with EMR systems and medical documentation review
Also asks
Excellent written and verbal communication skills
Preferred
Education
Bachelor’s degree in Nursing (BSN)Preferred Qualifications: Bachelor’s degree in Nursing (BSN)
Also asks
Familiarity with Medicaid and/or CMS guidelinesPreferred Qualifications: Familiarity with Medicaid and/or CMS guidelines
What it pays
Against similar roles
Pays above most Washington staff RN rolesWashington staff RN postings that state pay run $39/hr to $52/hr, the middle half $41/hr to $44/hr, across 71 postings.
Monday–Friday, 8:00 AM – 5:00 PM (4 days onsite, 1 remote with some flexibility)
Pay Rate: $45.00 – $57.00 per hour
Position Overview
The Appeals & Grievances RN is responsible for reviewing denied cases, evaluating medical necessity, and supporting the resolution of member appeals. This role involves clinical analysis, provider communication, and collaboration with internal committees to ensure accurate, timely, and compliant decision-making.
Key Responsibilities
Conduct clinical reviews of denied services to determine medical necessity and eligibility
Analyze medical records and identify gaps in documentation
Contact provider offices to obtain additional clinical information as needed
Present case findings and recommendations to the Appeals & Grievances Committee
Draft clear, compliant resolution letters in accordance with regulatory requirements
Ensure all reviews and documentation meet organizational and compliance standards
Required Qualifications
Active Registered Nurse (RN) license
Experience in health plan operations, Appeals & Grievances, Utilization Management, or Quality
Strong clinical judgment and analytical skills
Proficiency with EMR systems and medical documentation review
Excellent written and verbal communication skills
Preferred Qualifications
Bachelor’s degree in Nursing (BSN)
Familiarity with Medicaid and/or CMS guidelines
Key Competencies
Ability to communicate effectively with both providers and patients/families
Strong attention to detail and organizational skills
Emotional intelligence and professionalism in sensitive situations
Collaborative, solutions-oriented mindset
What This Role Offers
Consistent weekday schedule with no overtime
Hybrid work environment
Supportive and collaborative team culture
Opportunity for long-term placement based on performance
Direct impact on patient care through the appeals process
Neighborhoods+Nurses and young professionals commonly look at Columbia Heights, Petworth, and Fort Totten inside the District, plus Hyattsville just into Maryland, for cheaper rent with Metro access. Arlington’s Crystal City, Pentagon City, and Rosslyn are repeatedly called nice and still workable; Alexandria plus DC’s Glover Park and North Michigan Park come up as other close-in affordable bets. Extra Space’s 2026 roundup puts Brookland as the cheaper residential option, Adams Morgan and Mount Pleasant mixing nightlife and housing, Foggy Bottom near the GW campus, and Logan Circle more polished. Georgetown, Capitol Hill, and Dupont Circle read as premium; Shaw and U Street mix historic row houses with newer development.
Nurses and young professionals commonly look at Columbia Heights, Petworth, and Fort Totten inside the District, plus Hyattsville just into Maryland, for cheaper rent with Metro access. Arlington’s Crystal City, Pentagon City, and Rosslyn are repeatedly called nice and still workable; Alexandria plus DC’s Glover Park and North Michigan Park come up as other close-in affordable bets.
Extra Space’s 2026 roundup puts Brookland as the cheaper residential option, Adams Morgan and Mount Pleasant mixing nightlife and housing, Foggy Bottom near the GW campus, and Logan Circle more polished. Georgetown, Capitol Hill, and Dupont Circle read as premium; Shaw and U Street mix historic row houses with newer development.
Getting around+Arlington is about 5 miles from the core, with 7 a.m. drives of 10-24 minutes; Alexandria runs 12-24 minutes and Silver Spring 14-28 minutes. Metro’s six color-coded lines plus WMATA buses—some running late—let many skip a car; about one in three residents use transit. Farther suburbs such as Ashburn mean 40-55 minute drives, and traffic is routinely called brutal. Living next to a station can erase parking, insurance, and gas costs; Foggy Bottom and Georgetown put campus-area workers in walking or short-ride range of the core.
Arlington is about 5 miles from the core, with 7 a.m. drives of 10-24 minutes; Alexandria runs 12-24 minutes and Silver Spring 14-28 minutes. Metro’s six color-coded lines plus WMATA buses—some running late—let many skip a car; about one in three residents use transit.
Farther suburbs such as Ashburn mean 40-55 minute drives, and traffic is routinely called brutal. Living next to a station can erase parking, insurance, and gas costs; Foggy Bottom and Georgetown put campus-area workers in walking or short-ride range of the core.
Outdoors+Rock Creek Park is the city’s everyday green space, often paired with a Georgetown loop. Kayaking launches from Key Bridge on the Potomac; paddling also happens on the Anacostia, and riverfront promenades fill in after work. The National Mall’s 1,000 acres function as a giant public lawn among the monuments. Spring cherry blossoms around the Tidal Basin and fall color are the two peak outdoor seasons; Metro and bikes make hopping between parks easy.
Rock Creek Park is the city’s everyday green space, often paired with a Georgetown loop. Kayaking launches from Key Bridge on the Potomac; paddling also happens on the Anacostia, and riverfront promenades fill in after work.
The National Mall’s 1,000 acres function as a giant public lawn among the monuments. Spring cherry blossoms around the Tidal Basin and fall color are the two peak outdoor seasons; Metro and bikes make hopping between parks easy.
Washington, DC is a walkable capital where 19 free Smithsonian museums, a six-line Metro, and embassy neighborhoods sit beside housing costs far above the national average. Nurses often pick Foggy Bottom or Georgetown for close-in living near major campuses, or Columbia Heights, Petworth, Brookland, and Arlington’s Crystal City, Pentagon City, and Rosslyn for lower rent and a 10-24 minute hop downtown. Adams Morgan’s 18th Street and U Street bring Ethiopian food, go-go, and late nights; Rock Creek Park and Potomac kayaking from Key Bridge are the daily outdoors. About one in three residents ride transit; driving from Ashburn can take 40-55 minutes in brutal traffic. Crime is well above average but concentrated, and seasons swing from cherry-blossom spring to a colorful fall with harsh stretches between. The payoff is a transplant magnet, healthcare employers such as Kaiser Permanente, and dropping into the Mall or Kennedy Center on a weeknight.
