DME Authorizations & Denials Nurse Specialist (RN/LPN)

Required Qualifications: Registered Nurse (RN) or Licensed Practical Nurse (LPN)

Position Summary
We are seeking a detail-oriented, motivated nurse with strong clinical knowledge, exceptional writing skills, and a passion for patient advocacy to join our Durable Medical Equipment (DME) Authorization Team.
This position focuses on managing pended and denied DME authorization requests through the U.S. Department of Labor (DOL).
The ideal candidate will have the ability to review complex medical records, identify supporting clinical evidence, and develop persuasive, medically sound written responses to support the approval of medically necessary equipment. This individual must be a strong advocate for patients, capable of communicating effectively with physicians, medical offices, and DOL representatives to help overcome authorization barriers.

Key Responsibilities

• Review pended and denied DME authorization requests to identify the specific reasons additional information is required or coverage was denied.
• Analyze medical records, physician office notes, diagnostic testing, and clinical assessments to identify evidence supporting medical necessity.
• Draft clear, professional, and clinically supported Letters of Medical Necessity (LMNs), reconsideration requests, and denial responses for physician review and signature.
• Develop strong medical justifications explaining how requested DME provides treatment, care, or relief of symptoms related to DOL-approved medical conditions.
• Research relevant medical literature, clinical guidelines, and DOL policies to strengthen authorization requests.
• Work directly 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 supporting objective evidence.
• Communicate professionally and confidently 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.

Required Qualifications

• Current RN or LPN license.
• Strong medical knowledge and ability to interpret clinical documentation, diagnostic testing, and physician assessments.
• Excellent written communication skills, with the ability to turn complex medical information into clear, compelling, and 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.
• Comfortable 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.

Preferred Qualifications

• 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.

Ideal Candidate
We are looking for someone who does more than simply process authorization requests. The right candidate will take ownership of difficult cases, investigate denial reasons, recognize gaps in medical documentation, and actively work toward solutions.
This individual must be a strong medical writer and dedicated patient advocate who understands how to connect a patient's documented medical conditions and functional limitations to the need for specific medical equipment.
Success in this role requires persistence, resourcefulness, sound clinical judgment, and the ability to build well-supported medical arguments without overstating or misrepresenting the clinical evidence.
Our goal is to ensure that every medically appropriate DME request receives a thorough, accurate, and well-supported review, giving our patients the strongest possible opportunity for approval.

At Unifi Healthcare, we are reimagining what healthcare can be—accessible, compassionate, and truly patient-centered. Our mission is to deliver a seamless, personalized experience that empowers individuals and supports them through their healthcare journey, helping people live longer, safer lives in the comfort of their own homes. Through our growing network of services and partners, we are building a model that reduces complexity, supports caregivers, and reimagines how at home healthcare is delivered across the U.S.

Unifi Healthcare manages this search directly. We're not working with outside recruiting agencies on this role, and we won't accept unsolicited candidate submissions or resumes from third parties.