Remote RN Appeals Nurse - Medical Necessity Expert
Elevance Health
- Remote job
Elevance Health is seeking a Nurse Appeals - Licensed Nurse to work virtually from Indianapolis, IN, conducting investigations for medical necessity appeals. The role requires a current RN license and a minimum of two years in managed care healthcare. Candidates must have strong clinical experience and leadership skills. This position operates Tuesday through Saturday with an 8-hour shift within business hours from 8 am to 8 pm EST. Elevance Health promotes a culture of diversity and equal opportunity, ensuring all qualified applicants receive consideration. #J-18808-Ljbffr Elevance Health
- Elevance Health seeks a Nurse Appeals - Licensed Nurse to investigate medical necessity appeals from members and providers. This role allows associates to work virtually... .... The successful candidate must hold an active RN license and have a minimum of 2 years of...Remote jobMedicalFull time
- ...Administrators LLC is hiring an Appeals Analyst to join BlueCross... ..., and ensuring compliance with medical necessity guidelines. The ideal candidate will have an RN license, a degree in a related... ...full-time with the option to work remotely or on-site, offering comprehensive...Remote workMedicalFull time
- ...BlueShield of South Carolina is hiring an Appeals Analyst to research and analyze complex... ...reviews to ensure compliance with medical necessity guidelines. The successful candidate will have an Associate's degree, an active RN license, and significant clinical experience...Remote jobMedicalFull timeWork at officeWork from home
- Medix™ is seeking a dedicated Appeals Nurse (RN) to join our team in a fully remote capacity. This role involves clinical reviews and appeal determinations while collaborating with Medical Review Analysts and Physician Consultants to ensure compliant outcomes. The ideal...Remote jobMedical
$50 per hour
...A leading healthcare staffing firm is seeking an experienced RN Clinical Reviewer to work remotely. You'll conduct detailed medical-legal reviews and appeals while maintaining high accuracy and integrity. Key qualifications include a New York State RN license and at least...Remote workMedical- ...to perform clinical reviews and audits on medical records, ensuring compliance with company... ...guidelines. This role requires an active RN license and the ability to analyze claims... ...documentation and reporting within the appeals process, contributing to continuous improvement...Remote jobMedical
- ...Innovative Systems Group is seeking a Registered Nurse for remote positions in IL, TX, NM, MT, or OK. The role involves collaborating... ...healthcare providers to optimize member benefits and evaluate medical necessity, ensuring compliance with established guidelines....Remote workMedical
- ...Are you a registered nurse ready to take your... ...to analyze medical records, documentation... ...Registered Nurse (RN) license Strong... ...vulnerable populations Remote work - enjoy the... ...determine medical necessity, appropriateness, quality... ...reason codes, and appeal rights in...Remote workMedicalFull timeTemporary workWork at officeWork from home
- ...Downtown Boulder Partnership is seeking a Nurse Reviewer for Appeals and Hearings to coordinate and perform... ...position is a full-time, permanent remote role that complies with work-from-home... ...have at least 5 years of clinical or medical record coding experience, strong communication...Remote workMedicalPermanent employmentFull timeWork from homeFlexible hours
- ...Are you a registered nurse ready to take your... ...to analyze medical records, documentation... ...Registered Nurse (RN) license Strong... ...vulnerable populations Remote work - enjoy the... ...eligibility, medical necessity, appropriateness,... ...reason codes, and appeal rights in accordance...Remote workMedicalFull timeTemporary workWork at office
- ...Corporation (WPS Health Solutions) is seeking a full-time remote Licensed Appeals Nurse. This role involves examining medical records and claims for first-level appeal cases,... ...guidelines. The ideal candidate should have an RN license, along with relevant nursing degrees and...Remote jobMedicalFull time
- ...part of BlueCross BlueShield, is hiring an Appeals Analyst. This role involves researching... ...full-time, Monday through Friday, and can be remote or on-site in Nashville, TN. Qualified... ...experience in clinical settings, and an active RN license. Benefits include 401(k) match,...Remote workMedicalFull timeMonday to Friday
- The Elevance Health Companies, Inc. is seeking a Nurse Appeals-RN to manage medical necessity appeal requests. The position allows for virtual work full-time with in-person training required. Successful candidates will investigate appeals, review medical records, and provide...Remote jobMedicalFull time
- Southcarolinablues is hiring an Appeals Analyst to join their team in... ...to ensure compliance with medical necessity guidelines. The position offers... ...and the option to work remotely or on-site. Ideal candidates... ...clinical experience, a valid RN license, and strong analytical...Remote jobMedicalFull time
$38.17 - $57.25 per hour
Elevance Health is seeking a Nurse Appeals RN to work virtually full-time, with in-person training required. The role involves investigating medical necessity appeals requests and requires a high school diploma and 2+ years of managed care healthcare experience. Candidates...Remote jobMedicalFull time- Elevance Health is looking for a Nurse Appeals - Licensed Nurse based in Louisville, KY. The... ...requires conducting investigations, reviewing medical necessity appeals, and preparing recommendations... ...decisions. Candidates need a current RN license and a minimum of 2 years'...Remote jobMedicalFlexible hours
- ...staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates to reside in PA, DE,... ...involve applying criteria for medical necessity, collaborating with providers, and...Remote jobMedical
$29.05 - $67.97 per hour
...review of documentation to ensure medical necessity and appropriate level of care... ...is not included in a compact RN license. Job Duties... ...retrospective, and concurrent review of appeals for denied prior... ...Qualifications At least 2 years clinical nursing experience, including at...Remote jobMedicalHourly payWork experience placementWork at office- UnitedHealth Group is seeking a Senior Clinical Appeals RN to analyze and respond to DRG Appeals. This role offers the flexibility to work remotely across the U.S. and is focused on improving care delivery and health outcomes. Ideal candidates will have an unrestricted...Remote job
$69.38k - $92.28k
Overview As a Clinical Appeals RN, you will review denied service authorizations... ...and claims, evaluate medical necessity, and work closely with... ...standing Graduate of an accredited nursing program (BSN preferred) 3‑5... ...a combination of office and remote settings. EEO Statement MVP...Remote workMedicalWork at office$38.17 - $57.25 per hour
Job Title Nurse Appeals-RN (California) Location & Remote Work Locations: Woodland Hills, CA and Costa Mesa, CA.... ...Responsibilities Investigate and process medical necessity appeal requests from members and... ...and serve as a subject matter expert for appeals/grievances/quality...Remote workMedicalFull timeLocal area$102.18k
...Customer Solution Center Appeals and Grievances RN Job Category:... ...Analyze the patient medical records, clinical documentation... ...to determine medical necessity. Prepares and reviews... ...'s Degree in Nursing for Registered Nurses... ..., holidays, a hybrid remote schedule, and occasional...Remote workMedicalFull timeShift workWeekend work- ...comprehensive range of services that include personal care, medical support, meal preparation, housekeeping, and... ...This is a part‑time hybrid role for a Registered Nurse located in Baltimore, MD, with flexibility for some remote work. The Registered Nurse will be responsible...Remote workMedicalPart time
$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the Appeals and Grievances Clinical Specialist - RN, LPN or Dental... ...pre-existing conditions, prior approval, medical necessity, pre-certification, continued stay,...Remote jobMedicalFull timeMonday to FridayShift work- Atlantic Health System in Morristown, NJ, is seeking a Hospital Appeals Specialist (RN) to join their Revenue Cycle Integrity department. The role involves reviewing and appealing medical claims denials, collaborating with physicians, and ensuring compliance with regulations...Medical
- Acentra Health is seeking a Physician Medical Reviewer (M.D. or D.O.) in McLean,... ...independent medical service appeal reviews for TennCare and providing expert testimony. Candidates must have 5+... ...certification. The position primarily offers remote work but requires occasional on-...Remote jobMedical
$88.85k
Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Location: Los Angeles,... ...Provider Claim Disputes, medical records or other issues and... ...be based on medical necessity reviews. Prepares authorizations... ..., holidays, a hybrid remote schedule, occasional flexibility...Remote workMedicalFull timeShift workWeekend work- ...solutions firm is looking for a Clinical Appeals Nurse (RN) to support revenue cycle operations by reviewing denied claims. This remote position requires an active RN license... .... Responsibilities include assessing medical necessity, drafting appeal letters, and collaborating...Remote workMedical
- ...staffing agency is looking for a Utilization Review Registered Nurse to work remotely with a major health insurance client. This role involves... ...care cases and ensuring requested services align with medical necessity while adhering to confidentiality policies. The ideal...Remote workMedical
- ...Kids for the Future is seeking a DRG Appeals Review Nurse to analyze and appeal denied MS-DRG and APR-DRG accounts. The ideal candidate will have a Registered Nurse License, relevant coding certifications, and extensive clinical experience. Key responsibilities include...Remote workWork from home
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