Remote RN Appeals Analyst — Clinical Review Expert
BlueCross and BlueShield of South Carolina
- Remote job
BlueCross BlueShield of South Carolina is seeking a nurse to research the substance of complex appeal requests, perform clinical review to determine medical necessity, and document decisions within required timeframes. This full-time remote role (40 hours/week, 8 a.m.–5 p.m. local time) requires an active RN license in the United States, CMS residency constraints, and strong analytical, communication, and confidentiality skills. #J-18808-Ljbffr BlueCross and BlueShield of South Carolina
- UnitedHealthcare is hiring a Clinical Appeals RN to provide expertise in appeals and grievances, analyze cases, and serve as a Clinical Interface... ...and program definitions while ensuring confidentiality. Remote work is allowed from anywhere in the U.S., with M-F 8:00-4:3...Remote jobLocal area
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$53.46k
...Researches the substance of complex appeal or retrospective review requests including pre-pay... .... Provides thorough clinical review or benefit analysis... ...: This is a full-time, remote (40-hours/week) working an... ...An active, unrestricted RN license from the United States...Remote workFull timeFor contractorsWork experience placementLocal areaMonday to FridayShift work- ...are currently hiring for an RN Appeals Analyst to join BlueCross BlueShield... ...complex appeal or retrospective review requests including pre-pay... ...requests, provide thorough clinical review or benefit analysis... ...EST and will be fully remote in South Carolina or Georgia...Remote workFull timeFor contractorsWork experience placementCurrently hiringWork at officeLocal areaMonday to Friday
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- Note: This is a remote position. Seeking applicants who... ...knowledge to evaluate clinical information using... ...medical claims and/or appeal cases and associated records... ...information for physician review or other external... ...answer to Wall Street analysts or pay dividends to investors...Remote workCasual workWork at office
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Guardian Life is seeking an RN Clinical Consultant to support disability claim decisions. You will review medical data, assess functional capacity, and collaborate with providers... ...and 3+ years in LTD/STD clinical consulting. Remote options nationwide are available, with salary...Remote job- Health Business Solutions LLC is seeking a Clinical Appeals Nurse (RN) for a remote role. The position focuses on reviewing denied claims for clinical accuracy and medical necessity, developing appeal strategies, and drafting payer-ready documentation to overturn denials...Remote job
$40 - $50 per hour
...Job Description Job Description Clinical Appeals RN – 100% Remote $40-$50/hour | Part-Time & Full-Time Opportunities Available Our team partners... ...Appeals RN, you'll use your clinical expertise to review and appeal insurance denials related to lack of authorization...Remote jobPermanent employmentFull timeTemporary workPart time$93.35k - $132.43k
...First (Days) Overview: Sentara Health Plans is hiring a Clinical Claims Reviewer/ RN - Remote! Status: Full-time, permanent position (40 hours)... ...we serve! Talroo - Nursing Clinical Claims Reviewer, Appeals, Denials, Utilization management, Registered Nurse, BSN,...Remote workPermanent employmentFull timeTemporary workWork at officeShift work$28 - $51 per hour
About This Role The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances, analyzing, reviewing, and evaluating appeals and grievances, and acting as a Clinical Interface Liaison to resolve issues concerning members, benefits, and...Remote jobFull timeDay shift- UnitedHealth Group is seeking a Clinical Coordinator RN for a Telecommute role in Texas. You will conduct comprehensive clinical reviews of appeals, evaluate medical records, and provide independent... ...and collaboration within a remote team, with weekday daytime hours....Remote jobWeekday work
- NTT DATA, Inc. seeks a Clinical Reviewer Specialist to perform clinical and medical necessity... ...reviews for member and provider appeals, evaluating records against NCQA... ...requirements. Role offers remote work within Florida, requires RN licensure, 3 years’ experience in...Remote job
$187.2k
...We're running a paid study on clinical decision-making to help benchmark... .... How It Works You will review a series of de-identified clinical... ...product images through our remote platform. For each case, you will provide detailed expert reviews and help develop scoring...Remote workContract work- New England Life Care, Inc. is seeking a Remote Clinical Review Specialist to perform utilization management reviews and provide essential clinical information to confirm patient coverage. The role emphasizes regulatory compliance, complex specialty drug knowledge, and...Remote job
$52 - $56 per hour
...done UM. You've worked appeals. Now find a role that uses... ...'re hiring a contract RN for a New York health... ...and MLTC). You'll own clinical grievances and appeals... ...utilization management. 100% remote (U.S.) | Contract | $52... ..., clinical review, decision and notification...Remote jobContract workAfternoon shift- AuraOne seeks a Medical Expert fluent in Mandarin Chinese for a remote, US-eligible contractor role to evaluate AI outputs in clinical review. Reviewers assess differential diagnosis, dosing logic, and guideline adherence, and document corrected reasoning for model training...Remote jobFor contractors10 hours per week
- ...are searching for a new RN to join our team. Our... ...the flexibility to work remotely and do not have face-to... ...skills in addition to clinical experience. Upon receipt... ...type requested, review medical records for completeness... ...in the capacity of Appeals/Grievances, Case Management...Remote jobHome officeMonday to FridayWeekend work
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