Senior Clinical Appeals RN - Remote DRG Expert & Coach
$35 - $63 per hourCrains Cleveland
- Remote job
Crains Cleveland is looking for a Senior Clinical Appeals RN who utilizes expertise in MS-DRG and APR-DRG auditing to respond to appeals and coach remote DRG Validation Specialists. This role allows for remote work across the U.S., with specific location requirements for Minneapolis and Washington, D.C. The ideal candidate will possess strong coding experience and be responsible for analyzing DRG Appeals, researching appeals, and collaborating with various teams. Compensation ranges from $35.00 to $63.00 per hour, with additional benefits including a comprehensive package and 401(k) contribution. #J-18808-Ljbffr Crains Cleveland
- UnitedHealth Group is seeking a Senior Clinical Appeals RN to utilize expertise in MS-DRG and APR-DRG auditing to manage appeals. This position allows remote work throughout the U.S., except for Minneapolis or Washington, D.C. hires, who need to work in-office at least...Remote jobSeniorWork at office
$35 - $63 per hour
The University of Minnesota School of Nursing is looking for a Senior Clinical Appeals RN. This role involves reviewing and responding to appeals in MS-DRG and APR-DRG auditing and provides coaching to remote specialists. Remote work is available within the U.S., but...Remote jobSeniorHourly payWork at office$35 - $63 per hour
Stryker Corporation is seeking a Senior Clinical Appeals RN to utilize clinical expertise in appealing... ...records. The role includes analyzing DRG appeals, conducting complex analyses,... ...years of coding experience with ICD-10. Remote work opportunities are available in the...Remote jobSeniorHourly pay$35 - $63 per hour
Optum is seeking a Senior Clinical Appeals RN to utilize expertise in MS-DRG and APR-DRG auditing for appeals management. This role involves analyzing appeals... ...and authoring rebuttals. The job can be performed remotely across the U.S., with certain locations requiring...Remote jobSeniorHourly payWork at office$35 - $63 per hour
...State and Territorial Epidemiologists is hiring a Senior Clinical Appeals RN. This position utilizes expertise in MS-DRG and APR-DRG auditing to review appeals and is... ...experience in ICD-10 coding. The role allows for remote work, and candidates should be solution-oriented...Remote jobSeniorHourly pay$35 - $63 per hour
...experienced healthcare coder to analyze DRG Appeals, prepare written appeals, and... ...The role requires an unrestricted RN license and extensive knowledge of ICD-10 coding as well as clinical judgment. Enjoy the flexibility to work remotely from anywhere in the U.S., with...Remote jobSeniorHourly payWork at officeLocal area- ...Company of America is seeking an experienced clinical professional for a remote role. The successful candidate will provide coaching to Clinical Consultants, oversee assessments... ...minimum of 5 years in direct patient care, RN required, and possess strong problem-solving...Remote jobSenior
- ...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... ...Nurse License, relevant coding certifications, and extensive clinical experience. Key responsibilities include reviewing claims for...Remote workWork from home
$35 - $63 per hour
...Analyze scope and resolution of DRG Appeals Respond to Level one, two or... ...written appeals Exercise clinical and/or coding judgment and experience... ...: Unrestricted RN (registered nurse) license in... ...enjoy the flexibility to work remotely from anywhere within the U.S....Remote jobSeniorHourly payMinimum wageFull timeWork experience placementWork at officeLocal area$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 work- Elevance Health is looking for a Diagnosis Related Group Clinical Validation Auditor - RN to work virtually, ensuring clinical documentation accuracy... ...significant experience in claims auditing, particularly with DRG-based claims. Elevance Health values work-life integration...Remote jobSeniorFlexible hours
- Optum is hiring a Clinical DRG RN auditor to verify DRG coding accuracy and reimbursements while telecommuting from anywhere in the U.S. In this role, you'll use your ICD-10 coding expertise to audit inpatient claims, identify overpayments, and support your findings with...Remote job
$70k - $80k
...analytics and solutions company is seeking a Clinical Validation Auditor to ensure accuracy in medical claims coding. This fully remote position requires a Registered Nurse with... ...skills, attention to detail, and experience in DRG audits. Competitive salary range is $70k -...Remote job- Stryker Corporation is seeking a Clinical DRG RN Auditor who will work remotely to validate DRG assignments and reimbursements. This role requires deep expertise in ICD-10 coding and offers flexibility to telecommute from anywhere in the U.S. The ideal candidate will have...Remote jobRelocation package
- ...company located in New York is looking for a Clinical Auditor to perform clinical reviews and... ...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 job
- ...Administrators LLC is hiring an Appeals Analyst to join BlueCross... ...complex appeal requests, conducting clinical reviews, and ensuring... ...ideal candidate will have an RN license, a degree in a related... ...-time with the option to work remotely or on-site, offering comprehensive...Remote workFull time
- ...healthcare consulting firm is expanding its team by hiring a Clinical Appeals Review Nurse. This role involves completing clinical... ...documentation. Required qualifications include an RN certification, experience with DRG denials, and preferred certifications like CCDS or...
- 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 job
- Elevance Health is seeking a Nurse Appeals - Licensed Nurse to work virtually from Indianapolis... ...appeals. The role requires a current RN license and a minimum of two years in... ...healthcare. Candidates must have strong clinical experience and leadership skills. This position...Remote jobShift work
- ...BlueShield of South Carolina is hiring an Appeals Analyst to research and analyze complex... ...time position involves conducting thorough clinical reviews to ensure compliance with medical... ...have an Associate's degree, an active RN license, and significant clinical experience...Remote jobFull timeWork at officeWork from home
- Blue Cross Blue Shield of Arizona needs a clinical expert for managing member and provider appeals. This remote position requires strong accuracy, knowledge of compliance timelines, and a focus on customer service. Applicants should possess a healthcare-related degree and...Remote job
$80k - $90k
...Responsibilities*** Performs clinical reviews on medical... ....* Conducts Appeals reviews on medical... ...subject matter expert for assigned business... ...HCPCs/ICD-9/ICD-10/MS-DRG coding may be... ...work independently in remote setting with minimum... ...Active unrestricted RN license #J-18808-...Remote workFlexible hours- A healthcare solutions company seeks a Manager of Clinical Appeals in New York. The role involves overseeing clinical appeals operations with... ...appeals and team leadership, particularly in managing remote teams. The position requires strong writing skills and a thorough...Remote workSenior
- ...IQVIA is seeking a Clinical Programmer (CP) with 6 to 12 years of experience. The role involves advanced SAS expertise and strong knowledge... ...or equivalent relevant experience. The position allows for remote or hybrid work modes and emphasizes attention to detail and commitment...Remote workSenior
$60.2k - $107.4k
...Capacity Path is seeking a Senior Clinical Administrative Nurse to engage with members through telephonic... .... The ideal candidate must hold a current RN compact license and have at least 2 years of nursing experience. Work is remote, with specific hours required, hence...Remote workSenior- ...Partnership is seeking a Nurse Reviewer for Appeals and Hearings to coordinate and perform... ...This position is a full-time, permanent remote role that complies with work-from-home policies... ...should have at least 5 years of clinical or medical record coding experience, strong...Remote workPermanent employmentFull timeWork from homeFlexible hours
$33 - $38 per hour
Astrana Health is seeking a Senior DRG Coder who will be responsible for reviewing inpatient medical records and assigning diagnosis and procedure codes accurately. This remote role requires strong knowledge of ICD-10-CM and ICD-10-PCS, ensuring compliance and coding accuracy...Remote jobSeniorHourly pay$60.2k - $107.4k
...UnitedHealthcare is seeking a Senior Clinical Administrative Nurse to engage with members and support... .... Ideal candidates will have a current RN compact license and at least 2 years of... ...health settings. The position offers remote work flexibility anywhere within the U.S...Remote workSenior$90k - $99k
...DRG Nurse Reviewer Appeals and Hearings- Remote Date: Jan 9, 2026 Location: Any city, FL, US, 99999 Work Mode:... ...and redeterminations using approved clinical and coding guidelines and documents... ...completes required CEUs to maintain RN license and/or coding certification...Remote workFull timeWork from homeFlexible hours- Texas Health Institute is looking for a full-time coding professional to perform inpatient DRG Coding, ensuring adherence to coding guidelines. The role offers flexibility for telecommuting from anywhere in the U.S. Ideal candidates should have over 3 years of experience...Remote jobSeniorFull time
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