Remote Appeals Registered Nurse - Medicare Medical Review
WPS—A health solutions company
- Remote job
WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims for first-level appeal cases, determining medical necessity and Medicare coverage compliance. The RN collaborates with Appeals Examiners to ensure redeterminations are reviewed and completed in a timely manner. This position supports remote work in approved states, including Ohio. Ideal candidates will have an ASN/BSN, active RN license, 1+ year clinical experience, and strong communication skills to #J-18808-Ljbffr WPS—A health solutions company
- ...WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records for first-level appeal cases... ...and determine medical necessity under Medicare guidelines. You will collaborate... ...communication and regulatory knowledge. Remote work is available in approved states...Remote workMedical
$52 - $56 per hour
...done UM. You've worked appeals. Now find a role that uses... ...New York health plan (Medicare Advantage, Medicaid and... ...you'll apply the same medical necessity judgment you... ...utilization management. 100% remote (U.S.) | Contract | $52... ..., clinical review, decision and notification...Remote jobMedicalContract workAfternoon shift- ...WPS Health Solutions seeks an Appeals Nurse (RN) to review medical records for first-level appeal cases and determine medical necessity under Medicare guidelines. The role collaborates with... ...clinical experience are required, with remote work options available in...Remote workMedical
- ...WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level appeals... ...to determine medical necessity under Medicare guidelines. The role collaborates... ...clinical experience are required, with remote work options available in approved...Remote workMedical
- ...WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level appeal determinations under Medicare guidelines. The RN collaborates with Appeals... ..., with 1+ year clinical experience. Remote work is allowed in several states with...Remote workMedical
- ...health solutions company, is hiring an Appeals Nurse to review medical records and claims for first-level... ...ensuring medical necessity and adherence to Medicare guidelines. The role collaborates... ...compliance with CMS requirements. Remote work is available from select states...Remote workMedical
- ...WPS—A health solutions company is seeking an Appeals Nurse (RN) to review medical records and claims for first-level appeal cases to determine medical necessity under Medicare guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations....Remote workMedical
- ...WPS Health Solutions is seeking an Appeals Nurse to review medical records for first-level appeals to determine medical necessity under Medicare guidelines. The RN collaborates with Appeals... ...clinical experience are required. Remote work options are available in specified...Remote workMedical
- ...WPS—A health solutions company is seeking an Appeals Nurse to review medical records and claims for first-level appeal cases to determine medical necessity and adherence to Medicare coverage guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations...Remote workMedical
- ...WPS Health Solutions is hiring an Appeals Nurse RN to review medical records and claims for first-level appeal cases to determine medical necessity according to Medicare guidelines. This remote-friendly role supports timely redeterminations and collaborates with Appeals...Remote workMedical
- ...WPS, a health solutions company, is seeking an Appeals Nurse (RN) to review medical records and Medicare denial cases for medical necessity. The role collaborates... ...experience and strong communication skills. Remote work options available for approved states, including...Remote workMedical
- ...WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims for first-level Medicare appeal cases, assessing medical necessity and adherence to CMS guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations...Remote workMedical
$66k - $68k
...WPS, a health solutions company, seeks an Appeals Nurse to review first-level appeal cases, assess medical necessity, and prepare rationale-supported letters. You... ...communication skills are essential. The role offers remote work options across approved states, with a base...Remote workMedical- ...WPS Health Solutions in Columbus, OH, is seeking an Appeals Nurse to review medical records and Medicare claims for first-level appeals to determine medical... ..., and ensure compliance with CMS guidelines. A registered nurse with strong communication and attention to detail...Remote workMedical
$66k - $68k
...WPS Health Solutions is seeking an Appeals Nurse to review medical records and determine the medical necessity of services for first-level Medicare appeal cases. You will collaborate with... ...CMS regulations. The role offers remote work within approved states and a salary...Remote workMedical- ...WPS—A health solutions company is seeking an Appeals RN to review medical records and claims for first-level appeal cases, ensuring services were medically necessary and compliant with Medicare guidelines. The role collaborates with Appeals Examiners to support timely...Remote workMedical
- ...WPS is seeking an Appeals Nurse to review medical records and Medicare claim information for first-level appeal cases. You will collaborate with Appeals Examiners... ...license, ASN/BSN, and 1+ year clinical experience. Remote work is permitted in several states, including New...Remote workMedical
- ...SCAN is seeking a California-licensed registered nurse to provide clinical review of medical claims and post-service appeals. You will ensure medical necessity and apply CMS... ...Director on denials and appeals. This is a remote position with competitive pay and benefits....Remote workMedical
- ...WPS—A health solutions company is seeking an Appeals Nurse to review medical records and claims information for first-level Medicare appeal cases, determining medical necessity... ...to ensure timely redeterminations. This remote role is eligible in several states,...Remote workMedical
- WPS Health Solutions is hiring an Appeals Nurse RN to review medical records and claims for first-level appeal cases to determine medical necessity according to Medicare guidelines. This remote-friendly role supports timely redeterminations and collaborates with Appeals...Remote jobMedical
$66k - $68k
...WPS is seeking an Appeals Nurse (RN) to evaluate medical records and claims for first-level Medicare appeals, ensuring medical necessity and compliance with guidelines. You... ...redeterminations promptly. The role supports remote work in approved US states, offers a salary...Remote workMedical- ...perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director on benefit and medical necessity... ...meeting criteria, and referring non-meeting cases. Remote opportunities available; competitive compensation...Remote workMedical
- ...conduct pre-service and post-service utilization reviews and appeals within a NCQA-compliant UM program, collaborating with our Medical Director. The role emphasizes applying... ...approvals, referrals, and handling appeals. Remote opportunities available and strong team...Remote workMedical
$53 per hour
...Phaxis - Healthcare is hiring for a REMOTE RN opportunity focused on Grievance & Appeals and Utilization Review. The role requires candidates to reside in New York State... ..., and experience with prior authorizations and medical necessity reviews. #J-18808-LjbffrRemote workMedicalLong term contractContract workMonday to Friday- ...NTT DATA, Inc. is seeking a Clinical Reviewer Specialist for a fully remote position based in Florida. You will perform clinical and medical necessity reviews for member and provider appeals, evaluating records and criteria to support Medical Director recommendations while...Remote workMedical
- ...pre-service and post-service utilization reviews and appeals for DMEPOS within a NCQA-compliant UM program. You will collaborate with the Medical Director to assess medical necessity... .../LVN license, with at least 3 years of nursing experience and 2 years in managed care...Remote workMedical
- ...and post-service utilization reviews and appeals in a managed care... ...You will collaborate with our Medical Director to evaluate medical... ...active licensure, 3+ years of nursing experience, and 2+ years UM... ...is preferred, and we offer remote work options and a comprehensive...Remote workMedical
- ...perform pre-service and post-service utilization reviews and appeals in a managed care UM program. This role collaborates with the Medical Director on benefit and medical necessity... ..., aligned with NCQA standards. The UM Nurse will review requests, approve those meeting...Remote workMedical
- ...perform pre-service and post-service utilization reviews and appeals in a managed care UM program. You will collaborate with the Medical Director to review benefit language,... ...processes. This role requires 3+ years of nursing experience, 2+ years in UM, and strong...Remote workMedical
- ...NTT DATA, Inc. seeks a Clinical Reviewer Specialist to perform clinical and medical necessity reviews for member and provider appeals, evaluating records against NCQA standards and Medicaid requirements. Role offers remote work within Florida, requires RN licensure,...Remote workMedical
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