Medicare Appeals Nurse - Remote Case Review Expert
WPS Health Solutions
WPS Health Solutions is looking for an Appeals Nurse responsible for examining medical records and claims for first-level appeal cases. The role involves reviewing denied services and working with redetermination representatives to ensure compliance with Medicare guidelines. Qualified candidates should have a nursing degree and an active RN license. The position offers remote work options along with a comprehensive benefits package that includes health insurance and a performance bonus. #J-18808-Ljbffr
- ...Health Solutions is seeking an Appeals Nurse in Michigan to examine... ...records and claims for appeal cases. This role involves collaboration... ...Examiners and entails thorough reviews to ensure regulatory... ...essential. This opportunity offers remote work options and various benefits...Remote work
- ...WPS Health Solutions is seeking an Appeals Nurse to examine medical records for first-level appeal cases, ensuring services meet Medicare coverage guidelines. With options for remote work, the ideal candidate will have a nursing degree and active RN license, accompanied...Remote work
- ...Downtown Boulder Partnership is seeking a Nurse Reviewer for Appeals and Hearings to coordinate and perform... ...analyzing provider appeals and preparing case summaries for hearings. This position is a full-time, permanent remote role that complies with work-from-home policies...Remote workPermanent employmentFull timeWork from homeFlexible hours
- ...WPS Health Solutions is seeking an Appeals Nurse to examine medical records for appeal cases regarding Medicare coverage. This remote position requires strong clinical expertise and the ability to interpret complex medical information. Qualified candidates must hold a...Remote work
$66k - $68k
...WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level appeal cases. In this role, you will collaborate with examiners to... ...medical necessity is determined in compliance with Medicare guidelines. Experience in clinical healthcare...Remote work- Santa Barbara Cottage Hospital is seeking a Case Manager - Utilization Review Specialist to work remotely. This role involves analyzing patient records, ensuring compliance with regulations, and managing appeals. Candidates should possess a current RN license and significant...Remote job
- ...Elevance Health seeks a Nurse Appeals - Licensed Nurse to investigate medical necessity appeals from members and providers. This role allows... ...of experience in managed care. Key responsibilities include reviewing medical records, preparing recommendations, and ensuring...Remote workFull time
- ...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
- ...WPS Health Solutions in Omaha is seeking an Appeals Nurse to examine medical records and claims for appeals. This role involves reviewing the medical necessity of services and... ...communication skills. The position offers remote work options and benefits including health...Remote work
- ...Elevance Health is seeking a Nurse Appeals - Licensed Nurse to investigate and process medical necessity appeals. The role enables associates... ...managed care healthcare setting. The selected candidate will review medical records and document grievances while ensuring timely...Remote workFull time
- ...WPS Health Solutions is seeking an Appeals Nurse to examine medical records and claims for appeal cases under Medicare regulations. This role involves assessing clinical necessity... ...clinical experience. The position offers remote work capabilities and competitive benefits...Remote work
- ...solutions company is seeking an Appeals Nurse to evaluate first-level appeal cases and ensure compliance with Medicare guidelines. The ideal... ...license. This position offers remote work options for residents... .... Responsibilities include reviewing appeals and preparing...Remote work
- ...solutions company is seeking an Appeals Nurse to review medical records and claims for appeal cases. You will collaborate with the... ...team and ensure compliance with Medicare guidelines for timely... ...offers a salary range of 66-68k, remote work options, and comprehensive...Remote work
- ...WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level appeal cases. This role collaborates with Appeals Examiners to ensure... ...RN license, and strong communication skills. Remote work options are available, and candidates...Remote work
$59.5k - $116.6k
UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services and requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate...Remote jobWeekend work- Overview Job Title: Registered Nurse - Claims & Appeals Review Location: Remote (Anywhere in Florida) Duration: 06 Months/Can be Extended Working hours: Day... ...actions. Key Responsibilities Review appeal cases and supporting documentation to ensure completeness and...Remote workContract workDay shift
$66k - $68k
...WPS Health Solutions is seeking an Appeals Nurse who will examine medical records for first-level appeals to ensure compliance with Medicare guidelines. This role involves collaboration... ...experience. The position allows for remote work in several states and offers a competitive...Remote work- ...Health is seeking a Physician Medical Reviewer (M.D. or D.O.) in McLean, Virginia... ...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 job
- ...Registered Nurse: Review and Evaluation Are you a registered nurse ready... ...in utilization review, case management, quality improvement... ...for vulnerable populations Remote work – enjoy the convenience... ...denial letters, reason codes, and appeal rights in compliance with...Remote workFull timeTemporary workWork at officeWork from home
- ...Are you a registered nurse ready to take your career... ...traditional bedside setting to review and audit claims,... ...in utilization review, case management, quality... ...vulnerable populations Remote work - enjoy the... ...letters, reason codes, and appeal rights in accordance with...Remote workFull timeTemporary workWork at office
- ...WPS Health Solutions is looking for an Appeals Nurse who will examine medical records for first... ...necessary services in line with Medicare guidelines. The ideal candidate will have... ...of clinical experience. The role offers remote work options, a performance bonus, and a...Remote work
$95k - $110k
...DRG Nurse Reviewer Appeals and Hearings- Remote It takes great medical minds to create powerful solutions that solve some of healthcare's most complex... ...appeal have been addressed properly and accurately; prepare case files and case summaries for hearings; and participate...Remote workFull timeWork from homeRelocation packageFlexible hours- ...solutions company is looking for an Appeals Nurse to examine medical records... ...for first-level appeal cases. The role involves collaboration... ...to assure compliance with Medicare guidelines. The ideal candidate... .... The position supports remote work and offers a range of benefits...Remote work
- ...Huntsville Memorial Hospital is seeking a Utilization Review Nurse to provide clinical reviews of cases for medical necessity. In this role, you'll collaborate with healthcare teams to ensure proper resource use and has a strong focus on quality assurance. This position...
- ...New York is looking for a Clinical Auditor to perform clinical reviews and audits on medical records, ensuring compliance with company... ...will be responsible for documentation and reporting within the appeals process, contributing to continuous improvement initiatives in...Remote work
- A leading staffing agency is looking for a Utilization Review Registered Nurse to work remotely with a major health insurance client. This role involves evaluating patient care cases and ensuring requested services align with medical necessity while adhering to confidentiality...Remote job
- ...clinically experienced Registered Nurse looking to apply your... ...patient care? As a Medical Review Nurse you will play a critical... ...support fair, evidence-based appeal outcomes-directly impacting both... ...Serve as a trusted clinical expert supporting accident and health...Remote workContract workWork at officeWork from homeWork visa
- ...Role Snapshot The Appeals Nurse examines medical records... ...for first-level appeal cases to determine whether services... ...necessary and meet Medicare coverage guidelines in... ...are medically reviewed as needed and completed... ...Location We are open to remote work in the following...Remote workFor contractorsImmediate start
$65 - $95 per hour
...About the job Remote | Nursing Clinical Review Expert - $65-$95/hour We are sharing a specialised part-time consulting opportunity for nursing... ...Experience in hospital, clinic, long-term care, home health, case management, telehealth, or healthcare quality...Remote workHourly payWeekly payContract workPart timeFor contractorsFlexible hours$60 - $85 per hour
...for an experienced registered nurse to join our content quality team as an Expert Question Reviewer for NCLEX-RN exam preparation materials... ...contract position — flexible, remote, and project-based. You'll work... ..., drag-and-drop, unfolding case studies) are structurally...Remote workHourly payContract workFlexible hours
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Medicare Appeals Nurse - Remote Case Review Expert. Be the first to apply!
- telecommute Monona, WI
- remote database management Monona, WI
- remote Monona, WI
- part time remote customer service Monona, WI
- remote work Monona, WI
- remote customer service chat Monona, WI
- fully remote Monona, WI
- remote software sales Monona, WI
- companies hiring remote Monona, WI
- remote online customer service Monona, WI

