Remote RN: Clinical Appeals & Denial Escalation Lead
Inside Higher Ed
- Remote job
Inside Higher Ed is seeking a Clinical Financial Case Manager - RN to handle clinical appeal services and complex patient account reviews. This role requires strong skills in evaluating payer contracts and managing appeal processes. The ideal candidate must have a Bachelor’s degree or equivalent experience, be a Registered Nurse, and possess 2-4 years of relevant experience. This position will be remote and focuses on developing strategies to prevent denial trends. #J-18808-Ljbffr Inside Higher Ed
$45.29 - $84.11 per hour
...Denial Prevention Nurse Position at Northwell... ...better. Hybrid/Remote Summary: The... ...and accurate clinical information to all... ...and deny claims and escalating any egregious payer... ...and trending all appeals and communicating... ...Required: Current RN License in Connecticut...Remote workHourly payDaily paidPart timeShift workNight shiftRotating shift- Remote Jobs is seeking an experienced clinical appeals specialist to join their team. The role requires a Registered Nurse (RN) with at least one year in ICU or demonstrated proficiency in appeals... ...services. You will review denials, conduct research, and collaborate...Remote work
$102.18k
Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Location: Los Angeles, CA, US, 90017 Position... ...of complex and/or escalated clinical A&G cases... ...the root cause of denials. Check, verify and... ...holidays, a hybrid remote schedule, and occasional...Remote workFull timeShift workWeekend work- A healthcare 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 and 3-5 years of clinical nursing experience. Responsibilities include assessing medical...Remote job
$80k - $90k
...organization. Machinify is a leading healthcare intelligence... ...-90k The Medical Review Clinical Appeals Auditor (RN) is responsible for conducting... ..., providing supplemental escalation support, and may perform... ...to work independently in remote setting with minimum supervision...Remote workFor contractorsImmediate startWork from homeHome officeFlexible hoursShift work$68.97k - $113.31k
...The Senior RN Clinical Consultant will work in partnership with Clinical... ...lines of business (STD/LTD/Appeals) and products, action... ...customer service Address escalated customer inquiries and formal... ...needed Location This is a remote position with occasional travel...Remote workFull timeVisa sponsorshipWork visaFlexible hours$29 - $52 per hour
...the flexibility to work remotely as you take on some... ...initial assessment review of appeals, medical records, and... ...Utilize Clinical nursing judgment assessment... ...valid, and unrestricted RN licensure in your state... ...including understanding of Denial Notice and NOMNC Proven...Remote jobHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaMonday to Friday$248.5k - $373k
Texas Health Institute is seeking an Appeals and Grievances Medical Director to oversee clinical review for appeals and grievances cases. The role involves detailed case analysis and collaboration with medical directors, while aiming to improve processes and communicate...Remote job$248.5k - $373k
Wellness Health Careers is seeking an Appeals and Grievances Medical Director responsible for clinical review and adjudication of appeals for UnitedHealthcare. The ideal candidate must be an MD or DO with a valid license and board certification. Responsibilities include...Remote job$29 - $52 per hour
...Health Institute is seeking a motivated RN to assess appeals and medical records, ensuring coverage... ...billable criteria. This role offers remote work flexibility, primarily within EST... ...have a valid RN license, 2+ years of clinical experience, and understanding of Medicaid...Remote jobHourly pay$29 - $52 per hour
UnitedHealth Group is seeking a Remote Registered Nurse (RN) in California to handle appeals and medical record reviews. The ideal candidate should possess a current RN license and have at least 2 years of clinical experience. This role also requires familiarity with Medicare...Remote jobHourly pay$28.94 - $51.83 per hour
Texas Health Institute is hiring a Clinical Appeals RN to represent MassHealth at appeal hearings and perform clinical coverage reviews. The successful candidate must have an unrestricted RN license in Massachusetts and at least 3 years of managed care or clinical experience...Remote jobHourly pay$71.59k - $116.48k
...prominent healthcare organization is seeking an A&G Clinical Specialist to manage health member complaints and appeals. This fully remote position requires expertise in clinical case... .... The ideal candidate should be an RN, LPN or Dental Hygienist with experience in appeals...Remote job- ...consulting firm is expanding its team by hiring a Clinical Appeals Review Nurse. This role involves completing clinical denial reviews, performing various audit services, and... .... Required qualifications include an RN certification, experience with DRG denials, and...
$36 - $40 per hour
...forging our own path. We’re a remote-first staffing and... ...coding career. If you are an Appeals and Denials Nurse looking for a new opportunity... ...benefits Our requirements: RN or FMG: CDIP, CCDS, CCS and/... ...0.00-$95,000.00 1 month ago Clinical Review Nurse - Prior Authorization...Remote workPermanent employmentFull timeWork visa- ...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
$75k - $89k
...POSITION SUMMARY: The Supervisor, Denials and Appeals supervises a team of Revenue Cycle Analysts... ...communication and ensure accuracy. Acts as an escalated level of response for concerns and... ...responsible experience. Lead and/or supervisory experience. Experience...Remote workWork experience placementWork at officeImmediate startWorldwide$68k - $113k
Job Family: Clinical Appeals Nurse Travel Required: None Clearance Required: None What You Will Do... ...of care and services rendered. Identify denial root causes and determine appeal... ...electronic medical record systems. Compact State RN License Experience with inpatient level‑...Full timeTemporary workFlexible hours- Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical Appeals Position Overview The Clinical... .... This role plays a critical part in overturning denials, improving reimbursement outcomes, and ensuring compliance...Remote work
$248.5k - $373k
Salem Health Hospitals & Clinics is looking for a qualified MD or DO to handle appeals and grievances for various health plans. The role allows you to work remotely from anywhere in the U.S. and will require strong telephonic and interpersonal communication skills. The...Remote job- ...Description Job Description: Clinical Supervisor, UM Denial Compliance Location: Los... ...Position Type: Hybrid (85% remote, 15% onsite in Burbank, CA)... ...Nursing Program; RN preferred. 2. Minimum of... ...years in prior-authorization, appeals & grievance, or health plan...Remote workPermanent employmentTemporary work
$248.5k - $373k
Wisconsin Psychiatric Association Inc is seeking an Appeals and Grievances Medical Director responsible for the clinical review of appeals and grievances cases for UnitedHealthcare-associated companies. Ideal candidates are MD or DO licensed professionals with at least...Remote job$248.5k - $373k
Stryker Corporation is looking for an Appeals and Grievances Medical Director to oversee clinical reviews related to appeals and grievances. The role demands a minimum of 5 years in clinical practice and substantial communication skills. Qualified candidates will have an...Remote job- .... Job Title: Clinical Financial Case Manager RN Department: Health... ...internal), clinical appeals, internal and external escalations, and denial management. RCCS is... ..., RN - Escalation Lead provides advanced clinical... ...: Location: Remote Location Position...Remote workWork at officeShift workDay shift
$102.18k
Job Information RN Job Shift: Full Time Pay Range: $102,183... ..., 90017 Job Description The Lead Appeals and Grievances RN is responsible... ...Appeals and Grievance (A&G) clinical unit. This position is... ...quality review of complex and/or escalated clinical A&G cases for all lines...Full timeShift work$81.1k - $116.48k
Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst... ...of or delivery of clinical and non-clinical services. A&G... ...providers. This position is 100% Remote. We are hiring for the following... ...assigned. Minimum Qualifications: RN, LPN OR Dental Hygienist...Remote jobContract workTemporary workWork experience placementLocal areaMonday to FridayShift work- ...Description: The Director, Clinical Denials provides... ...driving clinical appeal performance across... ...appeal workflows, escalation pathways, and quality... ...and Quality • Lead the development, review... ..., team leads, RN appeal writers,... ...Primarily office or remote-based environment...Remote workWork at office
$36.38 - $56.39 per hour
...FROEDTERT HOSPITAL facility. This job is REMOTE. FTE: 0.500000 Standard Hours... ...responsibility for managing inpatient denials for all payers related to medical necessity and clinical validation audits, and coordinates the appeal process with physicians, coding, third...Remote workHourly payTemporary workShift work$248.5k - $373k
UnitedHealth Group is seeking an Appeals and Grievances Medical Director responsible for reviewing and adjudicating... ...role requires an MD or DO with experience in clinical practice and Quality Management. This position offers remote work flexibility, allowing for a dynamic work...Remote job- ...for Career Enhancement is seeking an Appeals Nurse Consultant to join our remote team. This critical role involves... ...ensuring fair and accurate resolution of clinical appeals through sound clinical... ...candidate will possess a valid RN license, 3+ years of clinical experience...Remote job
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