Remote DRG Nurse Appeals Specialist
$90k - $99kGainwell Technologies LLC
- Remote job
Gainwell Technologies LLC is seeking a DRG Nurse Reviewer Appeals and Hearings to coordinate and perform appeal-related duties, including analyzing and responding to appeals, participating in hearings, and maintaining current clinical knowledge. The role requires an active RN license, relevant coding certifications, and strong communication skills. The position offers a salary range of $90,000.00 - $99,000.00 per year, with additional flexible benefits including a 401(k) match and health coverage. This is a remote role with up to 25% travel expected. #J-18808-Ljbffr Gainwell Technologies LLC
$90k - $99k
...DRG Nurse Reviewer Appeals and Hearings- Remote Date: Jan 9, 2026 Location: Any city, FL, US, 99999 Work Mode: Virtual (Exception only) It takes... ...Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA...Remote workFull timeWork from homeFlexible hours$90k - $99k
A leading healthcare solutions provider seeks a DRG Nurse Reviewer Appeals and Hearings to coordinate appeal duties and engage in hearings, both... ...must have an active RN license and coding certification. This remote role offers flexibility and opportunities for career...Remote workFlexible hours$85k - $95k
...Clinical Validation Nurse At MedReview, our mission is to bring... ...integrity solutions including DRG Validation, Cost Outlier and Readmission... ...CCS (Certified Coding Specialist) or CIC (Certified Inpatient... ...applications at the same time Remote Work Requirements: High...Remote workFull timeMonday to Friday$67.32k - $133.71k
...for an experienced professional to work remotely from within the greater Baltimore... ...activities. PURPOSE: The Clinical Appeals Nurse completes research, basic analysis, and... ...obtaining clinical opinions from physician specialists, to determine if adverse decisions are...Remote workWork experience placementWork at officeImmediate start- ...Remote Appeals Pharmacist – Fair Medication Access | Work From Home | Strong Clinical Writing Focus Combine clinical expertise with advocacy... ...supporting appeal outcomes. Collaborate with physicians, nurses, and medical directors during case reviews. Track and...Remote workWork from home
$90k - $110k
...DRG Revenue Integrity Auditor Remote CareNational is looking for an experienced DRG Revenue Integrity Auditor ! Ideal candidates will have... ...party vendor as a DRG Auditor or Clinical Documentation Specialist (CDS). ~ Prior experience working as a CDI/Coding auditor...Remote workImmediate startWork from home- ...as a hospital liaison with external third-party payors to appeal denied claims. Works closely with Physician advisor team to... ...management team. Job Description Clinical Appeals Nurse - Full Time Remote - Jefferson Health Articulates the job's main responsibilities...Remote workDaily paidFull timeTemporary workPart timeFlexible hoursShift work
$50 per hour
...We are looking for a Clinical Appeals Nurse to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate... ...Utilization Management. Benefits Full-time or part-time remote position Choose which projects you want to work on...Remote workHourly payFull timePart timeFor contractorsFlexible hours- ...Integra Partners is seeking a licensed Practical Nurse (LPN/LVN) experienced in managed care UM to perform pre-service and post-service utilization reviews and appeals for DMEPOS, working with our Medical Director in a NCQA-compliant UM program. You will review benefit...Remote work
$238k - $357.5k
...to start Caring. Connecting. Growing together. Work at home!The Appeals and Grievances Medical Director is responsible for ongoing... ...UnitedHealthcare associated companies.You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough...Remote workMinimum wageWork experience placementLocal areaWork from home$52 per hour
...Hiring for RN - Appeals (Remote Role) in Somerville, MA Shift : Days 5x8 (08:00 - 17:00) Duration : 13 Weeks (Temp to Perm)... ...AHA) ~100% remote ~ Looking for a registered nurse with payor experience (Commercial and Medicaid) ~ Would like...Remote workPermanent employmentTemporary workShift work- ...an experienced IP Coder to perform inpatient coding, including DRG assignment and validation. You will work with the CDI team, Coding... ..., and strong knowledge of medical terminology and anatomy. Remote work is available with secure, high-speed internet requirements....Remote work
- ...Universal Health Services is seeking an Inpatient Coder to ensure DRG accuracy and timely coding of inpatient records. You will use... ...team, Coding Manager, Business Office and Case Management.This remote role requires strong medical terminology knowledge, hospital coding...Remote workWork at office
$36 - $40 per hour
...exclusive features. At Norwood we’re forging our own path. We’re a remote-first staffing and consulting company specializing in mid-... ...long term fulfillment in your coding career. If you are an Appeals and Denials Nurse looking for a new opportunity to sharpen your skills, we...Remote workPermanent employmentFull timeWork visa$45 - $63 per hour
...Description A-Line Staffing is now hiring Full-time RN Grievance and Appeals Supervisor in the Los Angeles, CA area. The RN Grievance and... ...required per business needs Location: · Primarily Remote work with Occasional in office visits required in Los Angeles,...Remote workHourly payFull timeCasual workWork at officeImmediate startMonday to Friday- ...Overview Job Title: Registered Nurse – Claims & Appeals Review Location: Remote (Anywhere in Florida) Duration: 06 Months/Can be Extended Working hours: Day Shift Job Type: Subcon Pay Rate: Negotiable Position Description The Quality Analyst...Remote workContract workDay shift
- 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...Remote job
- ...seeking a Senior Medical Coding Professional, Inpatient to support payment integrity by reviewing inpatient claims for coding accuracy, DRG assignment, and guideline compliance.You will report to the Manager, Payment Integrity. The role involves auditing inpatient records,...Remote work
- ...Minnesota, United StatesCompany: UnitedHealth GroupPosted: 2026-08-10UnitedHealth Group is seeking an experienced Inpatient DRG Coder to join the remote coding team. You will assign ICD-10-CM/PCS and DRG codes for facility services, adhering to official coding guidelines...Remote work
- A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching...Remote job
- UnitedHealth Group's Optum is seeking a Clinical DRG RN auditor to apply MS-DRG/APR-DRG coding and CMS guidelines to inpatient claims. Remote work is available nationwide; you will... ...coding proficiency are essential. #J-18808-Ljbffr University of Minnesota School of NursingRemote job
- ...integrity by reviewing inpatient claims for coding accuracy and DRG assignment. You report to the Manager, Payment Integrity and collaborate... ...experience, with strong DRG knowledge and CDI/SOI concepts. Remote/hybrid work options are available within the Humana network.#J-1...Remote work
$45 per hour
SPECTRAFORCE is seeking a Clinical Appeals Specialist to handle member-generated appeal processes remotely from California. The role involves reviewing medical records... ...will have strong managed care and clinical nursing experience, exceptional attention to detail, and...Remote jobHourly pay- ...Appeals Nurse The Appeals Nurse examines medical records and claims information for first-level appeal cases to determine whether services... ..., skills, and experience. Work Location: We are open to remote work in the following approved states: Colorado, Florida, Georgia...Remote workFor contractorsLocal areaImmediate start
- A national healthcare company is seeking a Senior Appeals Representative to manage and resolve appeals and grievances. This remote role requires strong analytical skills and the ability to communicate effectively with members and providers. Candidates must have a High...Remote workWork at office
- ...A leading healthcare organization in Boston is seeking a detailed-oriented professional to conduct inpatient DRG reviews. The role requires an RN or LVN and an inpatient coding certification within 4-6 months of hire. Responsibilities include performing comprehensive DRG...Remote work
- A healthcare management company is seeking a Remote Coverage Review Pharmacist located in Tennessee. This role requires a Doctor of Pharmacy... ...for reviewing medication-related prior authorizations, appeals, and grievances, working independently or in a team to deliver...Remote work
$70k - $80k
Piper Companies is seeking a Remote Clinical Appeals Analyst to provide clinical expertise in reviewing and resolving complex member and provider appeals. Candidates must hold an active North Carolina licensure as an RN, LPN, PT, or OT and have significant clinical experience...Remote jobFull timeContract workMonday to Friday- ...support staff. Assist, on an as needed basis, with claims agent job functions. Including, but not limited to, claim status, drafting appeals, VA Forms, etc. Work on special projects Qualifications Requires Bachelor's degree or equivalent experience. Must...Remote workTemporary workCasual workWork at officeLocal areaWork from homeFlexible hours
$120 per hour
...Psychiatric Nurse Practitioner (PMHNP) $120-$210/hr | Remote | Flexible Schedule Pay & Flexibility Hourly Rate: $120-$210 per hour. Predictable Income: Guaranteed bi-weekly payments. Total Autonomy: Set your own hours with full control over your availability...Remote workBi-weekly payHourly payExtra incomeFull timePart timePrivate practiceFlexible hours
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