Remote Clinical Review & Appeals Specialist
CorroHealth Inc
- Remote job
CorroHealth Inc. is seeking a Clinical Review Specialist to support medical necessity reviews and appeals on a remote, US-only basis. The role focuses on DRG downgrades, level-of-care decisions, and payer guideline alignment across inpatient and outpatient services. You will review medical records, ensure timely submissions, and maintain quality and compliance with CMS, Medicaid, and commercial payer requirements. Strong documentation and communication are essential. #J-18808-Ljbffr CorroHealth Inc
- MedImpact Healthcare Systems, Inc. seeks an Appeals Clinical Specialist to lead clinical reviews, evaluate medical records, and determine benefit coverage for... ...position is based in San Diego with potential remote work per management approval. #J-18808-Ljbffr MedImpact...Remote workFull time
- ...delivering care supported by technology to help millions live healthier lives. The Clinical Appeals RN defends MassHealth prior authorization decisions and conducts pre-service reviews, working with managers and peers. Based in Massachusetts with telecommute options for...Remote job
- Santa Barbara Cottage Hospital is seeking a PRN Clinical Review Specialist to provide remote clinical review support. You will evaluate medical necessity... ...clinical experience, and 2+ years in Utilization Review/Appeals. Strong documentation and Epic EMR skills are expected...Remote jobRelief
- CorroHealth Inc. is seeking a Clinical Review Specialist to provide remote, full-time review of inpatient and outpatient medical records for medical necessity... ..., with emphasis on accurate documentation and timely appeals, under the supervision of clinical leadership as...Remote jobFull timeMonday to Friday
- Piper Companies is seeking a Clinical Appeals Nurse for a fully remote healthcare-based opportunity. This Clinical Appeals Nurse position is a long-term contract role focused on clinical review, appeal resolution, regulatory compliance, and member/provider support within...Remote jobLong term contract
$80 per hour
...authorization, utilization management, clinical review, medical necessity criteria, payer authorization... ...This role supports current and upcoming remote consulting opportunities focused on AI-... ...status tracking, denial outcomes, appeal pathways, escalation processes, and turnaround...Remote workHourly payPart timeFor contractorsWork at officeFlexible hours- ...concurrent and retrospective review of inpatient, outpatient, ambulatory... ...and level of care, including appeal requests initiated by... ...of stays, etc. using approved clinical protocols. Analyze, research... ...0 Renaissance Ctr, Detroit, MI, 48243, US (Remote) UST HealthProofRemote workWork at officeLocal area
$58.9k - $80.07k
...The Appeals & Grievances (A&G) unit processes member and non-contracted... ...and complete care. Appeals Specialist is the subject matter expert responsible for non-clinical case development and case resolution... ...regulatory independent reviewer for denied cases. Preferred...Remote workTemporary workWork experience placement$50k
...Complete pre-authorizations, concurrent reviews, and internal utilization review assessments... ...reviews and coordinate urgent/expedited appeals Staff individual cases with medical... ...Nurse, Licensed Practical Nurse, Licensed Clinical Social Worker, Licensed Mental Health...Remote work$45.9k - $78.6k
...feels valued. Medica’s Appeals and Grievance Specialist plays a vital role in ensuring... ...whether each case is clinical or non-clinical and ensuring... ...This position is a Remote role.To be eligible for consideration... ...information, please review the Know Your Rights notice...Remote workWork experience placement$45k - $55k
...clickhere . Back to jobs Utilization Review Specialist Remote Weekly outpatient therapy isn't always... ...Specialist will act as the liaison between the clinical team and the insurance company,... ...Coordinating physicians’ reviews and appeals. Who You Are: Bachelor’s Degree (preferred...Remote workWork at office$29.7 - $31.8 per hour
...Description The Acute Coding Appeals Specialist integrates medical coding... ...Specialist is responsible for reviewing and writing appeals for inpatient... ...DRG and to address the clinical documentation utilized in the... ...experiences. This is a remote position; however, candidates...Remote workTemporary workWork at officeLocal area- ...healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and... ...case resolutions. This is a 100% remote role requiring an RN, LPN, or... ...practice and knowledge of Utilization Review Guidelines. The position offers a competitive...Remote work
- Judi Health is seeking a Clinical Appeals Reviewer to review coverage determinations and appeals for Commercial and Medicare lines, ensuring medical... ...thorough detail, while maintaining turnaround times in a remote environment. This remote role allows you to work from a...Remote jobWork from homeHome office
- ...seeking a detail-oriented Utilization Review (UR) Specialist to ensure high quality patient care and... ...reviews medical records for clinical necessity and regulatory alignment, serving... ...submitting authorizations, and drafting appeals, while advising staff on documentation...
- ...Seeking an experienced and detail-driven Utilization Review Specialist, the full-time remote position will manage a caseload of 50-75 patients, conducting... ...authorizations, and serving as a liaison between clinical operations and managed care organizations. Key Responsibilities...Remote workFull time
$39.31 - $46.73 per hour
...seeking a capable Cardiac Device Specialist who has acquired broad... ...programming to each individual clinical situation. This position may... ...arrhythmias, assessing symptoms, reviewing patients medical history and... ...ordering equipment to ensure remote connectivity and continuity...Remote workHourly pay$28 - $37 per hour
...Remote Coding Specialists, Clinics - single path (Fac and Profee) We offer comprehensive health and wellness plans, including medical, dental and... ...full range. Essential Job Responsibilities Thoroughly review and analyze medical records to identify pertinent...Remote workHourly payExtra incomeFull timeTemporary workLocal areaWork from homeHome office- ...Medica is seeking an Appeals and Grievance Specialist to manage member complaints, grievances, and regulatory... ...will determine whether cases are clinical or non-clinical, route them to the... ...Services, Legal, and Markets. This is a remote position with a competitive total...Remote work
$95k - $110k
...individual for a DRG Nurse Reviewer Appeals and Hearings to coordinate and... ...using approved clinical and coding guidelines and documents... ...Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional... ...expect in this role Remote (Work from Home) Up to 25%...Remote workFull timeWork from homeRelocation packageFlexible hours- ...Vee Healthtek is seeking an experienced Clinical Documentation Integrity (CDI) Specialist to perform concurrent inpatient reviews that improve accuracy, completeness, and clinical integrity of the medical record. The role partners with physicians, coding, and quality...Remote work
- ...care UM to perform pre-service and post-service utilization reviews and appeals for DMEPOS, working with our Medical Director in a NCQA-compliant... ...benefit and medical necessity criteria, coordinate with clinical and non-clinical staff, and communicate outcomes both...Remote work
- A leading medical review organization is seeking Board-Certified physicians in Gastroenterology for a flexible remote opportunity. This role requires conducting independent Utilization... ...in Gastroenterology, and 5 years of clinical experience. Adherence to HIPAA regulations...Remote workFlexible hours
- ...Alliance Health is seeking a UM Clinical Specialist-LTSS for full-time remote work, NC-based. You will perform utilization reviews and authorizations for I/DD and TBI waivers, ensuring services meet clinical guidelines and are provided in the least restrictive setting...Remote workFull time
$56.27k - $69.9k
...Appeals or Grievances Specialist II Working Title: Appeals Specialist II FLSA Status: Exempt Posting... ...6,270 - $69,898 Office Location: Remote within North Carolina. Make an... ...submission, your resume will be reviewed to ensure it meets the essential criteria...Remote workWork at officeLocal areaImmediate startWork from homeFlexible hours$29.62 - $45.31 per hour
...Department Coordinate and execute the review and research functions required to support... ...inquiries, provider resolutions, etc.) Remote Work This position offers 100% remote... ...caregivers serve in over 50 hospitals, over 1,000 clinics and a full range of health and social...Remote workMinimum wageFull timeWork experience placementLocal areaShift work- ...Compass Health Center is seeking a Remote Utilization Review Specialist to obtain insurance authorization for patients receiving Behavioral Health treatment... ...care. The UR Specialist serves as a liaison between the clinical team and insurers, helping patients overcome financial...Remote work
- ...Utilization Review Specialist The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to... ...thorough evaluation of patient records, treatment plans, and clinical data to determine the appropriateness of care and resource utilization...Remote work
- ...ABA Utilization Review SpecialistSpectrum Billing Solutions offers... ...ABA Utilization Review (UR) Specialist to our growing team. The ABA... ...knowledge and skills to review clinical information and obtain... ...environment. This is a fully remote or office/home hybrid position...Remote workWork at officeFlexible hours
- ...healthcare management company is seeking a Remote Coverage Review Pharmacist located in Tennessee. This... ...a Doctor of Pharmacy (PharmD) degree, clinical experience, and a solid understanding... ...-related prior authorizations, appeals, and grievances, working independently...Remote work
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