Remote RN Appeals Analyst - Medicare Medical Review
Southcarolinablues
- Remote job
Southcarolinablues is hiring an Appeals Analyst to join their team in Nashville, Tennessee. This role involves analyzing appeal requests and performing clinical reviews to ensure compliance with medical necessity guidelines. The position offers a full-time schedule and the option to work remotely or on-site. Ideal candidates should have at least two years of clinical experience, a valid RN license, and strong analytical skills. Benefits include health plans, 401(k), paid annual leave, tuition assistance, and wellness programs. #J-18808-Ljbffr Southcarolinablues
- ...BlueCross BlueShield, is hiring an Appeals Analyst. This role involves... ...requests and performing clinical reviews. The job is full-time, Monday through Friday, and can be remote or on-site in Nashville, TN.... ...clinical settings, and an active RN license. Benefits include 401...Remote workMedicalFull timeMonday to Friday
- ...BlueShield of South Carolina is hiring an Appeals Analyst to research and analyze complex... ...conducting thorough clinical reviews to ensure compliance with medical necessity guidelines. The successful... ...an Associate's degree, an active RN license, and significant clinical...Remote jobMedicalFull timeWork at officeWork from home
$70k - $85k
...Defense restrictions. Our Medical Review Nurse Analyst - Registered Nurse (RN) is responsible for... ...to authorizations, appeals, and medical review claims... ...Location We are open to remote work in the following... ...for beneficiaries of the Medicare program and manage benefits...Remote workMedicalContract workFor contractorsWork at officeLocal areaImmediate start- ...Job Description Fully remote- Must have state of MI unrestricted RN license. You will perform... ...and retrospective review of inpatient, outpatient,... ...ancillary services to ensure medical necessity, appropriate length... ...level of care, including appeal requests initiated by...Remote workMedicalWork at officeFlexible hours
$70k - $80k
Piper Companies is seeking a Remote Clinical Appeals Analyst to provide clinical expertise in reviewing and resolving complex member and... ...Carolina licensure as an RN, LPN, PT, or OT and have significant... ...along with company-subsidized medical, dental, and vision benefits....Remote jobMedicalFull timeContract workMonday to Friday- ...Job Title: Remote RN Review Analyst About Kyyba: Founded in 1998 and headquartered in Farmington... ...ambulatory and ancillary services to ensure medical necessity, appropriate length of stay,... ...service and level of care, including appeal requests initiated by providers,...Remote workMedicalContract workWork at officeLocal areaVisa sponsorshipWork visa
$50 per hour
...A leading healthcare staffing firm is seeking an experienced RN Clinical Reviewer to work remotely. You'll conduct detailed medical-legal reviews and appeals while maintaining high accuracy and integrity. Key qualifications include a New York State RN license and at least...Remote workMedical- Medix™ is seeking a dedicated Appeals Nurse (RN) to join our team in a fully remote capacity. This role involves clinical reviews and appeal determinations while collaborating with Medical Review Analysts and Physician Consultants to ensure compliant outcomes. The ideal...Remote jobMedical
- ...telephonic and e-referral case review and authorization of services... ...mental health and substance abuse medical necessity criteria to provide... ...position is full-time, fully remote (work from home) and requires... ...of Michigan clinical license (RN, LMSW, LP, LPC, or LLP)...Remote workMedicalFull timeWork from homeShift workWeekend workAfternoon shift
$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 and ensuring compliance with... ...communication skills. A California RN license and ADN are required. The...Remote jobMedicalHourly pay$29.05 - $67.97 per hour
...knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of... ...is not included in a compact RN license. Job Duties Facilitates medical... ..., and concurrent review of appeals for denied prior authorizations. Includes...Remote jobMedicalHourly payWork experience placementWork at office$80k - $90k
...*** Performs clinical reviews on medical records to maintain subject... ...expertise.* Conducts Appeals reviews on medical... ...and/or claims software analyst experience may be... ...work independently in remote setting with minimum supervision... ...* Active unrestricted RN license #J-18808-...Remote workMedicalFlexible hours- WPS—A health solutions company is looking for a Medical Review Nurse Analyst to evaluate medical records for TRICARE policy compliance... .... The ideal candidate should have a BSN, RN license, and 3 years in healthcare. Remote work is offered, and benefits include a...Remote jobMedical
- ...Administrators LLC is hiring an Appeals Analyst to join BlueCross... ..., conducting clinical reviews, and ensuring compliance with medical necessity guidelines. The... ...candidate will have an RN license, a degree in a related... ...with the option to work remotely or on-site, offering...Remote workMedicalFull time
- ...Boulder Partnership is seeking a Nurse Reviewer for Appeals and Hearings to coordinate and perform... ...This position is a full-time, permanent remote role that complies with work-from-home... ...should have at least 5 years of clinical or medical record coding experience, strong...Remote workMedicalPermanent employmentFull timeWork from homeFlexible hours
- ...currently hiring for an Appeals Analyst at BlueCross... ...appeal or retrospective review requests including pre... ...requested services meet medical necessity guidelines,... ...active, unrestricted RN license from the United... ...Knowledge of MCS systems. Medicare Part B experience. CMS...MedicalFull timeFor contractorsCurrently hiringWork at officeLocal areaWork from homeMonday to Friday
- ...currently hiring for an Appeals Analyst to join BlueCross... ...appeal or retrospective review requests including pre... ...requested services meet medical necessity guidelines.... ...active, unrestricted RN license from the United... ...MCS System Knowledge. Medicare Part B knowledge. CMS...MedicalFull timeFor contractorsCurrently hiringWork at officeLocal areaMonday to Friday
$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 challenges... ...successfully completes required CEUs to maintain RN license and/or coding certification. Responsible...Remote workMedicalFull timeWork from homeRelocation packageFlexible hours- ...Overview ShimSpine is looking for a Nurse Reviewer / Analyst to use our patented software to analyze... ...experience, with a strong grasp of medical terminology, treatments, and standards... ...development opportunities This is an onsite position. No remote work. #J-18808-Ljbffr...Remote workMedicalTemporary work
- ...Solutions) is seeking a full-time remote Licensed Appeals Nurse. This role involves examining medical records and claims for first-level... ...appeal cases, ensuring compliance with Medicare guidelines. The ideal candidate should have an RN license, along with relevant...Remote jobMedicalFull time
- Maximus is hiring a Senior Appeals Administrator to work within the California Independent Medical Review team. This role entails ensuring fair resolutions for medical review cases by analyzing data, maintaining case documentation, and serving as a subject matter expert...Remote jobMedical
- Maximus is seeking a Senior Appeals Administrator for the California Independent Medical Review team, responsible for ensuring fair resolutions for medical review cases. This role requires strong expertise in data analysis and communication skills to manage appeals effectively...Remote jobMedical
- Maximus is hiring a Senior Appeals Administrator in Providence, Rhode Island. In this role... ..., you will ensure fair resolutions for medical review cases by analyzing data and serving as a... ...to work independently within a fast-paced, remote environment. #J-18808-Ljbffr MaximusRemote jobMedical
- Maximus is seeking a Senior Appeals Administrator for the California Independent Medical Review team. This role focuses on ensuring fair resolutions for medical cases. Responsibilities include data analysis, serving as a subject matter expert, and maintaining project knowledge...Remote jobMedical
- Maximus is hiring a Senior Appeals Administrator for the California Independent Medical Review team. This role is essential for ensuring fair resolutions in medical review cases. You will serve as a subject matter expert, analyze data for medical reviews, and maintain project...Remote jobMedical
- Maximus is seeking a Senior Appeals Administrator to join their California Independent Medical Review team. This critical role ensures fair resolutions for medical cases... ...insurance coverage, the position supports remote work with required minimum internet speeds. An...Remote jobMedical
$24 per hour
Maximus is looking for a Senior Appeals Administrator in Denver, Colorado. In this role, you will ensure fair resolutions for medical review cases, analyze data for Independent Medical Reviews, and assist clients with the appeals process. Qualifications include an associate...Remote jobMedicalHourly pay$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX... ...and will include 80% travel. Remote role. Will require a driver... ...and resolving complaints and appeals. Licensed Clinical Social... ...top-tier hospitals and medical institutions nationwide, helping...Remote workMedicalHourly payFull timeContract workImmediate startShift work3 days per week$24 per hour
Maximus is hiring a Senior Appeals Administrator for its California Independent Medical Review team. In this position, you'll ensure timely resolutions for medical reviews, enhancing the quality of care provided. Ideal candidates have experience in data entry and MS Office...Remote jobMedical- Maximus is seeking a Senior Appeals Administrator for its California Independent Medical Review team. This role ensures fair resolutions for medical review cases and... ...MS Office applications. The role allows for remote work and offers a range of benefits including competitive...Remote jobMedical
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