Remote Clinical Appeals RN - Review & Resolve
Stryker Corporation
- Remote job
UnitedHealthcare is seeking a Clinical Appeals RN to provide expertise in clinical appeals and grievances, analyzing, reviewing, and evaluating appeals and grievances, and acting as a Clinical Interface Liaison with facilities, providers, carriers, and resolution of issues concerning members and benefits. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. #J-18808-Ljbffr Stryker Corporation
- ...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
- UnitedHealth Group is seeking a Clinical Appeals RN to analyze appeals and grievances, acting as... ...facilities, providers, and carriers. Remote work is offered across the U.S. with a... ...alternating Saturdays. Responsibilities include reviewing records for eligibility, interpreting...Remote job
- ...Cottage Hospital is seeking a PRN Clinical Review Specialist to provide remote clinical review support. You will evaluate... .... The role requires an active RN license (compact preferred), 3-5... ...and 2+ years in Utilization Review/Appeals. Strong documentation and Epic EMR...Remote jobRelief
$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 workFull timeContract workMonday to Friday$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization that delivers... ...to support negotiations and appeals process Interacts with internal... ...audit adjustments and resolve issues Research reference... ...~ Active and unrestricted RN license OR LPN in the state of...Remote workHourly payMinimum wageFull timeTemporary workWork experience placementLocal area- Registered Nurse (RN) Clinical Denials and Appeals United States Job Description Inova... ...role will be Full-Time Remote, Monday-Friday (8-Hours per... ...Appeals Job Responsibilities: Reviews denied claims to identify... ...external stakeholders to resolve complete appeal issues and...Remote workFull timeMonday to FridayFlexible hours
- Medica, a nonprofit health plan, is seeking a remote Appeals & Grievances Clinical Specialist III to review and resolve appeals and grievances with clinical oversight. The... ...staff. This position requires an active RN license and 5+ years of clinical experience, preferably...Remote job
- UnitedHealth Group is seeking an experienced Clinical Appeals RN to analyze and resolve appeals and grievances. This remote role supports facilities, providers, and members... ...Medical Directors. Responsibilities include reviewing records, interpreting plan language, and...Remote job
- Alaffia is seeking a Clinical Itemized Bill Reviewer to join our Appeals and Disputes team. You will review disputes tied to Payment Integrity findings, focusing... ...of CPT/ICD-10/HPCS coding guidelines. This is a remote role in the United States. #J-18808-Ljbffr NearaRemote job
$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the Appeals and Grievances Clinical Specialist... ...: Develop and resolve clinical cases such as pre-existing... ...and prepare cases for review and appeals. Minimum Qualifications...Remote jobFull timeMonday to FridayShift work$95k - $110k
...DRG Nurse Reviewer Appeals and Hearings- Remote It takes great medical minds to create powerful solutions... ...and redeterminations using approved clinical and coding guidelines and documents... ...completes required CEUs to maintain RN license and/or coding certification....Remote workFull timeWork from homeRelocation packageFlexible hours$81.1k - $116.48k
Position Summary: The Appeals & Grievances (A&G)... ...of or delivery of clinical and non-clinical... ...the organization to resolve issues in a timely... ...This position is 100% Remote. We are hiring for... ...for Medical Director Review ensuring that all... ...Minimum Qualifications: RN, LPN OR Dental...Remote jobContract workTemporary workWork experience placementLocal areaMonday to FridayShift work- ...belong at St. Joe’s. Job Summary The Clinical Denial Appeals Coordinator supports the Revenue Cycle... ..., and other healthcare providers to resolve denials, underpayments,... ...Participate in telephone clinical reviews and multidisciplinary discussions regarding...Remote workWork at office
$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 position...Remote jobHourly pay- UnitedHealthcare is seeking a Clinical Appeals RN to provide expertise in appeals and grievances... ...providers, and carriers. The role allows remote work from anywhere in the U.S., with a... ...overtime. Responsibilities include reviewing medical records, determining eligibility...Remote job
$90k - $105k
...impact on the lives of others! We are looking for a RN Reviewer to join our team! Position Overview: The RN Clinical Documentation Reviewer reviews clinical... ...nurses, clinical leadership, and support staff to resolve documentation issues and support timely record completion...Remote job$60 per hour
...organization in Jericho, NY is seeking a Full-time Registered Nurse Clinical Reviewer. This role requires a Baccalaureate degree in Nursing and... ...will have 1-3 years of experience in utilization review or appeals and strong communication skills, contributing to patient...Hourly payFull time- UnitedHealth Group is seeking a Clinical Appeals RN to attend MassHealth appeal hearings, defend prior... ...perform pre-service clinical coverage reviews. You will work with managers and peers... ...in Managed Care or clinical settings. Remote work within Massachusetts is available...Remote job
- Optum is hiring a Clinical Review Clinician to serve as a subject matter expert for itemized bill reviews and hospital facility bill analysis... ...guideline interpretation, and supporting negotiations and appeals. Remote work is available nationwide with full benefits and...Remote job
- ...patients. Ensures completion of appropriate clinical review of all applicable patients as stated in... ...days for first week. This role will be remote BUT regular meetings/trainings require... ...assistance and/or clinical support to aid in appeal process. Serves as resource to Case...Remote workReliefWeekend work3 days per week
- Optum, a part of UnitedHealth Group, seeks a Clinical Appeals RN to attend MassHealth appeal hearings, defend prior authorization decisions, and conduct clinical coverage reviews for the MA program. This role supports the MA MLTSS program and requires in-state nursing credentials...Remote job
$28.94 - $51.83 per hour
...Clinical Appeals RN Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives... ...pre-service/prior authorization clinical coverage review of services. Works closely with managers and peers. If you...Remote jobHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal area- WPS Health Solutions is hiring an Appeals Nurse to review medical records and claims for first-level Medicare appeal cases... ...medically reviewed. Qualifications include an active RN license (state of practice), 1+ years clinical experience, and strong communication skills. #J-...Remote job
- UnitedHealth Group in Massachusetts is seeking a Clinical Appeals RN to attend appeal hearings and defend MassHealth prior authorization decisions. The role supports pre-service/prior authorization reviews and requires MA licensure and clinical experience. The position...Remote job
- Healthfirst is seeking an A&G Clinical Specialist to lead the... ...cases for member and provider appeals, ensuring compliance with applicable... ...policies. The role can be remote or on-site at the NYC or Lake... ...cases for internal and external reviews. #J-18808-Ljbffr HealthfirstRemote work
$29 - $52 per hour
...Connecting. Growing together. The Clinical Claim Review RN will be responsible for performing compliance... ...applicable, the Auditor will support appeal and fraud investigation activities.... ...your schedule. This position is Remote in Massachusetts. You will have the...Remote workHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work- Inova Health System is seeking a dedicated Registered Nurse (RN) Clinical Denials and Appeals to join the team as a Full-Time Remote role. The position supports review of denied claims, development and submission of timely appeals, and collaboration across UR, Coding,...Remote jobFull time
- ...BlueShield of South Carolina is hiring an RN Appeals Analyst to research complex appeal... ...support both pre- and post-payment reviews. The role is full-time, remote with on-site requirements for... ...needs. Requires nursing licensure and clinical review experience. #J-18808-Ljbffr...Remote jobFull time
$71.59k - $116.48k
...organization is seeking an A&G Clinical Specialist to manage health member complaints and appeals. This fully remote position requires expertise... ...and the ability to effectively resolve cases independently. The ideal candidate should be an RN, LPN or Dental Hygienist with...Remote job- ...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 job
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