Remote Appeals RN: Grievances & Medical Necessity Expert
HealthEdge
- Remote job
HealthEdge is seeking an experienced clinical professional to manage appeals and grievances in a remote setting. The role involves investigating requests from members and providers and ensuring compliance with regulations. This position requires a Bachelor's degree, a valid nursing license, and a minimum of two years of related experience. The work environment is fully remote, offering competitive compensation. #J-18808-Ljbffr HealthEdge
- ...Solutions is seeking a Clinical Appeal and Grievance Nurse to conduct clinical... ...role requires an active RN or LPN license and at least... ...responsibilities include analyzing medical necessity appeals, preparing cases... .... This position is remote and emphasizes independence...Remote jobMedical
$102.18k
...Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical... ...cases. Analyze the patient medical records, clinical... ...policies to determine medical necessity. Prepares and reviews A&G files... ...weekends, holidays, a hybrid remote schedule, and occasional flexibility...Remote workMedicalFull timeShift workWeekend work$88.85k
...Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals... ...Provider Claim Disputes, medical records or other issues... ...would be based on medical necessity reviews. Prepares... ...weekends, holidays, a hybrid remote schedule, occasional flexibility...Remote workMedicalFull timeShift workWeekend work- 260 CGS Administrators, LLC is seeking a RN Appeals Analyst to join their team. This fully remote role involves conducting thorough clinical reviews to determine medical necessity guidelines for appeals. Ideal candidates will have a nursing degree and relevant clinical...Remote jobMedicalWork at office
- ...nursing judgment to analyze medical records, documentation,... ...Registered Nurse (RN) license Strong clinical... ...populations Remote work – enjoy the convenience... ...to determine medical necessity, appropriateness,... ...letters, reason codes, and appeal rights in compliance...Remote jobMedicalFull timeTemporary workWork at officeWork from home
- ...to perform clinical reviews and audits on medical records, ensuring compliance with company... ...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 jobMedical
- The Elevance Health Companies, Inc. is seeking a Nurse Appeals RN-Quality of Care based in Metairie, Louisiana. The role involves investigating medical necessity appeals and reviewing member grievances to ensure timely resolutions. Applicants must have a current RN license...Remote jobMedicalFull time
- ...Nurse Appeals RN-Quality of Care Nurse Appeals RN-Quality of... ...investigating and processing medical necessity appeals requests from members... ...and reviews of member grievances and Quality of Care cases.... ...serves as a subject matter expert for grievances/quality of care...Remote workMedicalFull timeWork at office
- ...Schedule : The position is 100% Remote, and the candidates must... ...Description: The Grievance & Appeals Nurse is responsible for managing... ...resource and subject matter expert for grievance and appeals processes... ...appeal cases to identify medical urgency and escalation needs...Remote workMedicalWork at officeImmediate start
$248.5k - $373k
UnitedHealth Group is seeking an Appeals and Grievances Medical Director responsible for reviewing and adjudicating cases in various health plans.... ...clinical practice and Quality Management. This position offers remote work flexibility, allowing for a dynamic work environment...Remote jobMedical- ...nursing judgment to analyze medical records, documentation,... ...Registered Nurse (RN) license Strong clinical... ...populations Remote work - enjoy the convenience... ...eligibility, medical necessity, appropriateness, and level... ..., reason codes, and appeal rights in accordance...Remote workMedicalFull timeTemporary workWork at office
- ...Schedule : The position is 100% Remote, and the candidates must... ...: The Temporary Grievance & Appeals Nurse (LVN) is responsible for... ...as a clinical subject matter expert, providing guidance on grievance... ...assign new cases based on medical urgency and regulatory timelines...Remote workMedicalTemporary workWork at officeImmediate start
- Knowtion Health is seeking an Appeals Nurse to oversee the review and appeal... ...candidate will have a valid RN license, experience in an acute... ...familiarity with utilization review. This remote position offers a variety of benefits, including medical, dental, vision, and a...Remote jobMedical
$35 - $45.94 per hour
...their team. The role involves performing medical necessity reviews and working with care providers... ...patient care. Candidates must hold an active RN license and have at least one year of... ...review or acute care settings. This remote position offers a competitive pay range...Remote jobMedicalHourly pay$102.95k - $154.42k
...Nurse Appeals Lead- RN Locations: Indianapolis, IN, Grand... ...processing the most complex grievances and appeals requests... ...or retrospective medical records of denied services for medical necessity. Extrapolates and summarizes... ...as subject matter expert for team and works on...Remote workMedicalFull timeWork at officeLocal area- ...Your Role The Medicare Appeals and Grievances team is responsible for clinically reviewing... ...The Medicare Appeals and Grievances RN Lead will report to the Appeals and Grievances... .... Reviews will also be performed for medical necessity and to meet the criteria for the...MedicalFull timeWork at officeLocal area
- Blue Cross Blue Shield of Arizona seeks a Clinical Appeals Specialist to utilize their clinical acumen for resolving member and provider appeals, grievances, and claims. The role requires a minimum of 1 year of healthcare-related experience and an Associate's Degree in...Medical
- ...Medicare Appeals And Grievances Rn Lead The Medicare Appeals and Grievances team is responsible... ...Reviews will also be performed for medical necessity and to meet the criteria for the coding... ...date. Serve as a subject matter expert to aid in identification of Quality-...MedicalFull timeContract workWork at officeLocal area
- ...hiring a full-time Licensed Medical Review Nurse to conduct... ...documentation while working remotely. This role involves managing appeals and validating claims to ensure medical necessity and compliance with guidelines... ...review, and a valid RN license in Florida or Kentucky...Remote jobMedicalFull time
- Your Role The Medicare Appeals and Grievances team is responsible for clinically... ...Appeals and Grievances RN Senior will report to Utilization... ...candidate will review both medical (Medicare Part B/C) and pharmacy... .../DSNP benefits, medical necessity, coding accuracy and medical...MedicalFull timeWork at officeLocal area
- Your Role The Member Appeals and Grievances team is responsible for clinically reviewing member appeals... ...denial. The Appeals and Grievances RN Senior will report to the Appeals and... ...member appeals for benefits, medical necessity, coding accuracy and medical policy compliance...MedicalFull timeWork at office
$28.94 - $51.63 per hour
...Association Inc is seeking a Clinical Appeals RN to manage appeals and grievances effectively. This role requires a... ...Microsoft Office. You will review medical records, assess clinical... ...with all regulations while working remotely from anywhere in the U.S. Attractive...Remote jobMedicalHourly payWork at office- BlueCross BlueShield of South Carolina is seeking a RN Appeals Analyst to join their team in a fully remote role. The analyst will handle complex appeal requests, ensuring compliance with medical necessity guidelines. This full-time position requires an Associate's degree...Remote jobMedicalFull time
- Elevance Health is seeking a Nurse Appeals RN for their Quality of Care team based in Louisiana. The role involves investigating member grievances and reviewing medical records, ensuring compliance with regulatory timeframes. Qualified candidates must have an active RN...Remote jobMedicalFull time
$248.5k - $373k
UnitedHealth Group is looking for an Appeals and Grievances Medical Director to oversee clinical reviews and adjudications. This role offers the flexibility to work remotely from anywhere in the U.S. Key responsibilities include reviewing appeals cases, communicating with...Remote jobMedical$246.1k - $344.2k
Humana Inc. is looking for a Corporate Medical Director to provide clinical interpretation and medical decision... ...collaboration with various teams to address grievances and appeals. With responsibilities in a remote setting, the role offers a competitive salary range...Remote jobMedical- Humana Inc. is seeking a Corporate Medical Director to provide clinical interpretation... ...collaborating with teams to address grievances, making independent decisions on appeal cases, and maintaining knowledge of regulations. This remote position allows flexibility while...Remote jobMedical
- Humana Inc. is seeking a remote Corporate Medical Director to provide clinical interpretation and decision-making on healthcare services... ...collaborating with cross-functional teams to resolve grievances and appeals while maintaining compliance with healthcare regulations...Remote jobMedical
$269.5k - $425.5k
UnitedHealth Group is looking for an Appeals and Grievances Medical Director in Boston, MA. This role involves reviewing clinical appeals and grievances... ...board certification and significant clinical experience. Remote work is possible. Competitive salary range is $269,500 to...Remote jobMedical- Humana Inc is seeking a Corporate Medical Director in Phoenix, Arizona. The... ...medical decisions on complex appeal cases, and collaborating with teams on grievances. The ideal candidate will have an... ...years of clinical experience. This remote position offers competitive compensation...Remote jobMedical
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