Remote Grievances RN - Clinical Appeals & Quality
UnitedHealth Group
- Remote job
UnitedHealth Group is seeking a Clinical Grievances Nurse to review retrospective cases and current cases ensuring appropriate care and addressing immediate member needs. This role offers PST hours with remote work options and a Monday–Friday schedule. You will perform clinical assessments, consult Medical Directors, document case chronology, and communicate with providers to obtain needed information while upholding UHG values. #J-18808-Ljbffr UnitedHealth Group
$28.94 - $51.63 per hour
...communities and removing barriers to quality care. The work you do here... .... Growing together. The Clinical Appeals RN is responsible for... ...expertise in clinical appeals and grievances (analyzing, reviewing, and... ...the flexibility to work remotely * from anywhere within the...Remote jobQualityHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaWeekday work$29 - $52 per hour
...Clinical Grievances Nurse At UnitedHealthcare, we're simplifying... ...removing barriers to quality care. The work you do... ...flexibility to work remotely as you take on some tough... ...Current, unrestricted RN license in the state... ...experience Clinical appeals and grievances...Remote jobQualityHourly payMinimum wageFull timeWork experience placementLive inLocal areaImmediate startMonday to Friday- MedStar Health is seeking a nurse leader to oversee Intake Clinical Appeals, Complaints and Grievances. This role focuses on service excellence, policy... ...ensure adherence to NCQA and other standards while driving quality improvements and operational efficiency. #J-18808-...Quality
- Medica is a nonprofit health plan serving diverse communities with a mission to provide coordinated, quality care. The Appeals and Grievances Clinical Specialist III role focuses on reviewing, investigating, and resolving member and provider appeals with clinical expertise...Remote jobQuality
$25 - $35 per hour
...Companies is seeking a Clinical Appeals Nurse to join a... ...organization for a contract remote opportunity located in... ...Registered Nurse (RN) license in the State... ...of healthcare appeals, grievance processes, utilization... ...regulatory compliance, quality improvement, benefit determinations...Remote workQualityHourly payContract work$83.1k - $120.36k
...Appeals & Grievances Clinical Specialist The Appeals & Grievances (A&G) unit manages... .... This is either a remote or on-site position located... ...measures productivity and quality for each Specialist against... ...Minimum Qualifications: ~ RN, LPN OR Dental Hygienist...Remote workQualityContract workTemporary workWork experience placementLocal area$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 - RN, LPN or Dental Hygienist - 100% Remote role at Healthfirst . Position Summary: The Appeals & Grievances (A&G) unit...Remote jobFull timeMonday to FridayShift work$29 - $52 per hour
About This Role As a Clinical Grievances Nurse, you will review incoming retrospective... ...hours and are looking for a remote opportunity. Highlights Pay :... .../or members Provide timely, quality service to members and... ...metrics Requirements Education RN license in the state of...Remote jobQualityFull timeLive inImmediate startDay shift$70.2k - $120.4k
...connected care, where coordinated, quality service is the norm and... ...member feels valued. The Appeals and Grievances Clinical Specialist III position is... ...Active, unrestricted RN license required 5+ years of... ...applications. This position is a Remote role.To be eligible for...Remote workQualityWork experience placementWork at office$52 - $56 per hour
...RN Grievance & Appeals Specialist Remote Contract RNs with direct payer-side Grievance & Appeals experience... ...seeking an RN who has personally managed clinical grievances and appeals from... ...resolution. Review medical necessity quality-of-care concerns and outpatient...Remote workQualityHourly payContract workAfternoon shift$55 - $60 per hour
...Phaxis is looking for a dedicated Remote RN Grievance and Appeals Specialist in Manhattan where your contributions... ...impact on patient care and overall clinic operations. We are looking for a... ...Review Entities). Track Quality Trends: Identify recurring claim denial...Remote workQualityHourly payPermanent employmentContract workTemporary workMonday to Friday$53 per hour
...Job Description Job Description REMOTE RN OPPORTUNITY – GRIEVANCE & APPEALS / UTILIZATION REVIEW $53/hour | 100% Remote | Long-Term Contract... ...Managed care, Medicare/Medicaid experience Strong clinical judgment and communication skills Why Apply? Work...Remote jobLong term contractWork from homeMonday to FridayShift workWeekday work$46 per hour
...is immediately hiring for a RN Clinical Appeals Specialist Position type:... ...: Philadelphia PA 19103 (Remote) As a RN Clinical Appeals... ...opportunities for process improvement quality improvement provider... ...management clinical appeals grievance and appeals operations or related...Remote workQualityHourly payFull timeContract workTemporary workFor contractorsWork experience placementWork at officeImmediate startWorldwideFlexible hours- 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 work
- ...Job Description LTSS Appeals Nurse (Remote) We are seeking a... ...perform high-volume clinical reviews within the appeals... ...Support departmental quality and process-... ...Registered Nurse (NY RN) license. Residency... ...utilization review, appeals, grievances, or clinical...Remote workQualityLocal areaMonday to FridayFlexible hoursShift work
- ...are searching for a new RN to join our team. Our... ...flexibility to work remotely and do not have face-to... ...skills in addition to clinical experience. Upon receipt... ...by the Bookkeeper. Quality review rough draft... ...preferably in the capacity of Appeals/Grievances, Case Management,...Remote jobQualityHome officeMonday to FridayWeekend work
- ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical Appeals Position Overview... ...Appeal overturn rate and recovery contribution Quality and clarity of appeal documentation Timeliness...Remote workQuality
- ...Clinical Supervisor, UM Denial Compliance Location... ...Position Type: Hybrid (85% remote, 15% onsite in Burbank... ...in ensuring a high-quality, efficient, and... ...Registered Nursing Program; RN preferred. Minimum... ...prior-authorization, appeals & grievance, or health plan compliance...Remote workQualityPermanent employmentTemporary work
- UnitedHealth Group is seeking a Clinical Appeals RN to provide expert analysis of appeals and grievances, acting as a clinical interface liaison with facilities, providers... ...confidentiality adherence. The position offers remote work from anywhere in the U.S., with an M-F...Remote job
- ...is seeking a Medical Director to lead appeals and grievances review for UnitedHealthcare. This role... ...HMO, MAPD, and PDP products, applying clinical criteria and regulatory requirements.... ...of clinical practice and 2+ years in quality management, strong telephonic communication...Remote jobQuality
$28 - $51 per hour
About This Role The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances, analyzing, reviewing, and evaluating appeals and grievances, and acting as a Clinical Interface Liaison to resolve issues concerning members, benefits, and...Remote jobFull timeDay shift- ...Medi-Cal Member Appeals And Grievances Rn Senior The Medi-Cal Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result... ...to identify any Potential Quality Issues (PQI), Quality of Service (QOS...QualityFull timePart timeWork at officeLocal areaWork from homeHome office2 days per week
- UnitedHealthcare is hiring a Clinical Appeals RN to provide expertise in appeals and grievances, analyze cases, and serve as a Clinical Interface Liaison with facilities... ...definitions while ensuring confidentiality. Remote work is allowed from anywhere in the U.S., with M...Remote jobLocal area
- Note: This is a remote position. Seeking applicants who reside with... ...members through our high-quality health, life, disability, dental... ...knowledge to evaluate clinical information using evidence-based... ...complex medical claims and/or appeal cases and associated records...Remote workQualityCasual workWork at office
- UnitedHealthcare is hiring a Clinical Appeals RN for remote work Monday-Friday, with alternating Saturdays. The role analyzes appeals and grievances, acts as a clinical liaison, and supports resolution with facilities, providers, and plans. We offer a flexible schedule,...Remote jobHourly payWork at officeMonday to FridayFlexible hours
- Cambia Health Solutions is seeking an Appeals Clinician I to join our Clinical Services team. This role conducts clinical reviews of... ...clinical cases, supporting patients’ access to quality care. The position supports a remote work model across Oregon, Washington, Idaho, and...Remote jobQuality
$53.46k
...the substance of complex appeal or retrospective review... .... Provides thorough clinical review or benefit analysis... ...This is a full-time, remote (40-hours/week)... ...information to identify quality of care issues To Qualify... ...An active, unrestricted RN license from the United...Remote workQualityFull timeFor contractorsWork experience placementLocal areaMonday to FridayShift work- ...are currently hiring for an RN Appeals Analyst to join BlueCross BlueShield... ...requests, provide thorough clinical review or benefit analysis to... ...EST and will be fully remote in South Carolina or Georgia.... ...information to identify quality of care issues. To Qualify for...Remote workQualityFull timeFor contractorsWork experience placementCurrently hiringWork at officeLocal areaMonday to Friday
- ...Clinical Coordinator Under the general direction of... ...to inquiries related to appeals following clinical determinations... ...improvement and quality assurance activities.•... ...experience required OR RN licensed to practice in... ...Conditions Remote/desk work with- some statewide...Remote workQualityWork experience placementWork at office
$246.1k - $344.2k
...of medical records for appeals decisions. The... ...Medical Director provides clinical interpretation and makes... ...appropriateness, necessity, and quality of services rendered... ...clinical reviews of grievance and appeal cases for... ...Work Style: Fully remote living in the USA. Occasional...Remote workQualityFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to FridayWeekend work
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