Remote RN: Medical Appeals & Care Policy Reviewer
$45 per hourSPECTRAFORCE
- Remote job
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 clinical policies. Ideal candidates will have strong managed care and clinical nursing experience, exceptional attention to detail, and effective communication skills. A California RN license and ADN are required. The position offers a competitive hourly rate of $45.00/hr. #J-18808-Ljbffr SPECTRAFORCE
- Dane Street, LLC seeks a remote physician reviewer to manage insurance appeals and determine medical necessity in accordance with client policies and evidence-based guidelines. You will review medical records across specialties, ensure transparent, well-documented decisions...Remote jobPolicyFor contractorsFlexible hours
$50 - $60 per hour
...Description Hospital Appeal UR Nurse... ...days onsite / 1 day remote; Potential future... ...initiative. This role will review denied or... ...preferably in an acute-care/hospital setting.... ...interpret complex medical records and billing... ...Familiarity with payer policies and multi-level...Remote workPolicyContract workLocal areaMonday to Friday- ...members whose cases come for review, in partnership with... ...Review Units' appeal process of service denials... ...Physician Review Units' policies and procedures. Actively... ...as assigned by the Medical Director. Board Certified... ...of managed care and demonstrate PC proficiency...Remote workPolicy
$115 per hour
...Title: Physician Reviewer Contract Duration... ...Arrangement: Remote in any state... ...criteria to make medical necessity determinations... ...quality patient care through clinical review... ...collaboration, appeals participation, and... ...Review Unit policies and procedures....Remote workPolicyContract work- ...to provide utilization review services for the Group... ...clinical expertise to review medical records and provide an... ..., and client-specific policies. Dane Street's... ...every day. We care for our customers, each... ...Prior Authorizations and Appeals including medical records...Remote workPolicy
- ...Description Physician Peer Reviewer – Multiple... ...Hearings and Appeals Services (FHAS) is... ...accredited Independent Medical Review... ...Pediatric Critical Care Medicine, Developmental... ...regulations, and applicable policy guides Completes... ...Job Type Contract Work Location Remote...Remote workPolicyContract workWork experience placementWork at office
$11.41 per hour
...Role Snapshot The Appeals Nurse examines medical records and claims... ...regulations and policies. The Appeals RN works in collaboration... ...are medically reviewed as needed and completed... ...We are open to remote work in the following... ...medical necessity of care. Prepare and submit...Remote workPolicyHourly payFull timeContract workFor contractorsLocal areaImmediate startShift work$70.97 - $125 per hour
Psychiatrist Physician Reviewer - PRN - Remote (Within Illinois)... ...hospitals to establish medical necessity and continued... ...goals and policies to improve clinical operations... ...organization through state appeal processes Review... ...of level of care Knowledge of Medicaid...Remote jobPolicyHourly payPart timeReliefLocal area- ...the quality of care, and influence healthcare... ...setting to review and audit claims... ...to analyze medical records, documentation... ...Nurse (RN) license Strong... ...populations Remote work - enjoy the... ...compliance with MA policies and identify potential... ...codes, and appeal rights in...Remote workPolicyFull timeTemporary workWork at officeWork from home
- ...seeking a Full-Time Utilization Management Physician Reviewer to provide accurate coverage determinations for... ...UM criteria, clinical judgment, and internal policies. You will coordinate with care teams to ensure medically appropriate care is delivered in the right...Remote workPolicyFull time
$80k
...and complexity of care as documented in patient medical records.... ...medical record review and interaction... ...and writes denial appeal letters. Collaborates... ...Education Current RN Licensure... ...Top Workplace for Remote Work 2024 Great... ...employer. It is our policy not to discriminate...Remote workPolicyLocal area- ...the quality of care, and influence healthcare... ...setting to review and audit claims... ...to analyze medical records, documentation... ...Nurse (RN) license Strong... ...populations Remote work - enjoy the... ...reason codes, and appeal rights in accordance... ...MA hospice policies, regulations, and...Remote workPolicyFull timeTemporary workWork at office
- ...All-Inclusive Care for the Elderly... ...adults with complex medical needs. We have... ...Utilization RN is responsible... ...retrospective clinical reviews to determine... ..., payer policies, and regulatory... ...-coverage, and appeal summaries that... ...Work Conditions Remote role with reliable...Remote workPolicyFull timePart timeWork at officeLocal areaWeekend workAfternoon shift
- ...appropriate cases to the Medical Director for review. Refer to and work... ...and medical policies and contractual benefits... ...benefits, and efficient care delivery processes. Ensures... ...and active NYS RN license required. Bachelors... ...be opportunity for remote work within all jobs...Remote workPolicyContract workWork at office
$2,128 per week
...Registered Nurse (RN) | Med/Surg / Telemetry Location... ...Title: RN II - MST / Medical Telemetry Profession:... ...telemetry. • Willingness to care for both Medical... ...patients is expected. Remote Monitor Technicians are... ...students. Cancellation policy allows for 4 shifts per...Remote workPolicyFull timeContract workFlexible hoursShift work- ...manage the total cost of care. We are currently looking for a Physician Reviewer to join our growing... ...support. Office Location Remote - flexible hours... ...software system(s). Applies medical judgement and pertinent... ...developing and reviewing policies as requested/needed....Remote jobPolicyFull timeWork at officeLocal areaWork from homeFlexible hours
$155 - $165 per hour
...EPITEC As a Physician Reviewer, you'll play a critical... ...quality, cost-effective care. You'll work closely with... ...opinions, and develop policies and procedures that... ...proficiency in PC (electronic medical records) Strong... ...activities What We Offer Fully remote work arrangement (...Remote workPolicyFull timeContract workWork at officeWeekend work$75.3k - $135.4k
...willing to obtain an RN license for the... ..., Concurrent Review, and/or... ...ensure appropriate care to members. Supervises... ...guidelines, policies, and procedures... ...knowledge of appeals and utilization... ...Services (Medical Management): Certified... ...NOTE: REMOTE RN candidates may...Remote workPolicyFull timePart timeWork experience placementWork at officeFlexible hours$130 - $145 per hour
...Health Physician Reviewer to join our Utilization... ...Behavioral Health Medical Director oversees... ...position is fully remote and open to... ...internal guidelines and policies, while utilizing... ...) and first-level appeals, within required turnaround... ...health managed care, utilization...Remote workPolicyHourly payFull timePart timeWork from homeHome office$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the Appeals... ...prior approval, medical necessity, pre-... ...reference internal policies. Make... ...prepare cases for review and appeals. Minimum... ...with care management systems...Remote jobPolicyFull timeMonday to FridayShift work- ...is seeking a Clinical Utilization Review Nurse (RN) for a 100% remote, full-time role supporting Alaska... ...contracts. The nurse will assess medical necessity and care quality through prospective,... ...InterQual criteria and organizational policies. Required BA/BS in Nursing with a...Remote workPolicyFull time
- ...RN - ER Excel is seeking highly skilled healthcare professionals for travel assignments... ...settings, providing essential medical care while exploring new locations and cultures... ...in accordance with healthcare facility policies and procedures. Collaborate with interdisciplinary...Remote workPolicyHourly pay
- ...RN - Telemetry Excel is seeking highly skilled healthcare professionals for travel... ...settings, providing essential medical care while exploring new locations and cultures... ...in accordance with healthcare facility policies and procedures. Collaborate with interdisciplinary...Remote workPolicyHourly pay
- ...RN - PCU/IMC/Stepdown Excel is seeking highly skilled healthcare professionals... ...healthcare settings, providing essential medical care while exploring new locations and cultures... ...in accordance with healthcare facility policies and procedures. Collaborate with interdisciplinary...Remote workPolicyHourly pay
- ...RN Principle Care Management (PCM) Program Manager The RN... ...involves managing a team of medical assistants,... ...implement workflows, policies, and procedures to enhance... ...Facilitate team meetings, case reviews, and interdisciplinary... ...with 1 day working remote Standard business...Remote workPolicyCasual workWork at officeAfternoon shift
- ...RN - Neuro ICU Excel is seeking highly skilled healthcare professionals for travel... ...settings, providing essential medical care while exploring new locations and cultures... ...in accordance with healthcare facility policies and procedures. Collaborate with interdisciplinary...Remote workPolicyHourly pay
- ...Behavioral Health Utilization Reviewer The Behavioral... ...requests, claims, and appeals to confirm medical necessity and appropriateness of care. The reviewer applies evidence... ...and/or medical policy and collaborates with the... ...behavioral health RN license in Louisiana can...Remote workPolicyWork at office
- ...a Telecommuter Utilization Review Clinician to evaluate clinical requests and determine medical necessity across inpatient,... ...with Medical Directors and Care teams to ensure cost-effective... ...InterQual and internal policies. The role requires RN licensure, a Bachelor's or...Remote jobPolicy
- ...delivering exceptional patient care. As our practice... ...role is ideal for an RN or LPN who enjoys patient... ...services. This role reviews medical histories, evaluates procedure... ..., and organizational policies. Qualifications... ...in the role, occasional remote work opportunities may...Remote workPolicyFull timeCasual workPrivate practiceWork at officeMonday to FridayFlexible hoursWeekend work
- ...exceptional patient care. As our practice... ...role is ideal for an RN or LPN who enjoys patient... ...the electronic medical record, phone, and... ...the physician for review and direction. Coordinate... ...and organizational policies. Contribute to a... ...off! Hybrid remote work may be...Remote workPolicyFull timePrivate practiceWork at officeMonday to FridayFlexible hours
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