Remote RN: Medical Appeals & Care Policy Reviewer

$45 per hour

SPECTRAFORCE

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

Apply

Vacancy posted 2 days ago

Similar jobs that could be interesting for youBased on the Remote RN: Medical Appeals & Care Policy Reviewer in California, MO vacancy

Remote Physician Reviewer: Clinical Appeals & Review (Contract)
...Healthforce is seeking a Physician Reviewer with 5+ years of clinical... ...clinical review of service requests remotely. The role requires board... ...managers, and contributing to policy development and quality initiatives... ...while supporting managed care #J-18808-Ljbffr Walker Healthforce...
Remote job
Policy
Full time
Contract work
Immediate start
Weekend work
Walker Healthforce, Inc.
Richardson, TX
2 days ago
Physician Reviewer
...remote in any state except NY, CA, HI or AK... ...whose cases come for review, in partnership... ...Physician Review Units' appeal process of service... ...Review Units' policies and procedures.... ...as assigned by the Medical Director. Board Certified... ...of managed care and demonstrate PC...
Remote work
Policy
Mindlance
Chicago, IL
17 hours ago
RN Clinical Appeals Specialist
$40 - $46 per hour
...immediately hiring for a RN Clinical Appeals Specialist... ...Philadelphia PA 19103 (Remote) As a RN... ...resolution including case review outreach... ...including denial letters medical records benefit... ...information medical policy clinical criteria... ...Management Care Management Claims...
Remote work
Policy
Hourly pay
Full time
Contract work
Temporary work
For contractors
Work experience placement
Work at office
Immediate start
Worldwide
Flexible hours
Innova Solutions
Philadelphia, PA
7 days ago
Utilization Management Physician Reviewer
...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 work
Policy
Dane Street
United States
4 days ago
Physician Reviewer Multiple Specialties - TEXAS and NEW MEXICO
...Physician Peer Reviewer - Multiple Specialties... ...Hearings and Appeals Services (FHAS) is... ...accredited Independent Medical Review... ...Pediatric Critical Care Medicine, Developmental... ...regulations, and applicable policy guides... ...Contract Work Location Remote
Remote work
Policy
Contract work
Work experience placement
Work at office
Federal Hearings and Appeals Services LLC
Wilkes Barre, PA
3 days ago
Utilization Management RN Reviewer
...Utilization Management RN Reviewer Location Cleveland Facility Remote Location Department... ...Specialist include medical record review,... ...concurrent denials appeals process, clinical team... ...experience with Care Guidelines, Medical... ...in accordance with policies and procedures Knowledge...
Remote work
Policy
Full time
Work at office
Shift work
Weekend work
ccf
New York, NY
3 days ago
Behavioral Health Physician Reviewer (Part-Time)
$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 work
Policy
Hourly pay
Full time
Part time
Work from home
Home office
Oscar
New York, NY
a month ago
w3r Consulting Physician Reviewer $90.25 - $109.25 / hour Utilization
In this remote contract role, the physician reviews clinical service requests from... ...judgment and managed care criteria to... ...case management, and appeal support, with some... ...to physician review policies, procedures, and continuous... ...as assigned by the Medical Director. Use...
Remote work
Policy
Full time
Contract work
Weekend work
Weekday work
Folioworks
New York, NY
3 days ago
Physician Reviewer | Remote | Contract
Back Physician Reviewer | Remote | Contract Business & Care Management Richardson , Texas Contract... ...Participate in appeals of service denials Support... ...development of clinical review policies and procedures Participate... ...as assigned by the Medical Director What We Offer: Competitive...
Remote job
Policy
Weekly pay
Full time
Contract work
Immediate start
Monday to Friday
Weekend work
Walker Healthforce, Inc.
Richardson, TX
2 days ago
Appeals Registered Nurse
Role Snapshot The Appeals Nurse examines medical records and claims information... ...regulations and policies. The Appeals RN works in... ...redeterminations are medically reviewed as needed and... ...We are open to remote work in the following... ...medical necessity of care. Prepare and...
Remote work
Policy
Contract work
For contractors
Local area
Immediate start
WPS Health Solutions
Columbus, OH
3 days ago
RN OASIS Reviewer
$40 - $52 per hour
...Clinical Data Coordinator/OASIS Review VNA Health Group Remote Per Diem This... ...with the Plan of Care and medication profile • Submit OASIS... ...Qualifications • Current NJ RN License required • BSN... ...state or local laws. This policy applies to all terms and...
Remote work
Policy
Daily paid
Work experience placement
Work at office
Local area
VNA Health Group
Neptune, NJ
2 days ago
Remote Appeals Clinician I - RN
...Solutions is seeking an Appeals Clinician I to join our Clinical... ...role conducts clinical reviews of member and provider... ...decisions in line with medical policy and regulations. You will... ...patients’ access to quality care. The position supports a remote work model across Oregon,...
Remote job
Policy
Cambia Health Solutions
New York, NY
4 days ago
RN Utilization Management Reviewer
$35 - $40 per hour
...analytics. Job Title RN Utilization Management Reviewer Responsibilities... ...procedures, Medicare Part B medications, LTSS, and Home... ...notification to primary care team, specialty... ...consistency in applying policy. Collaborate with UM... .... Location: Fully remote work at home role....
Remote work
Policy
Hourly pay
Temporary work
Monday to Friday
Flexible hours
Weekend work
Sagility LLC
New York, NY
1 day ago
Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Medical Assistance Expert)
...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 work
Policy
Full time
Temporary work
Work at office
Work from home
The CKHobbie Group
Pittsburgh, PA
2 days ago
Clinical Appeals & Grievances Expert (RN)
...of clinical cases for member and provider appeals, ensuring compliance with applicable laws and internal policies. The role can be remote or on-site at the NYC or Lake Mary... ...guidelines, and prepare cases for internal and external reviews. #J-18808-Ljbffr Healthfirst
Remote work
Policy
Healthfirst
New York, NY
2 days ago
Remote Utilization Management Physician Reviewer
...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 work
Policy
Full time
Oak Street Health
Richmond, VA
2 days ago
Physician Reviewer - Internal Medicine
...Certified Internal Medicine physicians to conduct Independent Medical Exams (IME) and Peer Reviews. This opportunity allows you to customize your schedule... ...recognized evidence-based guidelines, client-specifics, policies, procedures, performance standards, and URAC guidelines....
Remote work
Policy
For contractors
Monday to Friday
Dane Street
United States
17 hours ago
Registered Nurse RN ICD 10 and Oasis Reviewer
...Registered Nurse Rn Icd 10 and Oasis Reviewer REGISTERED NURSE (RN) - EPISODE ASSESSMENT... ...- HOME HEALTH SERVICES - REMOTE Must live in South Carolina... ..., where we deliver quality care where the patients choose... ...in accordance with policy and the individualized care...
Remote work
Policy
Live in
Flexible hours
PruittHealth
Norcross, GA
7 hours ago
Utilization Management Physician Reviewer
$230k
...Utilization Management Physician Reviewer We're building a... ...colleagues who care deeply, innovate with purpose... ...Location: Fully Remote Hours: Full-Time, Monday... ...judgment, and internal policies and procedures.... ...responsible for ensuring medically appropriate care is recommended...
Remote work
Policy
Full time
Monday to Friday
CVS Corporation
United States
4 days ago
Remote Utilization Management Nurse RN - Appeals Specialist
...seeking an Utilization Management Nurse to review medical records, extract case details, and craft defensible appeal letters under policy guidance. The role supports telecommuting within... ...an Associate’s degree, an unrestricted RN license, 3+ years bedside nursing in acute...
Remote job
Policy
Work at office
Monday to Friday
UnitedHealth Group
Newtown Square, PA
1 day ago
RN Clinical Documentation Specialist - Referrals
$80k
...and complexity of care as documented in patient medical records.... ...medical record review and interaction... ...and writes denial appeal letters. Collaborates... ...~ Current RN Licensure... ...Top Workplace for Remote Work 2024 Great... ...employer. It is our policy not to discriminate...
Remote work
Policy
Local area
Ensemble Health Partners
Putnam, CT
3 days ago
Physician Reviewer - Utilization Management
$219k - $286.9k
...'re hiring a Physician Reviewer to join our Utilization... ...You will determine the medical appropriateness of inpatient... ...Location: This is a remote position, open to... ...internal guidelines and policies, while utilizing clinical... ...in a managed care plan (health care industry...
Remote work
Policy
Full time
Local area
Work from home
Home office
Weekend work
Oscar Health
Phoenix, AZ
1 day ago
Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Hospice Expert)
...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 work
Policy
Full time
Temporary work
Work at office
The CKHobbie Group
Harrisburg, PA
2 days ago
Document Processing Associate
$44.46k - $52.3k
...Association of American Medical Colleges is a not-for-... ...to transforming health care by supporting the entire... ...HybridWork - Primarily remote roles with theabilityto... .... Team members review, validate, and process... ...AMCAS and Fee Assistance policies and procedures. Engage...
Remote work
Policy
Hourly pay
Work experience placement
Association of American Medical Colleges
Washington DC
17 hours ago
Utilization Review RN
...of All-Inclusive Care for the Elderly) Centers... ...with complex medical needs. We have four... ...: Utilization Review RN Job Summary... ...based criteria, payer policies, and regulatory... ...non-coverage, and appeal summaries that... ...Work Conditions ~ Remote role with reliable...
Remote work
Policy
Full time
Part time
Work at office
Local area
Weekend work
Afternoon shift
Miami Jewish Health
Doral, FL
4 days ago
Remote Physician Reviewer - Utilization & Guidelines
Oscar Health seeks a Physician Reviewer to join the Utilization Management team in a remote US-based role. You will determine the medical appropriateness of services and document decisions... ..., and adherence to laws and internal policies. The role offers strong benefits and a...
Remote job
Policy
Oscar Health
Phoenix, AZ
1 day ago
Physician Reviewer - US Healthcare - 1+ Years - Pan India
Physician Reviewer - (Medical Reviewer - US Healthcare) - 1+ Years - Pan India We are looking for... ...quality-driven environment. Location - Remote / Work From Home (India) Your Future Employer... ...information security and regulatory policies. Requirements MBBS from India or MD (...
Remote work
Policy
Work from home
Day shift
Crescendo Global Leadership Hiring India
New York, NY
3 days ago
REMOTE LTSS Appeals RN (NY License)
...Description LTSS Appeals Nurse (Remote) We are seeking... ...-volume clinical reviews within the... ...evaluating complex medical records and Long-... ...all organizational policies and healthcare regulations... ...Nurse (NY RN) license. Residency... ...with Personal Care Aide (PCA)...
Remote job
Policy
Local area
Monday to Friday
Flexible hours
Shift work
Medix
New York, NY
a month ago
Physician Reviewer
$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 work
Policy
Full time
Contract work
Work at office
Weekend work
EPITEC
New York, NY
3 days ago
Physician Reviewer/Medical Director
...Resources, Inc ( IRI ) Title: Medical Director Location: REMOTE Duration: 06+ months (... ...Director’s work includes reviewing all submitted medical records... ...CMS requirements, Company policies, clinical standards, and (... ...direct clinical patient care experience post residency...
Remote work
Policy
Contract work
Integrated Resources, Inc ( IRI )
New York, NY
17 hours ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote RN: Medical Appeals & Care Policy Reviewer. Be the first to apply!