Remote RN: Medical Appeals & Care Policy Reviewer
$45 per hourSPECTRAFORCE
California, MO
- 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
Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the Remote RN: Medical Appeals & Care Policy Reviewer in California, MO vacancy
- ...Job Title- Appeal and Grievance Coordinator Reviewer Location- Phoenix, AZ or Remote Duration- 03 Month+ Contarct Job Summary: Support medical and pharmacy appeals and grievances by researching... ...to interpret healthcare policies, procedures, and guidelines....Remote workPolicyWork at office
Apolis
United States5 days ago - ...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
Dane Street
United States9 hours ago - ...Participates in the Physician Review Units' appeal process of service... ...Review Units' policies and procedures. Actively... ...duties as assigned by the Medical Director. Board... ...understanding of managed care and demonstrate PC proficiency... ...diagnosis.) Remote 20 - 40 hours/week and...Remote workPolicyContract workWeekend work
VIVA
United States5 days ago - ...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 workPolicyContract workFor contractorsLocal areaImmediate start
WPS Health Solutions
Columbus, OH5 days ago - ...features. Location: Remote (Must reside in IL... ...team as Physician Reviewers. In this remote... ...cost-effective care for our members. This... ...patient care or medical diagnosis. Key... ...Physician Review Unit’s appeals process for... ...refinement of unit policies and procedures....Remote workPolicyFull timeWeekend work
Solving IT
New York, NY4 days ago - ...Massachusetts Public Records Law and support the Supervisor in processing appeals and providing legal guidance. The role involves complex legal... ...on records access rules. Some in-state travel may be required; remote work is not offered. #J-18808-Ljbffr Commonwealth MuseumRemote workPolicyLocal area
$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 payReliefLocal area- ...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 HealthfirstRemote workPolicy
- ...is seeking an experienced RN for a fully remote Prior Authorization reviewer role. The position supports... ...and ensures services are medically necessary according to guidelines and policies. Preference given to those... ...authorization in Molina-like managed care, with Illinois licensure...Remote jobPolicyWork at office
- ...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
The CKHobbie Group
Pittsburgh, PA4 days ago $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 workPolicyLocal areaEnsemble Health Partners
Putnam, CT5 days ago$219k - $286.9k
...Physician Reviewer - Utilization Management Hi, we'... ...You will determine the medical appropriateness of inpatient... ...Location: This is a remote position, open to... ...internal guidelines and policies, while utilizing clinical... ...experience in a managed care plan (health care industry...Remote workPolicyFull timeLocal areaWork from homeHome officeWeekend workOscar Health
United States2 days ago$155 - $165 per hour
...EPITEC As a Physician Reviewer, you'll play a critical... ..., cost-effective care. You'll work closely with... ...opinions, and develop policies and procedures that align... ...proficiency in PC (electronic medical records) ~ Strong... ...What We Offer Fully remote work arrangement (...Remote workPolicyFull timeContract workWork at officeWeekend workEPITEC
New York, NY5 days ago- ...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
The CKHobbie Group
Harrisburg, PA4 days ago - ...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 jobPolicyFull time
- ...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... ...The opportunity for remote work may be possible...Remote workPolicyContract workWork at office
$174.07k - $374.92k
...Utilization Management Physician Reviewer We're building a... ...colleagues who care deeply, innovate with purpose... ...Health Location: Remote/ Treehouse Role... ...judgment, and internal policies and procedures. Regardless... ...responsible for ensuring medically appropriate care is...Remote workPolicyHourly payFull timeAvery Healthcare Group Ltd.
United States5 days ago- ...concurrent and retrospective review of inpatient,... ...ancillary services to ensure medical necessity,... ...service and level of care, including appeal requests initiated by... ...community related to policies, procedures, benefits... ...Detroit, MI, 48243, US (Remote) UST HealthProofRemote workPolicyWork at officeLocal area
$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 payPart timeWork from homeHome office$28.94 - $51.83 per hour
...Clinical Appeals RN Optum is a global organization that delivers care, aided by technology, to help millions... ...clinical coverage review of services. Works closely... ...specific regulations, medical necessity guidelines, standards... ...Group's Telecommuter Policy. Pay is based on...Remote jobPolicyHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal area$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- ...turnaround times. Our reviewers are compensated on a per... ...and reviews insurance appeals, as well as prospective... ...interpretation of the medical necessity of services provided... ...with client-specific policies, nationally recognized... ..., and standards of care. Major Duties And Responsibilities...Remote workPolicyFor contractors
- ...RN - ICU 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
James Cancer Hospital and Research
Columbus, OH1 day ago - ...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
Adventist - Reedley
Reedley, CA2 days ago - ...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
Novant Health Presbyterian Medical Center
United States5 days ago - ...RN - L&D 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
Providence Queen of the Valley Medical Center
United States5 days ago - ...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
Marshfield Clinical Health System
Marshfield, WI2 days ago - ...and provides skilled professional nursing care to them, their families and caregivers as... ...Hospice licensure laws and agency policies and procedures. Provides the initial assessment... ...preferred with current hospice, home health, medical, surgical or critical care experience....Remote workPolicyWork experience placementWork at officeWork from home
Allied Services Integrated Health System
United States1 day ago $81.1k - $116.48k
Position Summary: The Appeals & Grievances (A... ...is 100% Remote. We are hiring... ...prior approval, medical necessity, pre-... ...issues Quality of Care Experience... ...internal health plans policies and procedures... ...Director Review ensuring that all... ...: RN, LPN OR Dental...Remote jobPolicyContract workTemporary workWork experience placementLocal areaMonday to FridayShift work- ...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
Ohio State University Hospital - Doan
United States9 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!
Related searches