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
- ...company is seeking a physician reviewer to utilize clinical expertise in reviewing insurance appeals and claims. This telework... ...compliance with client-specific policies. Candidates must hold an active... ...Responsibilities include reviewing medical records, providing clear...Remote workPolicyContract workFor contractors
- ...Can work remotely in any state except CA, NY, HI or... ...Participates in the Physician Review Units' appeal process of service... ...Review Units' policies and procedures. Actively... ...as assigned by the Medical Director. Board Certified... ...of managed care and demonstrate PC proficiency...Remote workPolicyWeekend work
- ...***/hour fully remote, but must reside in... ...cases come for review, in partnership with... ...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 workPolicyMonday to FridayShift workWeekend work
- ...features. Location: Remote (Must reside in IL... ...team as Physician Reviewers. In this remote... ...and 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. Support...Remote workPolicyFull timeWeekend work
- ...Role Snapshot The Appeals Nurse examines medical records and claims... ...Medicare regulations and policies. The Appeals RN works in... ...redeterminations are medically reviewed as needed and... ...Location We are open to remote work in the... ...medical necessity of care. Prepare and submit...Remote workPolicyContract workFor contractorsImmediate start
$90.87 - $154.33 per hour
...healthcare management company is seeking a remote Physician Clinical Reviewer specializing in Dermatology. This... ...providing clinical rationale for appeals. Candidates must hold a DO/MD and... ...to ensure compliance with internal policies and regulations. Competitive pay ranges...Remote workPolicy- A healthcare review company is seeking a Physician Reviewer to work telecommuting. This role... ...clinical expertise to review insurance appeals and claims. Candidates must possess an... ...guidelines. Responsibilities include reviewing medical records, ensuring documentation quality,...Remote workFor contractors
- Dane Street, LLC is looking for a physician reviewer to utilize clinical expertise in reviewing insurance appeals and claims for compliance with guidelines. This telework... ...of work. Ideal candidates must have a valid medical license in NM, TX, MN, or NC. Responsibilities include...Remote jobFlexible hours
- ...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... ...Type Contract Work Location Remote...Remote workPolicyContract workWork experience placementWork at office
$39.32 - $48.06 per hour
...The Clinical Utilization Reviewer is responsible for facilitating care for members who may have... ...healthcare needs, authorizing medically necessary services at the... ..., and company medical policies to conduct reviews that... ...appropriate to position (RN) Licensure in additional...PolicyHourly payFull timeFlexible hoursShift work- ...Medicine, and Neurology 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 workPolicyFor contractorsMonday to Friday
- ...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
$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$93.4k - $116.8k
...Are you an experienced RN with a strong... ...including quality of care reviews, incident investigation... ...and your loved ones, Medical, Dental, Vision, Life... ...Revises/develops processes, policies and procedures to address... ...in the Grievance and Appeals process. Follows-up...Remote workPolicyWork experience placementFlexible hours- ...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
$60.2k - $107.4k
...simplifying the health care experience,... ...members, caregivers, medical providers, and internal... ...to work remotely from anywhere within... ...support through the appeals process Educate... ...Comply with all policies, procedures, and documentation... ...Current and unrestricted RN compact license ~...Remote workPolicyMinimum wageFull timeWork experience placementLocal areaWeekday work$174.07k - $374.92k
...helping to simplify health care one person, one family and... ...Utilization Management Physician Reviewer Location: Remote/ Treehouse Role Description... ...judgment, and internal policies and procedures. Regardless... ...is responsible for ensuring medically appropriate care is...Remote workPolicyHourly payFull timeLocal area- ...Auditor to perform clinical reviews and audits on medical records, ensuring compliance with company policies and quality assurance guidelines... ...This role requires an active RN license and the ability to... ...documentation and reporting within the appeals process, contributing to...Remote jobPolicy
$31 - $33.5 per hour
RN - Clinical Field Reviewer job at Mountain Pacific. Glasgow, MT. Mountain Pacific... ...advance better health and health care services. Are you self-... ...Registered Nurses working remotely across the state of Montana... ...as authorized following policies set forth by the State of Montana...Remote jobPolicyHourly payFull timeLocal areaWork from homeHome officeFlexible hours$3,504 per month
...to provide for the care and supervision of youth... ...requests for health/medical care submitted by youth. Reviews the admission... ...Youth Services (DYS) policy. Documents all encounters... ...of Employment & Appeal Rights Applicants... ...training and more ~ Remote work arrangements...Remote workPolicyPermanent employmentFull timeTemporary workPart timeWork experience placementWork at officeLocal areaFlexible hoursShift workWeekend work$29.05 - $67.97 per hour
...experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/... ...regulations, and Molina policies; validates the... ...included in a compact RN license. Job Duties... ...concurrent review of appeals for denied prior authorizations...Remote jobPolicyHourly payWork experience placementWork at office$69.38k - $92.28k
Overview As a Clinical Appeals RN, you will review denied service... ...and claims, evaluate medical necessity, and work closely... ...management, managed care or LTSS is highly desirable... ...with medical policies Use clinical judgment... ...combination of office and remote settings. EEO...Remote workPolicyWork at office$80k - $90k
...Performs clinical reviews on medical records to maintain... ....* Conducts Appeals reviews on medical... ...department quality policies and procedures, scoring... ...such as Millimen Care Guidelines (MCG) or... ...independently in remote setting with minimum... ...unrestricted RN license #J-18808-Ljbffr...Remote workPolicyFlexible hours- ...an experienced nurse for a 10-month contract role primarily focused on reviewing clinical data and managing member appeal requests in accordance with company policies. The position allows for remote work, preferably from Iowa, with possible on-site visits. Key responsibilities...Remote workPolicyContract work
$90k - $99k
...solutions provider seeks a DRG Nurse Reviewer Appeals and Hearings to coordinate... ...Candidates must have an active RN license and coding certification. This remote role offers flexibility and opportunities... ..., including a flexible vacation policy and educational assistance. #J-1...Remote workPolicyFlexible hours$102.18k
...Solution Center Appeals and Grievances RN Job Category: Clinical... ...in 1997, L.A. Care Health Plan is an... ...for the quality review of complex and/or... ...alignment with L.A. Care policy and procedures... ...the patient medical records, clinical... ...holidays, a hybrid remote schedule, and...Remote workPolicyFull timeShift workWeekend work- ...Registered Nurse to join their remote team. The successful... ...coordinate and communicate medical services, ensuring quality care for members. Candidates must hold a compact RN license and possess over a... ...retirement savings, and leave policies. The position also includes...Remote workPolicy
$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$110k - $130k
...Document Specialist III - Remote Salary: $110,000 - $130,00... ...providing a wide range of medical services including emergency care, heart and cancer treatment... ...Specialist. RN, NP, or PA licensure. Experience... ...subject to Jobot's Privacy Policy, the Jobot California Worker...Remote workPolicyLocal areaRelocation package- ...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
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