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
- ...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
- ...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
- ...***/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
- ...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
- ...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
- 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
- ...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
- ...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
$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$35 - $40 per hour
...Job title: RN Utilization Management Reviewer Job Description:... ...authorization review for medical necessity and decision... ...to the primary care team, specialty providers... ...in applying policy Works with UM Manager... ...This is a fully remote work at home role. You...Remote workPolicyHourly payTemporary workCurrently hiringMonday to FridayFlexible hoursWeekend work- ...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
- ...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
$174.07k - $374.92k
...passionate colleagues who care deeply, innovate with purpose... ...Management Physician Reviewer Location: Remote/ Treehouse Role Description... ...judgment, and internal policies and procedures. Regardless... ...is responsible for ensuring medically appropriate care is recommended...Remote workPolicyHourly payFull timeLocal 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
$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... ...#LI-LL1 #LI-REMOTE Join an award... ...employer. It is our policy not to discriminate...Remote workPolicyFull timeLocal area$80k - $90k
...Hiring Range: $80-90k The Medical Review Clinical Appeals Auditor (RN) is responsible for... ...with department quality policies and procedures, scoring and... ...making tools such as Millimen Care Guidelines (MCG) or... ...to work independently in remote setting with minimum supervision...Remote workPolicyFor contractorsImmediate startWork from homeHome officeFlexible hoursShift work- ...functions of grievances and appeals, the full-time remote Appeals Coordinator will... ...in accordance with policies and guidelines Prepare case files for review and identify opportunities... ...similar role Knowledge of MediCal and Medicare Managed Care Plans Ability to type 40...Remote workPolicyFull timeWork at office
$44.57 - $60.44 per hour
...301 Lippincott Drive Remote Type: On-Site Employment... ...: Home Health Care experience. Preferred... ...care needs, wellness, medications, safety issues, etc. Collaborates... ...Must have a valid NJ RN License. Approved licenses... ...plan documents and policies. For more benefits information...Remote workPolicyHourly payFull timeTemporary workPart timeWork experience placementLocal areaFlexible hoursShift workWeekend workDay 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. Bachelor... ...be opportunity for remote work within all jobs...Remote workPolicyContract workWork 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$2,057 per week
...Registered Nurse (RN) | Telemetry Location:... ...several years of experience caring for post-op surgical... ...surgeries). This is a 23 bed medical surgical unit caring... ...Telemetry, Telemetry - remote monitoring, Total joint... ...near by Return Staff Policy: Gone from all UK affiliated...Remote workPolicyFull timeContract workLocal areaShift workNight shiftWeekend work- Actalent is seeking an Appeals Clinical Reviewer for remote, contract-to-hire engagement based in Saint Louis, MO. The role focuses on reviewing member and provider appeals related to medical necessity, authorization decisions, and claims outcomes. Applicants should have...Remote jobContract work
$28.94 - $51.63 per hour
...simplifying the health care experience,... ...to work remotely from anywhere within... ...Responsibilities Conducts reviews of member and provider appeals Analyzes... ...with policies and procedures,... ...and summarizes medical information for... ...Active, unrestricted RN license in state...Remote jobPolicyHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaShift workWeekend work$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- ...Pride Health is seeking a Grievances and Appeals Nurse for a remote contract position. This role is vital in investigating and resolving grievances... ...in member services, thorough understanding of CMS policies, and a nursing license valid in Arizona. Pride Health offers...Remote workPolicyContract work
$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$50k - $80k
...Details Job Title: Compliance Reviewer Location: Remote - USA Reports To:... ...engaging culture that truly cares about each other, our agents... ...on a variety of crops and policy types. You will be joining... ...advancement Comprehensive medical, vision, and dental coverage...Remote workPolicyFull timeWork experience placementLocal areaFlexible hours- ...experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/... ..., and Molina policies; validates the medical... ...concurrent review of appeals for denied prior authorizations... ...• Registered Nurse (RN). License must be...Remote workPolicyFull timeWork at office
- ...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
$102.18k
...Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical... ...Established in 1997, L.A. Care Health Plan is an... ...regulations, policies, protocols, and procedures... ...holidays, a hybrid remote schedule,... ...Reimbursement Retirement Plans Medical, Dental and Vision...Remote workPolicyFull timeShift workWeekend work
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