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
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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- ...seeking an MD or DO with an active license for a remote role within the United States. You will review appeals, respond to regulatory inquiries, and collaborate with medical directors to interpret benefits and policies. The position emphasizes quality management, data...Remote workPolicy
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...DRG Nurse Reviewer Appeals and Hearings- Remote Date: Jan 9, 2026 Location... ...) It takes great medical minds to create powerful... ...CEUs to maintain RN license and/or... ...knowledge of clinical policies, procedures, rules,... ...together people who care deeply about making...Remote workPolicyFull timeWork from homeFlexible hours- ...Clinical Utilization Review Nurses (RN) Based In Alabama Comagine... ...has engaged in health care quality consulting and... .... Our talented remote workforce spans the country... ...Alabama to assess the medical necessity and quality... ..., organizational policies, and contract requirements...Remote workPolicyFull timeContract work
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...highly skilled critical care nurse with at least... ...provides advanced, autonomous medical care to critically ill... ...restrictions within policy. Ability to perform strenuous... .... If applying for a remote or hybrid role, this... ...HiredScore assists in reviewing applications, all final...Remote workPolicyHourly payFull timeShift workNight shift
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