Remote Nurse Appeals Specialist
Hispanic Alliance for Career Enhancement
CVS Health is seeking an Appeals Nurse Consultant for a fully remote, full-time role focused on fair and accurate resolution of clinical appeals. You will apply clinical judgment and regulatory knowledge to review documentation and determine appropriate criteria for member and provider issues. Ideal candidates hold an active RN license in their state, with 3+ years of clinical experience and an Associate’s degree. Strong communication, multitasking and system navigation skills are essential. #J-18808-Ljbffr
$90k - $99k
Gainwell Technologies LLC is seeking a DRG Nurse Reviewer Appeals and Hearings to coordinate and perform appeal-related duties, including analyzing... ...benefits including a 401(k) match and health coverage. This is a remote role with up to 25% travel expected. #J-18808-LjbffrRemote workFlexible hours$67.32k - $133.71k
...Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and... ...for experienced clinicians to work remotely from within the greater Baltimore... ...obtaining clinical opinions from physician specialists, to determine if adverse decisions are...Remote workWork experience placementWork at officeImmediate start- ...as a hospital liaison with external third-party payors to appeal denied claims. Works closely with Physician advisor team to... ...management team. Job Description Clinical Appeals Nurse - Full Time Remote - Jefferson Health Articulates the job's main responsibilities...Remote workDaily paidFull timeTemporary workPart timeFlexible hoursShift work
- A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching...Remote work
$50 per hour
...We are looking for a Clinical Appeals Nurse to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate... ...Utilization Management. Benefits Full-time or part-time remote position Choose which projects you want to work on...Remote workHourly payFull timePart timeFor contractorsFlexible hours$90k - $99k
DRG Nurse Reviewer Appeals and Hearings- Remote Date: Jan 9, 2026 Location: Any city, FL, US, 99999 Work Mode: Virtual (Exception only) It takes great... ...Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (...Remote jobFull timeWork from homeFlexible hours- ...Integra Partners is seeking a licensed Practical Nurse (LPN/LVN) experienced in managed care UM to perform pre-service and post-service utilization reviews and appeals for DMEPOS, working with our Medical Director in a NCQA-compliant UM program. You will review benefit...Remote work
$52 per hour
...Hiring for RN - Appeals (Remote Role) in Somerville, MA Shift : Days 5x8 (08:00 - 17:00) Duration : 13 Weeks (Temp to Perm)... ...AHA) ~100% remote ~ Looking for a registered nurse with payor experience (Commercial and Medicaid) ~ Would like...Remote workPermanent employmentTemporary workShift work$90k - $99k
A leading healthcare solutions provider seeks a DRG Nurse Reviewer Appeals and Hearings to coordinate appeal duties and engage in hearings, both... ...have an active RN license and coding certification. This remote role offers flexibility and opportunities for career development...Remote workFlexible hours$70k - $80k
...Piper Companies is seeking a Remote Clinical Appeals Analyst to provide clinical expertise in reviewing and resolving complex member and provider appeals. Candidates must hold an active North Carolina licensure as an RN, LPN, PT, or OT and have significant clinical experience...Remote workFull timeContract workMonday to Friday- ...Utilization Review Medical Appeals Nurse - USRN NTT DATA Services is currently seeking a Utilization Review Medical Appeals Nurse -... ...skills) ~ Able to work independently, strong analytic skills ~ Required shift timings - US daytime ~ Can work remotely...Remote workShift work
- Blue Cross Blue Shield of Arizona needs a clinical expert for managing member and provider appeals. This remote position requires strong accuracy, knowledge of compliance timelines, and a focus on customer service. Applicants should possess a healthcare-related degree...Remote job
$80k - $90k
...$80-90k The Medical Review Clinical Appeals Auditor (RN) is responsible for conducting... ...the ability to work independently in remote setting with minimum supervision and direction... ...license in good standing and diversified nursing experience providing direct care in an...Remote workFor contractorsImmediate startWork from homeHome officeFlexible hoursShift work$60.52k - $129.62k
...Appeals Nurse Consultant We're building a world of health around every individual — shaping a more connected, convenient and compassionate... ...is seeking a dedicated Appeals Nurse Consultant to join our remote team. In this role, you will play a critical role in ensuring...Remote workFull timeLocal areaMonday to FridayShift work- ...Appeals Processor III - RN ~ salary ~ Unavailable ~ Hours per week ~40 ~ Shifts ~5/8's ~ Start Date ~ Unavailable ~... ...Appeals Processor III (APP III) to join our dedicated team in a remote capacity. The Appeals Processor III (APP III) is responsible for...Remote workContract workFor contractorsFor subcontractorShift work
- ...Geisinger is seeking a dedicated professional to support the administration of the Appeals and Grievance process. The role involves acting as a liaison between members and the Plan regarding denied claims, services, and other concerns. Responsibilities include managing...Remote work
$132.91k - $216.78k
...El Centro Regional Medical Center is seeking a Clinical Nurse Specialist (CNS) to provide advanced clinical leadership and expertise within... ...California only. A geographical pay differential may be applied for remote employees who reside out of state. ECRMC strives to ensure...Remote work- Overview Job Title: Registered Nurse - Claims & Appeals Review Location: Remote (Anywhere in Florida) Duration: 06 Months/Can be Extended Working hours: Day Shift Job Type: Subcon Pay Rate: Negotiable Position Description The Quality Analyst is responsible for ensuring...Remote workContract workDay shift
$36 - $40 per hour
...exclusive features. At Norwood we’re forging our own path. We’re a remote-first staffing and consulting company specializing in mid-... ...long term fulfillment in your coding career. If you are an Appeals and Denials Nurse looking for a new opportunity to sharpen your skills, we...Remote workPermanent employmentFull timeWork visa$93.81 - $133.97 per hour
...Location: Los Angeles, CA, USA Onsite or Remote Fully On-Site Work... ...5+ years of exp as an oncology certified nurse (experience in infusion center is a plus)... ...committed any misconduct; or have filed an appeal of a finding of substantiated misconduct...Remote workHourly payShift workWeekday work$19.43 - $32.98 per hour
...fresh perspective on workplace flexibility. THIS POSITION IS REMOTE/WORK FROM HOME. PREFER APPLICANTS WHO RESIDE IN THE STATE OF ILLINOIS... ...and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hours- A healthcare management company is seeking a Remote Coverage Review Pharmacist located in Tennessee. This role requires a Doctor of Pharmacy... ...for reviewing medication-related prior authorizations, appeals, and grievances, working independently or in a team to deliver...Remote work
$25.87 - $30.34 per hour
...Carolina); Omaha, NE (Nebraska); Work from Home Work Arrangement: Remote: Work at home employee residing outside of a commutable... ...review of denied Dental Claims . You will manage dental claims appeals by providing an independent review of the facts and circumstances...Remote workWork experience placementWork at officeWork from homeRelocation package- ...support staff. Assist, on an as needed basis, with claims agent job functions. Including, but not limited to, claim status, drafting appeals, VA Forms, etc. Work on special projects Qualifications Requires Bachelor's degree or equivalent experience. Must...Remote workTemporary workCasual workWork at officeLocal areaWork from homeFlexible hours
- ...ShiftFirst (Days)Overview:Sentara Health Plans is hiring a Prevention Nurse Specialist- Richmond, VirginiaThis is a PRN position, hours may vary (... ...Williamsburg south to Hampton)Travel reimbursementThis is a remote PRN status position with Day Shift Hours, requires onsite...Remote workTemporary workReliefSeasonal workDay shift
$111.51k - $167.27k
...Clinical Nurse Specialist City: Phoenix State: AZ Remote: No Department: Nursing Why Mayo Clinic: Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the...Remote workFull timeWork experience placementImmediate startMonday to FridayFlexible hours- ...seeking an experience LPN or RN for the role of Wellness Nurse Specialist . This critical position ensures the successful implementation... ..., frontline team members-through a blend of on-site and remote support across multiple states as needed. What We're Looking...Remote work16 hoursFull timeImmediate startLong distanceShift workWeekend work
- ...Our team of oncology-trained registered nurses answer every call helping you navigate appointment... ...'s to make referrals to any of the specialist providing care at the Siteman Cancer... ...to manage a department that is largely remote workers. Manages individual(s) including...Remote workFull timeFlexible hours
$67.86k - $135.72k
...across the health system. As a Clinical Documentation Specialist, you bring a seasoned nursing perspective into a high-impact environment where your insight... ...and completeness of the clinical story. This fully remote opportunity is ideal for experienced registered nurses...Remote workTemporary workPart timeWork experience placementFlexible hours- Elevance Health is seeking a Grievance/Appeals Representative I to work virtually full-time from Atlanta, Georgia. This role focuses on conducting investigations and reviews of customer grievances and appeals related to service and benefit coverage issues. Candidates will...Remote workFull timeFlexible hours
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