Remote Appeals RN - Clinical Decision Expert
UnitedHealth Group
UnitedHealth Group is seeking a Clinical Appeals RN to provide expert analysis of appeals and grievances, acting as a clinical interface liaison with facilities, providers, and carriers. The role supports equitable, efficient decisions and requires strong documentation and confidentiality adherence. The position offers remote work from anywhere in the U.S., with an M-F schedule of 8:00–4:30 and alternating Saturdays. A valid RN license and 2+ years of clinical experience are required.
#J-18808-Ljbffr- ...research the substance of complex appeal requests, perform clinical review to determine medical necessity, and document decisions within required timeframes. This full-time remote role (40 hours/week, 8 a.m.-5... ...time) requires an active RN license in the United States,...Remote jobFull timeLocal area
- ...UnitedHealthcare is hiring a Clinical Appeals RN to provide expertise in appeals and grievances, analyze cases, and serve as a Clinical Interface... ...and program definitions while ensuring confidentiality. Remote work is allowed from anywhere in the U.S., with M-F 8:00–4:3...Remote workLocal area
$68.97k - $113.31k
...Guardian Life is seeking an RN Clinical Consultant to support disability claim decisions. You will review medical data, assess functional capacity, and collaborate... ...care and 3+ years in LTD/STD clinical consulting. Remote options nationwide are available, with salary...Remote work- UnitedHealth Group is seeking a Clinical Appeals RN to provide expertise in clinical appeals and grievances, analyzing and evaluating appeals, and serving as a Clinical Interface Liaison to resolve issues on member benefits and program definitions. The role involves reviewing...SuggestedDay shift
- ...role, you'll use your clinical knowledge outside ofthe... ...unrestricted Registered Nurse (RN) license Strong... ...populations Remote work - enjoy the convenience... ...utilization review decisions and clinical rationale... ...letters, reason codes, and appeal rights in compliance with...Remote workFull timeTemporary workWork at officeWork from home
- ...HealthEdge Software, Inc. is seeking a contract-based professional to manage complex grievances and appeals for members and providers in a remote US-based role. The candidate will review medical necessity across inpatient, outpatient, and ancillary services and prepare...Remote workContract work
- A leading telehealth provider is seeking a Remote Telehealth Triage Nurse to provide telephone triage and health advice to patients across... ...should have a compact nursing license and a minimum of 3 years clinical experience. This full-time position allows for flexible...Remote workFull timeFlexible hours
$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist... ..., and reference internal policies. Make decisions, document cases, and manage work within...Remote jobFull timeMonday to FridayShift work- ...Guardian Life is seeking a registered nurse (RN) Clinical Consultant to evaluate disability claims, analyze medical data, and advise on functional capacity and recovery timelines. You will collaborate with providers, claimants, and vocational specialists to support appropriate...Remote work
- ...Health Business Solutions LLC is seeking a Clinical Appeals Nurse (RN) for a remote role. The position focuses on reviewing denied claims for clinical accuracy and medical necessity, developing appeal strategies, and drafting payer-ready documentation to overturn denials...Remote work
- ...Registered Nurse to join the cardiac device clinic team at Advocate Christ Medical Center.... ...pacemakers and ICDs, device interrogations, and remote monitoring in a high-volume environment.... ...care) with EP/Device exposure, and active RN licensure with CPR and ACLS. #J-18808-...Remote work
- ...UnitedHealth Group seeks an IBR Clinical Appeals Analyst to analyze and respond to claim review appeals. This fully remote role requires expertise in auditing, coding, and clinical... ...of appeals experience and an unrestricted RN license are mandatory. The ideal candidate will...Remote work
- ...CorroHealth, Inc. seeks a Supervisor, Clinical Appeals to lead a denials-management team of Appeal Coordinators supporting Corro Clinical clients. This remote role requires an RN in good standing and strong leadership to mentor staff, manage workflows, and ensure quality...Remote work
- ...UnitedHealth Group is seeking a Clinical Coordinator RN for a Telecommute role in Texas. You will conduct... ...comprehensive clinical reviews of appeals, evaluate medical records, and provide... ...and collaboration within a remote team, with weekday daytime hours. Ideal...Remote workWeekday work
$28.94 - $51.63 per hour
...Join us to start Caring. Connecting. Growing together. The Clinical Appeals RN is responsible for providing expertise in clinical appeals... ...and clarification). You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges...Remote workHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaWeekday work- UnitedHealth Group is seeking a Remote Appeals Clinician in Texas. You will conduct comprehensive reviews... ...), evaluate records, and provide independent clinical judgments on medical necessity. Requirements include a Texas RN license and 2+ years in Medicaid with data-entry...Remote jobFlexible hours
- Optum in the United States is seeking a Clinical DRG RN auditor to apply MS-DRG/APR-DRG coding expertise to inpatient claims. You will validate ICD-10 coding, DRG assignments, and discharge statuses, producing clear rationales and supporting audit findings. You can telecommute...Remote job
- ...CorroHealth Inc. is seeking a Supervisor, Clinical Appeals to lead the Appeals team in denials management for our clinical clients. You will... ...drive process improvements across workflows. This is a remote position requiring strong leadership, collaboration with payers...Remote work
$40 - $50 per hour
...Job Description Job Description Clinical Appeals RN – 100% Remote $40-$50/hour | Part-Time & Full-Time Opportunities Available Our team partners with healthcare providers and hospital organizations to deliver revenue cycle and accounts receivable support services...Remote jobPermanent employmentFull timeTemporary workPart time$28 - $51 per hour
About This Role The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances, analyzing, reviewing, and evaluating appeals and grievances, and acting as a Clinical Interface Liaison to resolve issues concerning members, benefits, and...Remote jobFull timeDay shift- A national health organization is seeking a Clinical Review Clinician - Appeals to conduct clinical reviews and manage appeals. The role requires an... ...standards and healthcare regulations. The position is fully remote and includes a comprehensive benefits package. Join us...Remote jobFlexible hours
- ...Clinical Appeals Specialist The Clinical Appeals Specialist completes research... ...adverse and adverse coverage decisions. The Clinical Appeals... ...appeal requests using nursing expert knowledge and all available clinical... .../Certifications: RN - Registered Nurse - State Licensure...Remote workWork at office
- UnitedHealthcare is hiring a Clinical Appeals RN for remote work Monday-Friday, with alternating Saturdays. The role analyzes appeals and grievances, acts as a clinical liaison, and supports resolution with facilities, providers, and plans. We offer a flexible schedule...Remote jobHourly payWork at officeMonday to FridayFlexible hours
$110 per hour
...Physician - Clinical Advisor (Women's Health Expert) Los Angeles, CA (Remote) Clinical Advisor (MD/DO) National Authority in Perimenopause & Menopause Care... ...support other clinicians through nuanced clinical decision-making ~ Availability for 20 hours per week, with...Remote workImmediate startShift work- ...Shriners Children’s is seeking an Authorization Denials Appeals Nurse to manage denial appeals by reviewing clinical documentation and determining if retro-authorization is warranted. The appeals nurse will serve as a clinical resource to the Central Authorization Unit...Remote work
- Tampa General Hospital in Tampa, FL, seeks a Clinical Nurse for the Emergency Dept Clinical Decision Unit. The role requires delivering direct, patient-centered... ...seven days, located on-site at the main campus. Florida RN licensure is required; graduates of accredited...Full time
- ...Elevance Health is seeking a Nurse Appeals professional to investigate... .... The role supports remote work with required in-person... ...findings, and determine payment decisions using clinical criteria and policies. The position requires an active RN license and a HS diploma,...Remote work
- ...Health Solutions is seeking an Appeals Clinician I to work remotely from within Oregon,... ...and provider appeals using clinical expertise and policy guidelines, supported by RN licensure and a BSN. This... ...communication and collaborative decision-making with physician...Remote work
$32.13 - $45 per hour
...States seeks a Triage Registered Nurse to provide effective telephone triage for patients. The ideal candidate will have a BSN, strong clinical assessment skills, and at least 2 years experience in triage. Responsibilities include conducting clinical assessments, educating...Remote workFull time$52 - $56 per hour
...done UM. You've worked appeals. Now find a role that uses... ...'re hiring a contract RN for a New York health... ...and MLTC). You'll own clinical grievances and appeals from intake to final decision letter, and you'll apply... ...utilization management. 100% remote (U.S.) | Contract | $52...Remote workContract workAfternoon shift
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