Senior Clinical Appeals RN - Remote DRG Expert & Coach
$35 - $63 per hourTexas Health Institute
Texas Health Institute is looking for a Senior Clinical Appeals RN to utilize expertise in MS‑DRG and APR‑DRG auditing. This role involves reviewing medical records and responding to appeals while providing coaching to remote DRG Validation Specialists. The position allows remote work within the U.S.; however, Minneapolis or D.C. hires must work in-office at least four days a week. Compensation ranges from $35.00 to $63.00 per hour, along with comprehensive benefits. #J-18808-Ljbffr
- ...UnitedHealth Group is seeking a Senior Clinical Appeals RN to utilize expertise in MS-DRG and APR-DRG auditing to manage appeals. This position allows remote work throughout the U.S., except for Minneapolis or Washington, D.C. hires, who need to work in-office at least...Remote workSeniorWork at office
$35 - $63 per hour
...The University of Minnesota School of Nursing is looking for a Senior Clinical Appeals RN. This role involves reviewing and responding to appeals in MS-DRG and APR-DRG auditing and provides coaching to remote specialists. Remote work is available within the U.S., but...Remote workSeniorHourly payWork at office$35 - $63 per hour
...Optum is seeking a Senior Clinical Appeals RN to utilize expertise in MS-DRG and APR-DRG auditing for appeals management. This role involves analyzing appeals... ...and authoring rebuttals. The job can be performed remotely across the U.S., with certain locations requiring...Remote workSeniorHourly payWork at office$35 - $63 per hour
...Stryker Corporation is seeking a Senior Clinical Appeals RN to utilize clinical expertise in appealing... ...records. The role includes analyzing DRG appeals, conducting complex analyses,... ...of coding experience with ICD-10. Remote work opportunities are available in the...Remote workSeniorHourly pay$35 - $63 per hour
...State and Territorial Epidemiologists is hiring a Senior Clinical Appeals RN. This position utilizes expertise in MS-DRG and APR-DRG auditing to review appeals and is... ...experience in ICD-10 coding. The role allows for remote work, and candidates should be solution-oriented...Remote workSeniorHourly pay$35 - $63 per hour
...experienced healthcare coder to analyze DRG Appeals, prepare written appeals, and... ...The role requires an unrestricted RN license and extensive knowledge of ICD-10 coding as well as clinical judgment. Enjoy the flexibility to work remotely from anywhere in the U.S., with...Remote jobSeniorHourly payWork at officeLocal area- ...Company of America is seeking an experienced clinical professional for a remote role. The successful candidate will provide coaching to Clinical Consultants, oversee assessments... ...minimum of 5 years in direct patient care, RN required, and possess strong problem-solving...Remote jobSenior
$35 - $63 per hour
...Analyze scope and resolution of DRG Appeals Respond to Level one, two or... ...written appeals Exercise clinical and/or coding judgment and experience... ...: Unrestricted RN (registered nurse) license in... ...enjoy the flexibility to work remotely from anywhere within the U.S....Remote jobSeniorHourly payMinimum wageFull timeWork experience placementWork at officeLocal area- Optum is seeking a Clinical DRG RN auditor to join their team remotely from anywhere in the United States. This role requires expertise in MS-DRG and APR-DRG coding and reimbursement methodologies, along with a commitment to ensuring accurate coding for inpatient claims...Remote job
$50 per hour
...A leading healthcare staffing firm is seeking an experienced RN Clinical Reviewer to work remotely. You'll conduct detailed medical-legal reviews and appeals while maintaining high accuracy and integrity. Key qualifications include a New York State RN license and at least...Remote work- Elevance Health is looking for a Diagnosis Related Group Clinical Validation Auditor - RN to work virtually, ensuring clinical documentation accuracy... ...significant experience in claims auditing, particularly with DRG-based claims. Elevance Health values work-life integration...Remote jobSeniorFlexible hours
- Optum is hiring a Clinical DRG RN auditor to verify DRG coding accuracy and reimbursements while telecommuting from anywhere in the U.S. In this role, you'll use your ICD-10 coding expertise to audit inpatient claims, identify overpayments, and support your findings with...Remote job
- Stryker Corporation is seeking a Clinical DRG RN Auditor who will work remotely to validate DRG assignments and reimbursements. This role requires deep expertise in ICD-10 coding and offers flexibility to telecommute from anywhere in the U.S. The ideal candidate will have...Remote jobRelocation package
$70k - $80k
...analytics and solutions company is seeking a Clinical Validation Auditor to ensure accuracy in medical claims coding. This fully remote position requires a Registered Nurse with... ...skills, attention to detail, and experience in DRG audits. Competitive salary range is $70k -...Remote job- ...company located in New York is looking for a Clinical Auditor to perform clinical reviews and... ...guidelines. This role requires an active RN license and the ability to analyze claims... ...documentation and reporting within the appeals process, contributing to continuous improvement...Remote job
- ...Administrators LLC is hiring an Appeals Analyst to join BlueCross... ...complex appeal requests, conducting clinical reviews, and ensuring... ...ideal candidate will have an RN license, a degree in a related... ...-time with the option to work remotely or on-site, offering comprehensive...Remote workFull time
- ...healthcare consulting firm is expanding its team by hiring a Clinical Appeals Review Nurse. This role involves completing clinical... ...documentation. Required qualifications include an RN certification, experience with DRG denials, and preferred certifications like CCDS or...
- ...Medix™ is seeking a dedicated Appeals Nurse (RN) to join our team in a fully remote capacity. This role involves clinical reviews and appeal determinations while collaborating with Medical Review Analysts and Physician Consultants to ensure compliant outcomes. The ideal...Remote work
- ...Elevance Health is seeking a Nurse Appeals - Licensed Nurse to work virtually from Indianapolis... ...appeals. The role requires a current RN license and a minimum of two years in... ...healthcare. Candidates must have strong clinical experience and leadership skills. This position...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 and...Remote job
$80k - $90k
...0-90k The Medical Review Clinical Appeals Auditor (RN) is responsible for conducting... ...serves as a subject matter expert, providing supplemental... ...CPT/HCPCs/ICD-9/ICD-10/MS-DRG coding may be necessary.... ...ability to work independently in remote setting with minimum...Remote workFor contractorsImmediate startWork from homeHome officeFlexible hoursShift work- ...Elevance Health seeks a Nurse Appeals - Licensed Nurse to investigate medical necessity appeals from members and providers. This role allows... ...as needed. The successful candidate must hold an active RN license and have a minimum of 2 years of experience in managed care...Remote workFull time
- ...Elevance Health is seeking a Nurse Appeals - Licensed Nurse to investigate medical necessity appeals from members and providers. This role... ...training sessions. The ideal candidate must hold an active RN license and have experience in a managed care setting. Responsibilities...Remote workFull time
- A healthcare solutions company seeks a Manager of Clinical Appeals in New York. The role involves overseeing clinical appeals operations with... ...appeals and team leadership, particularly in managing remote teams. The position requires strong writing skills and a thorough...Remote workSenior
$86.56k - $129.84k
The Elevance Health Companies, Inc. is seeking a Patient Safety DRG Clinical Validation Auditor to work virtually full-time, facilitating in... ...documentation accuracy. Candidates must possess a current RN license and have at least 10 years of experience in claims auditing...Remote jobSeniorFull time- ...Santa Barbara Cottage Hospital is seeking a clinical professional for a fully remote role focused on medical management. The position requires an active New York State RN licensure and involves analyzing authorization requests to determine medical necessity. The successful...Remote workFlexible hours
- UTMB Health is looking for a Senior DRG Coder to work remotely in Galveston, Texas. This full-time position involves coding diagnoses and procedures accurately, ensuring optimal DRG assignments, and maintaining coding compliance. The ideal candidate should have at least...Remote jobSeniorFull timeWork at office
$60.2k - $107.4k
...Capacity Path is seeking a Senior Clinical Administrative Nurse to engage with members through telephonic... .... The ideal candidate must hold a current RN compact license and have at least 2 years of nursing experience. Work is remote, with specific hours required, hence...Remote workSenior$33 - $38 per hour
Astrana Health is seeking a Senior DRG Coder who will be responsible for reviewing inpatient medical records and assigning diagnosis and procedure codes accurately. This remote role requires strong knowledge of ICD-10-CM and ICD-10-PCS, ensuring compliance and coding accuracy...Remote jobSeniorHourly pay$60.2k - $107.4k
...UnitedHealthcare is seeking a Senior Clinical Administrative Nurse to engage with members and support... .... Ideal candidates will have a current RN compact license and at least 2 years of... ...health settings. The position offers remote work flexibility anywhere within the U.S...Remote workSenior
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