Remote Clinical Appeals RN - MassHealth Expert
Palo Verde Community College District
- Remote job
UnitedHealth Group is seeking a Clinical Appeals RN to attend MassHealth appeal hearings, defend prior authorization decisions, and perform clinical coverage reviews. The role collaborates with managers and peers to uphold quality standards. Applicants must hold an Associate’s degree in Nursing and an unrestricted MA RN license, with 3+ years in managed care or clinical settings. Remote work is possible for MA residents, with 10% travel within MA. #J-18808-Ljbffr Palo Verde Community College District
- Inova Health System is seeking a Registered Nurse (RN) for Clinical Denials and Appeals. This full-time remote role supports denials and appeals across facilities, with start times between 7:30 AM-9:00 AM ET. The role requires a bachelor’s or associate degree with RN license...Remote jobFull time
- WPS Health Solutions is seeking an Appeals Nurse to review medical records and appeals for... ...services. This role involves evaluating clinical necessity, preparing compelling rationales... ...ideal candidate holds an ASN/BSN, an active RN license, and 1+ year of clinical...Remote job
- WPS Health Solutions is hiring an Appeals Nurse to review medical records and claims for first-level Medicare appeal... ...medically reviewed. Qualifications include an active RN license (state of practice), 1+ years clinical experience, and strong communication skills. #J-1880...Remote job
$28.94 - $51.83 per hour
...Clinical Appeals RN Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier... ...RN is responsible for attending appeal hearings, defending MassHealth prior authorization decisions, and performing pre-service/prior...Remote jobHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal area- WPS Health Solutions is seeking an Appeals Nurse (RN) to review first-level appeal cases and determine clinical necessity in accordance with Medicare guidelines. The role involves assessing medical records, preparing appeal letters, and ensuring timely resolutions with...Remote job
- UnitedHealth Group is seeking a Clinical Review Clinician in Plymouth, Minnesota. This role involves conducting forensic reviews of hospital... .... Candidates should have an Associate's degree, an active RN or LPN license, and at least 2 years of clinical experience. Benefits...Remote job
- Providence Home Services Oregon is seeking a Clinical Documentation Specialist RN to perform OASIS and Plan of Care reviews for CMS compliance, working remotely with day shifts and weekdays. The... ...Health leadership and acts as Oasis expert and consultant across the region....Remote jobDay shiftWeekday work
Clinical Documentation Specialist RN to ensure CMS program compliance through meticulous review of OASIS... ...and Plans of Care. This full-time, day shift role is remote for eligible states and collaborates with Home Health leadership...
Remote jobFull timeDay shift- UnitedHealth Group seeks a Clinical Review Clinician to serve as the subject matter expert for itemized bill reviews and analysis of hospital facility bills. You will document, research, and identify adjustments as part of a team preparing Forensic Reviews for clients....Remote job
- UnitedHealth Group is seeking an Utilization Management & Clinical Validation RN to accurately review medical records and extract case details, crafting defensible appeal letters using evidence-based literature and coding knowledge. You will work from anywhere in the U...Remote jobFlexible hours
- CorroHealth, Inc. is seeking a part-time PRN Clinical Review Nurse (RN) to remotely review medical records for medical necessity, authorization compliance, and payer guideline alignment, supporting appeal submissions. You will perform clinical reviews, review inpatient...Remote jobPart timeRelief
- Providence Health and Services is seeking a Clinical Documentation Specialist, RN for the Oregon Home Services team. This role focuses on quality review... ...and Home Health leadership, acting as an Oasis expert and consultant to staff across the region, while upholding...Remote job
- Inova Health System is seeking a dedicated Registered Nurse (RN) Clinical Denials and Appeals to join the team as a Full-Time Remote role. The position supports review of denied claims, development and submission of timely appeals, and collaboration across UR, Coding, Billing...Remote jobFull time
- ...Cottage Hospital is seeking a PRN Clinical Review Specialist to provide remote clinical review support. You will evaluate... .... The role requires an active RN license (compact preferred), 3-5... ...and 2+ years in Utilization Review/Appeals. Strong documentation and Epic EMR...Remote jobRelief
$71.59k - $116.48k
...prominent healthcare organization is seeking an A&G Clinical Specialist to manage health member complaints and appeals. This fully remote position requires expertise in clinical case... .... The ideal candidate should be an RN, LPN or Dental Hygienist with experience in appeals...Remote job- Medica, a nonprofit health plan, is seeking a remote Appeals & Grievances Clinical Specialist III to review and resolve appeals and grievances with clinical... ...and clinical staff. This position requires an active RN license and 5+ years of clinical experience, preferably...Remote job
- UnitedHealth Group is seeking an experienced Clinical Appeals RN to analyze and resolve appeals and grievances. This remote role supports facilities, providers, and members by applying clinical criteria and coordinating with Medical Directors. Responsibilities include...Remote job
$70k - $80k
Piper Companies is seeking a Remote Clinical Appeals Analyst to provide clinical expertise in reviewing and resolving complex member and provider... ...must hold an active North Carolina licensure as an RN, LPN, PT, or OT and have significant clinical experience. The...Remote jobFull timeContract workMonday to Friday- Managed Medical Review Organization, Inc. seeks an experienced RN Clinical Case Manager to support a disability claim review program. You... ..., owning caseload from start to finish. You will work remotely within allowed US states, performing telephonic assessments, developing...Remote job
$28.94 - $51.63 per hour
...Clinical Appeals RN At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers... ...and clarification). You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough...Remote jobHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaWeekday work- Phamily is seeking a Clinical Care Lead RN to work in a hybrid capacity, supporting patients through digital communication tools. This role involves managing a digital patient panel, developing personalized care plans, and leading a clinical team. Ideal candidates will...Remote job
- ...Inova 8095 - Fairfax East is looking for a dedicated Registered Nurse (RN) Clinical Denials and Appeals to join the team. This role will be Full-Time Remote, Monday-Friday (8-Hours per Day); Start Time to be between 7:30 AM – 9:00 AM Eastern Time (EDT/EST) Inova is consistently...Remote workFull timeMonday to FridayFlexible 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 - 100% Remote role at Healthfirst . Position Summary: The Appeals & Grievances...Remote workFull timeMonday to FridayShift work- WPS Health Solutions is seeking an Appeals Nurse to review medical records for first-level appeal cases to determine medical necessity... ...timely redeterminations and adherence to CMS regulations, with remote-work options for approved states. It involves preparing written...Remote job
$100 - $150 per hour
...Management / Case Management leader (RN/Physician-advisor) Type:... ...100–$150/hour Location: Remote Role Responsibilities... ...necessity determinations and clinical review outputs for accuracy and... ...peer review requests, and denial appeals. Coordinate with clinical teams...Remote workContract workSummer workNight shift- ...seeking an experienced ICU Registered Nurse to serve as a PRN remote Subject Matter Expert (SME) for healthcare content development. The role is 1099... ...AM to 4:00 PM EST. Qualified candidates will have current RN licensure, at least 2 years ICU RN experience within the...Remote jobFor contractorsInterim roleRelief
$81.1k - $116.48k
Position Summary: The Appeals & Grievances (A&G) unit... ...authorization of or delivery of clinical and non-clinical... ...is the subject matter expert responsible for all clinical... ...This position is 100% Remote. We are hiring for the... ...Qualifications: RN, LPN OR Dental Hygienist...Remote jobContract workTemporary workWork experience placementLocal areaMonday to FridayShift work- ...rewarding role, you'll use your clinical knowledge outside of the... ...unrestricted Registered Nurse (RN) license Strong clinical background... ...for vulnerable populations Remote work enjoy the convenience and... ...letters, reason codes, and appeal rights in compliance with...Remote jobFull timeTemporary workWork at officeWork from home
$100k - $150k
...Clinical Expert, Care Team Operations New York Thesis is building the... ...Review prior authorizations, appeals, and other clinical-... ...clinical licensure : Current RN, NP, or equivalent clinical license... ...Location : This role may be remote or hybrid. NYC-based candidates...Remote work- ...Seeking a Registered Nurse (RN) – Expert Medical Examination Consultant... ...hybrid schedule (three days remote, two days onsite). This position... ...for performing detailed clinical and administrative reviews to... ...responsibilities include supporting appeals and follow-up reviews,...Remote jobLong term contractFull timeContract work
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