Remote Appeals RN for Medicare Medical Necessity
WPS—A health solutions company
Raleigh, NC
- Remote job
WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims for first-level appeal cases to determine medical necessity per Medicare guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations and compliant resolutions. A valid RN license and clinical experience are required. The position offers remote work options across approved states with competitive benefits and opportunities for professional development. #J-18808-Ljbffr WPS—A health solutions company
Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Remote Appeals RN for Medicare Medical Necessity in Raleigh, NC vacancy
- WPS Health Solutions is seeking an Appeals Nurse (RN) to examine medical records and claims for first-level appeal cases to determine medical necessity and adherence to Medicare guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations...Remote jobMedical
- ...Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims for first-level... ...cases to determine medical necessity and compliance with Medicare guidelines. You will collaborate... ...quality outcomes. The role supports remote work in multiple states and...Remote jobMedical
- WPS Health Solutions seeks an Appeals Nurse (RN) to review medical records for first-level appeal cases and determine medical necessity under Medicare guidelines. The role collaborates with Appeals... ...experience are required, with remote work options available in...Remote jobMedical
- WPS Health Solutions seeks an Appeals Nurse (RN) to review medical records for first-level appeal cases to determine medical necessity under Medicare guidelines. You will collaborate with Appeals... ...and organizational skills. Remote work is available for designated states...Remote jobMedical
- ...Solutions is hiring an Appeals Nurse to review medical records and determine medical necessity for first-level... ...redeterminations in line with Medicare guidelines. The ideal... ...ASN/BSN, an active RN license, and 1+ year of... ...organizational skills. Remote work options are available...Remote jobMedical
- ...Clinical Reviewer Specialist for a fully remote position based in Florida. You will perform clinical and medical necessity reviews for member and provider appeals, evaluating records and criteria to... ...NCQA compliance. The role requires RN licensure (Florida or compact), 3+...Remote jobMedical
- WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims information... ...appeal cases, determining medical necessity under Medicare guidelines. You will collaborate... ...skills, and the ability to work remotely from approved states. #J-18808-Ljbffr...Remote jobMedical
- ...Authorization Management Clinical Reviewer - Appeals and Denials to join our remote team. You will review acute and post-acute requests to determine medical necessity using InterQual guidelines and payer... .... The role requires an active RN license, 4-6 years of relevant...Remote jobMedical
- WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level Medicare appeals, ensuring medical necessity and policy alignment. The role collaborates... ...maintain regulatory compliance. The RN will lead documentation, write compelling...Remote jobMedical
$66k - $68k
WPS is seeking an Appeals Nurse (RN) to review medical records and claims for first-level appeal cases to determine medical necessity and compliance with Medicare coverage guidelines. The role collaborates... .... The position offers a remote-friendly environment with a salary...Remote jobMedical- ...solutions company, is hiring an Appeals Nurse to review medical records and claims for... ...cases, ensuring medical necessity and adherence to Medicare guidelines. The role... ...with CMS requirements. Remote work is available from... ...include an ASN/BSN, an active RN license, 1+ year of...Remote jobMedical
- WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims for first-level Medicare appeal cases, assessing medical necessity and adherence to CMS guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations...Remote jobMedical
- ...a health solutions company, is seeking an Appeals Nurse (RN) to review medical records and Medicare denial cases for medical necessity. The role collaborates with Appeals Examiners... ...and strong communication skills. Remote work options available for approved states...Remote jobMedical
$66k - $68k
WPS, a health solutions company, seeks an Appeals Nurse to review first-level appeal cases, assess medical necessity, and prepare rationale-supported letters. You will collaborate... ...skills are essential. The role offers remote work options across approved states, with a...Remote jobMedical- WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records and CMS-denial redeterminations... ...Appeals Examiners to ensure medical necessity is demonstrated and guidelines are... ...communication and detail orientation. Remote-friendly with eligibility to work in...Remote jobMedical
$52 - $56 per hour
...Contract RN For New York Health Plan You've... ...done UM. You've worked appeals. Now find a role that... ...New York health plan (Medicare Advantage, Medicaid and... ...you'll apply the same medical necessity judgment you built in... ...utilization management. 100% remote (U.S.) | Contract | $5...Remote jobMedicalContract workAfternoon shift- ...Role Snapshot The Appeals Nurse examines medical records and claims information... ...necessary and meet Medicare coverage guidelines... .... The Appeals RN works in collaboration... ...Location We are open to remote work in the following... ...the clinical necessity of services and make...Remote workMedicalFor contractorsImmediate start
Wisconsin Physicians Service Insurance Corporation
Grove City, OH4 days ago $66k - $68k
WPS is seeking an Appeals Nurse (RN) to evaluate medical records and claims for first-level Medicare appeals, ensuring medical necessity and compliance with guidelines. You will collaborate with... ...promptly. The role supports remote work in approved US states, offers a...Remote jobMedical- WPS Health Solutions is seeking an Appeals Nurse (RN) to analyze medical records for first-level appeals and determine medical necessity under Medicare guidelines. The role collaborates with... ...communication and computer skills. Remote work is available in listed states,...Remote jobMedical
- Centene Corp. in California seeks a remote nurse reviewer to handle medical necessity grievances, appeals and denials. The role requires CA RN/LPN/LVN licensure and 2+ years of clinical nursing experience, with NCQA and InterQual knowledge preferred. You will review cases...Remote jobMedicalFlexible hours
$53 per hour
REMOTE RN OPPORTUNITY - GRIEVANCE & APPEALS / UTILIZATION REVIEW We're hiring experienced Registered Nurses to join... ...Experience with prior authorizations and medical necessity reviews Grievance & Appeals experience Managed care, Medicare/Medicaid experience Strong clinical...Remote jobMedicalLong term contractMonday to Friday- WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims for first-... ...appeal cases, determining medical necessity and Medicare coverage compliance. The RN collaborates... ...manner. This position supports remote work in approved states,...Remote jobMedical
- Centene Corp. is seeking a remote RN/LPN/LVN with 2+ years of clinical nursing experience to facilitate medical necessity grievances, appeals and denials. The role requires California licensure and PST hours. You will review clinical data, prepare case reviews for the...Remote jobMedical
- The Appeals Nurse role at WPS—A health solutions... ...on reviewing medical records and claims... ...determine medical necessity for first-level appeal cases under Medicare guidelines. You will... ...include an active RN license, ASN/BSN, 1... ...with MS Office tools; remote work options are available...Remote jobMedical
- 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 jobMedical
- ...solutions company is seeking an Appeals Nurse to review medical records and claims for first-level... ...appeal cases to determine medical necessity and adherence to Medicare coverage guidelines. The role... ...candidates hold an ASN/BSN with an active RN license and 1+ year of clinical...Remote jobMedical
- WPS Health Solutions is seeking an Appeals Nurse to review medical records for first-level appeals to determine medical necessity under Medicare guidelines. The RN collaborates with Appeals... ...clinical experience are required. Remote work options are available in specified...Remote jobMedical
- WPS is seeking an Appeals Nurse (RN) to review medical records and denial information for first-level Medicare appeals, ensuring services meet medical necessity and CMS guidelines. You will collaborate with... ...experience, and offers remote work options in approved states...Remote jobMedical
- Centene Corporation is seeking a fully remote RN appeals reviewer to support processing of medical necessity reviews for appeals. You will research medical records... ...Familiarity with MCG/InterQual criteria and Medicaid/Medicare regulations is advantageous. #J-18808-Ljbffr...Remote jobMedical
- WPS—A health solutions company is seeking an Appeals Nurse (RN) to review medical records and claims for first-level appeal cases to determine medical necessity under Medicare guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations. In...Remote jobMedical
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Appeals RN for Medicare Medical Necessity. Be the first to apply!
