Remote Clinical Appeals Reviewer - RN-Preferred
Centene Corp.
- Remote job
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- ...Authorization Management Clinical Reviewer – Appeals and Denials This job is responsible for reviewing... ...with CarePort Care Management preferred. ~ Licensed RN, with the ability to obtain other... ...periods of time. #LI-PG1 #LI-Remote WellSky is where independent thinking...Remote workFull timeWork experience placementWork at office
- NTT DATA, Inc. seeks a Clinical Reviewer Specialist to perform clinical and medical necessity... ...reviews for member and provider appeals, evaluating records against NCQA... ...requirements. Role offers remote work within Florida, requires RN licensure, 3 years’ experience in...Remote job
- UnitedHealth Group is seeking a Senior Clinical Administrative RN to review member appeals and fair hearing requests from a Texas-based remote location. The role focuses on clinical and chart review, audits, and regulatory alignment within a managed care setting. The ideal...Remote job
$85k - $92k
...~$41–$44/hr Location: Remote Schedule: Must work AZ... ...Candidates must meet required AND preferred qualifications... ...unrestricted license: RN Minimum 3+ years clinical experience (med/surg and/or... ...Clinical Quality / Utilization Review / Case Review experience...Remote workHourly payDay shift$75.2k - $120.5k
...Job Summary: The Clinical Care Reviewer II - Massachusetts is responsible for processing medical... ...completion of an accredited registered nursing (RN) degree program required Three (3)... ...care or home health experience preferred Utilization Management/Utilization...SuggestedHourly payFull timeWork at office- ...among the first 25 applicants Job Title:Clinical Review Nurse (RN) - Utilization Management Location:... ...Management or Clinical Review Preferred Qualifications: ·Experience in Case Management... ...) Clinical Program Coordinator RN *Remote* Clinical Program Coordinator RN *...Remote workContract work
- ...Performs medical reviews using clinical/medical information provided... ...This is a full-time remote (40-hours/week) working... ...the basis of the appeal or retrospective review... ...Certificate: Active RN licensure in state hired... ...Compact (NLC). What We Prefer: Preferred...Remote workFull timeFor contractorsWork experience placementWork at officeLocal areaWork from homeMonday to FridayShift work
$60.2k - $107.4k
...Senior Clinical Administrative Nurse At UnitedHealthcare, we're simplifying... ...including support through the appeals process Educate members on... ...~ Current and unrestricted RN compact license ~ Ability to... ...i.e. MS Word, Outlook) Preferred Qualifications: ~...Remote workMinimum wageFull timeWork experience placementLocal areaWeekday work- ...determine the viability of the claim for further review in a production environment. Primary Responsibilities: Clinical Case Reviews - 75% Perform clinical review... ...will be required for this position) Preferred Qualifications: Experience working with medical...Remote jobContract workWork at officeLocal areaMonday to Friday
$40 - $50 per hour
...Job Description Job Description Clinical Appeals RN – 100% Remote $40-$50/hour | Part-Time & Full-Time... ...you'll use your clinical expertise to review and appeal insurance denials related... ...or degrees (e.g., RN, NP, or PA) preferred. Minimum of 2 years of clinical experience...Remote jobPermanent employmentFull timeTemporary workPart time- ...is seeking a professional to manage the appeal of unpaid medical claims within the Central... .... Responsibilities include reviewing and appealing denials, following up on appeals... ...certification and 3 years of coding experience are preferred. #J-18808-Ljbffr University of...Remote jobWork at office
- ...is seeking an experienced RN to own grievance and appeals cases from intake to final decision in a fully remote setting. You will handle outpatient... ...Medicaid/MLTC, and strong clinical writing. Prior utilization/case management foundation preferred, with ability to manage...Remote job
$119.14k - $184.95k
...Care Manager Appeals RN - REMOTE position. This position is Per Diem and will work 8- hour, Day... ...overall management and communication of clinically-based appeals between Providence... ...in an acute hospital setting. Preferred Qualifications: Bachelor's Degree...Remote workDaily paidMinimum wageShift workDay shift- ...Off Job Summary The Appeal Specialist II reviews, analyzes, and resolves insurance... ...as needed. Files other clinical appeals on in scope denial... ...Therapy, or Speech Therapy preferred ~3-5 years of experience... ...Licenses and Certifications RN - Registered Nurse - State...Remote workFull timeContract workWork at office
- Care Manager AppealsRN - REMOTE position. This position is Per Diem and will work 8... ...overall management and communication of clinically-based appeals between Providence Health and Services... ...manager in an acute hospital setting. Preferred Qualifications: Bachelor's Degree in...Remote workDaily paidDay shift
- ...Care Manager Appeals RN - Remote Position This position is Per Diem and will work 8-hour, Day... ...overall management and communication of clinically-based appeals between Providence... ...manager in an acute hospital setting. Preferred Qualifications: Bachelor's Degree...Remote workDaily paidDay shift
$80k - $100k
Clinical Reviewer Registered Nurse (RN) Washington State. Clinical Reviewer Registered Nurse (RN) Washington... ...Comagine Health | Washington State | Remote / Work From Home Department: Care... ...commitment to confidentiality. Preferred Qualifications Bachelor's degree (BA...Remote workFull timeContract workLocal areaWork from homeHome office- ...Mosaic Life Care is seeking a CDI reviewer to perform initial and intermediate clinical documentation integrity reviews. You will work with providers to clarify... ...include reviewing denials, participating in appeals with physician advisors, and collaborating with the...Remote work
$70k - $120k
...Fully Remote: Clinical Documentation Specialist Facilitate the improvement... ...concurrent and retrospective reviews of medical records to ensure... ...Qualifications Registered Nurse (RN) with a current license from... ...is very expensive so they prefer local). Have all the benefit...Remote workLocal areaMonday to Friday- ...perform initial to intermediate clinical documentation integrity reviews. You will work under the... ...issues, support appeals, and participate in mortality... .... The role requires an RN license, 3 years of ICU experience... ...ICD-10-CM/PCS coding. Remote work is considered for...Remote work
- ...UChicago Medicine , as a RN Manager for the... ...Department. The Manager, Clinical Revenue Integrity & Appeals is responsible for... ...clinical review, medical necessity validation... ...certification preferred. Skills Experience... ...Location: Flexible Remote (Will need to commit...Remote workFull timeMonday to FridayFlexible hoursShift work
$38.46 - $43.27 per hour
...DescriptionJob DescriptionAs the Clinical Reviewer, you will be responsible for... ...NY office. Ability to work remotely one day per week after... ...Nurse, required (open to any RN state license).Graduate of a... ...management and peer review, preferred.The salary range and/or hourly...Remote workHourly payFull timeFor contractorsWork at office1 day per week- ...improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our... ...and professionally. Position Overview We are seeking an RN to perform Clinical Review work and QIDP reviews work. Team member will serve as the...Remote workContract work
$52 per hour
...Hiring for RN - Appeals (Remote Role) in Somerville, MAShift: Days 5x8 (08:00 - 17:00) Duration: 13 Weeks (Temp to Perm)Pay Rate: $52/hr on... ...have at least 2 years of Health Plan appeals experienceWorks closely with our medical directors on case reviews and decisions...Remote workPermanent employmentTemporary work- ...healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member... ...case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license... ...and knowledge of Utilization Review Guidelines. The position offers a...Remote work
$37.88 - $63.14 per hour
...patients. The mission of the Clinical Documentation... ...degree. This is a fully remote position and available... ...position is responsible for reviewing content of the medical... ...Requires Registered Nurse (RN) license in state of... ...team format. PREFERRED QUALIFICATIONS Experience...Remote workWork experience placementLive inMonday to FridayShift work- ...- FRI) JOB SUMMARY: The Clinical Documentation Specialist (CDS)... ...performs pre-visit and retrospective reviews of ambulatory clinical... ...organizational and planning skills. Preferred Qualifications: Bachelor of... ...and auditing preferred. RN with Current Certified...Remote workReliefWork at officeShift work
$66.58k - $142.58k
Appeals Nurse Consultant (Remote)### Appeals Nurse Consultant (Remote)Apply... ...resolution of clinical appeals by applying... ...Responsible for the review and resolution of clinical... ...and unrestricted RN licensure in state of... ...clinical experience.**Preferred Qualifications***...Remote workHourly payFull timeTemporary workLocal areaWork from homeMonday to FridayShift work- ...HEDIS RN – Clinical Quality Reviewer Manhattan, NY | 6 Openings | Hybrid | Full-Time HumanEdge Healthcare Staffing is recruiting experienced HEDIS... ...in Manhattan, 100 Church Street. Monday and Friday: Remote. Hours: 8:30 AM–5 PM. Responsibilities Perform medical...Remote workFull timeContract workWork experience placementMonday to Friday
$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... ...colleagues and prepare cases for review and appeals. Minimum... ...LPN, or Dental Hygienist Preferred Qualifications: Bachelor’s...Remote jobFull timeMonday to FridayShift work
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