Remote Appeals Nurse for Medicare Medical Review
WPS Health Solutions
WPS Health Solutions in Columbus, OH, is seeking an Appeals Nurse to review medical records and Medicare claims for first-level appeals to determine medical necessity and coverage alignment.
The role collaborates with Appeals Examiners to prepare timely redeterminations, document clinical rationales, and ensure compliance with CMS guidelines. A registered nurse with strong communication and attention to detail is essential for success in this fast-paced environment.
#J-18808-Ljbffr- UnitedHealth Group is seeking a Remote Appeals Clinician in Texas. You will conduct comprehensive reviews of Medicaid-related assessments (H6516/H2060), evaluate records... ...and provide independent clinical judgments on medical necessity. Requirements include a Texas RN license...Remote jobMedicalFlexible hours
$95k - $110k
...It takes great medical minds to create powerful solutions that solve some of healthcare... ...a talented individual for a DRG Nurse Reviewer Appeals and Hearings to coordinate and perform... ...What you should expect in this role Remote (Work from Home) Up to 25% Travel for...Remote workMedicalFull timeWork from homeRelocation packageFlexible hours$45 per hour
SPECTRAFORCE is seeking a Clinical Appeals Specialist to handle member-generated appeal processes remotely from California. The role involves reviewing medical records and ensuring compliance... ...strong managed care and clinical nursing experience, exceptional attention...Remote jobMedicalHourly pay- Santa Barbara Cottage Hospital is seeking an experienced RN/LPN to perform remote clinical reviews for appeal cases. You will review medical records, apply InterQual criteria, and prepare clinical determinations for physician review. The role requires Florida licensure,...Remote jobMedicalContract work
- Role Snapshot The Appeals Nurse examines medical records and claims information for... ...medically necessary and meet Medicare coverage guidelines in... ...redeterminations are medically reviewed as needed and completed... ...Location We are open to remote work in the following approved...Remote workMedicalContract workFor contractorsLocal areaImmediate start
$36 - $40 per hour
...forging our own path. We’re a remote-first staffing and... ...coding career. If you are an Appeals and Denials Nurse looking for a new opportunity... ...letters Responsibilities: Reviews and completes continuous daily... ...behavioral health patients with medical needs) Analyzes work queues...Remote workMedicalPermanent employmentFull timeWork visa- ...seeking an experienced Registered Nurse to facilitate member and provider appeals and ensure processes meet guidelines... ...standards. You will partner with Medical Directors and Customer Service to... ...knowledge of managed care. This is a remote/work-from-home position with...Remote jobMedicalWork from homeShift work
- ...a leading healthcare intelligence company. The Medical Review Nurse II audits home health claims, working remotely with a multi-location team to ensure compliance... ...claims, reference guidelines, and participate in the appeals process while staying current with coding...Remote jobMedicalWork from home
- R1 RCM, Inc. is seeking a Clinical Coding Appeals Nurse for a remote US-based role. You will review medical records and draft appeals for denied or underpaid claims, applying ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance. Strong MS Office skills are essential for this...Remote jobMedical
$69.8k - $125.9k
...seeking a dedicated RN to facilitate member and provider appeals, coordinating with Medical Directors and Customer Service to ensure compliant processes... ...and a solid foundation in healthcare operations. This remote position supports the U.S. market. Compensation ranges from...Remote jobMedical$63.9k - $83.08k
...Integrated Transitional Care, the Claims Review Nurse, LVN is responsible for conducting timely medical reviews of IEHP facility and professional claims and appeals. The Claims Review Nurse, LVN... ...in managed care, MediCal, Medicare preferred High school diploma or...Remote workMedicalTemporary workWork experience placementFlexible hours- ...Are you a bedside nurse seeking a change from the... ...ideal candidate will : Review Nurse, Elderly and... ...responsible for the complete medical review and appropriate... ...required for appeals and fair hearings in a... ...but may be conducted in remote or field locations. The...Remote workMedicalContract workTemporary workWork at officeFlexible hours
- ...Overview Job Title: Registered Nurse – Claims & Appeals Review Location: Remote (Anywhere in Florida) Duration: 06 Months/Can be Extended Working hours: Day Shift Job Type: Subcon Pay Rate: Negotiable Position Description The Quality Analyst...Remote workContract workDay shift
- ...to partner with providers, case managers, and payors for medical necessity reviews and appeals. You will conduct concurrent peer-to-peer discussions... ...outcomes, regulatory compliance, and cost-effective care with remote work within the U.S. Optum Insight functions are...Remote jobMedical
- ...seeks an experienced Clinical Appeals Reviewer for the Itemized Bill Review... ...analyzes appeals, reviews medical records, and drafts written... ...coding and auditing expertise. Remote work within the U.S. is... ...coding. #J-18808-Ljbffr University of Minnesota School of NursingRemote jobMedical
- ...Registered Nurse – Utilization Review (Remote) Position Overview: This is a fully remote Utilization Review... ...: Minimum of 3 years acute medical Care Management/Utilization Review experience... .... Strong knowledge of Medicare regulations and associated utilization...Remote workMedical
- ...Management Department (Fully Remote)Job Summary:• Provides health... ...discharge planning and utilization review.Responsibilities:• Reviews... ...concurrent and retrospective medical necessity and/or compliance with... ...reimbursement and claim denials/appeals.• Assesses and coordinates...Remote workMedical
- ...highly skilled and experienced Registered Nurse with specialties in Medical/Surgical, ICU, ER, Psychiatric, Labor... ...Experience in Utilization Review or case management roles. Specialty... ...Strong ability to work independently in remote settings. Must be able to handle...Remote workMedicalFlexible hours
$1,813 - $1,908 per week
...Registered Nurse:Utilization Review,16:00:00-04:30:00 Location: Torrance... ...Stay Reviews Determine Medical Necessity per Evidence-Based... ...Regulatory CMS: Centers for Medicare and Medicaid Services... ...Goals Additional Skills remote UR work CA and Medi-Cal...Remote workMedical$52 per hour
...Hiring for RN - Appeals (Remote Role) in Somerville, MAShift: Days 5x8 (08:00 - 17:00... ...00% remoteLooking for a registered nurse with payor experience (Commercial and... ...Health Plan appeals experienceWorks closely with our medical directors on case reviews and decisions...Remote workMedicalPermanent employmentTemporary work$30 - $38 per hour
...organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves... ...for pre-certification requests, processing appeals, and working collaboratively with hospital staff....Remote workMedicalHourly payPart time$1,600 - $1,800 per week
...NOW HIRING: Registered Nurse - Utilization Management Location... ...weekends, no holidays, no telehealth/remote work Minimum... ...Utilization Management, Utilization Review, or Case Management ~• Preferred... ..., Case Management, or Medical-Surgical (ANCC or NCQA)...Remote workMedicalContract workImmediate startMonday to Friday- ...To support a growing healthcare platform, the full-time Medical Review Nurse will ensure compliance with CMS regulations for durable medical... ...coverage policies, and maintain data security while working remotely. Key Responsibilities Review DMEPOS orders and medical records...Remote workMedicalFull timeFlexible hours
$1,908 per month
...Little Company of Mary Medical Center Torrance... ...Travel Offering Nursing Profession... ...Specialty Utilization Review Job ID 17789... ...Regulatory CMS: Centers for Medicare and Medicaid Services... ...Additional Skills remote UR work CA and Medi-...Remote workMedicalWeekly payShift workNight shift- ...Health Plan in California seeks an LVN-validated Claims Review Nurse to audit medical necessity across inpatient and outpatient claims and support... ...year of relevant experience, and familiarity with Medi-Cal/Medicare concepts, with a focus on accuracy #J-18808-LjbffrRemote workMedical
$34 per hour
...The kozmetickesluzby.vecnakraska.sk - Jobboard is seeking a Sr. Medical Review Nurse for a remote position based in Baltimore, MD. This role involves comprehensive reviewing of medical records, coding practices, and working with stakeholders to ensure compliance and accuracy...Remote workMedicalHourly payFull time- ...Review NurseThis is a contract assignment that will start right away and end on April 30th 2024Summary Description:The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS)...Remote workMedicalContract workImmediate start
$1,946.5 per month
...Travel Offering Nursing Profession... ...Specialty Utilization Review Job ID 38399... ...) - Knowledge of Medicare regulations and processes... ...concurrent reviews, medical necessity determinations... ...Unit Details: - 100% remote work environment - Rotation...Remote workMedicalWeekly payShift workWeekend workDay shift$61.05k - $98.33k
...Itemization Review Nurse The Itemization Review Nurse provides a summary and analysis of items by reviewing... ...all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. This is a remote position. Essential Functions & Responsibilities...Remote workMedicalFull timeWork at officeFlexible hours- ...Clinical Coordinator RN to conduct clinical reviews and evaluations related to Medicaid appeals, ensuring compliance and accuracy in assessments. This remote role is ideal for experienced RNs... ...-care impact. You will review medical records, identify discrepancies, provide...Remote workMedicalFull time
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