Medicare Appeals RN - Remote Review Specialist
$66k - $68kWPS—A health solutions company
- Remote job
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 with Appeals Examiners to ensure timely redeterminations and adherence to CMS guidelines. Strong clinical background and communication skills are essential. The role offers remote work options across approved states, with a base salary in the 66k–68k USD range and growth opportunities within a supportive team. #J-18808-Ljbffr WPS—A health solutions company
- WPS is seeking an Appeals Nurse to review medical records and Medicare claim information for first-level appeal cases. You will collaborate... ...with CMS guidelines. Required RN license, ASN/BSN, and 1+ year clinical experience. Remote work is permitted in several states, including...Remote job
- ...service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and... ...case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license... ...practice and knowledge of Utilization Review Guidelines. The position offers...Remote work
- ...expertise and dedication. Paid Time Off Job Summary The Appeal Specialist II reviews, analyzes, and resolves insurance denials to ensure... ...software and Google Suite. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure...Remote workFull timeContract workWork at office
- ...solutions company, is hiring an Appeals Nurse to review medical records and claims... ...necessity and adherence to Medicare guidelines. The role... ...compliance with CMS requirements. Remote work is available from select... ...include an ASN/BSN, an active RN license, 1+ year of clinical...Remote job
- WPS, a health solutions company, is seeking an Appeals Nurse (RN) to review medical records and Medicare denial cases for medical necessity. The role collaborates... ...experience and strong communication skills. Remote work options available for approved states, including...Remote job
- 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 job
- ...healthcare employer to recruit a Case Manager - Utilization Review Specialist for a fully remote role in the United States. The position focuses on... ...necessity determinations, and coordination of multi-level appeals to support appropriate patient care and financial performance...Remote job
- Centene is seeking a California-licensed nurse (RN or LPN/LVN) for a remote role aligned to Pacific Standard Time hours. You will facilitate medical necessity grievances, appeals, and denials, review clinical data, and determine if criteria are met under NCQA guidelines...Remote job
- Quorum Health Corporate is seeking a remote Utilization Review Specialist with a registered nurse background to manage admission decisions and concurrent... ...standards. Responsibilities include coordinating appeals, documenting denials, and collaborating with health-care...Remote job
- ...Corporation is seeking an experienced Denial Mitigation-Appeal Specialist II RN to support revenue cycle by reviewing clinical cases, preparing appeals, and... ...reimbursement and ensure timely appeal submissions. Remote work may be possible after probation upon meeting...Remote workTrial period
- Phaxis is seeking an experienced registered nurse to investigate and manage clinical grievances, appeals, and external reviews from intake to resolution. The role emphasizes reviewing medical necessity, quality-of-care concerns, and coordination across settings from outpatient...Remote job
- WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records and CMS-denial redeterminations. You will collaborate with Appeals... ..., with strong communication and detail orientation. Remote-friendly with eligibility to work in designated states. #J...Remote job
$52 - $56 per hour
...Contract RN For New York Health Plan You've done UM. You've worked appeals. Now find a role that uses both. We... ...New York health plan (Medicare Advantage, Medicaid and... ...management. 100% remote (U.S.) | Contract | $5... ...investigation, clinical review, decision and notification...Remote jobContract workAfternoon shift- UnitedHealth Group is seeking a Senior Clinical Administrative RN to support Texas remote reviews of appeals and fair hearings. The role emphasizes clinical review, chart audits, and collaboration with cross-functional teams to ensure accurate determinations and compliance...Remote job
- ..., seeks an experienced Case Manager - Utilization Review Specialist to oversee admission and concurrent reviews remotely in the United States. You will evaluate medical records for medical necessity, coordinate appeals, and collaborate with clinicians and payers to improve...Remote job
- ...CVS Health Corporation is seeking an RN Concurrent Review Nurse to join a remote team delivering inpatient clinical expertise to ensure medically necessary care across the continuum. This role offers work-from-home scheduling, Monday–Friday, with some weekend coverage....Remote workWork from homeMonday to FridayWeekend work
- ...Sedgwick is seeking a Telecommuter RN for Utilization Review in the United States. The role requires an active RN license, an associate degree... ...utilization review. Certification is a plus. The position offers remote work with a comprehensive benefits package and competitive...Remote work
- Jobgether, listing on behalf of a partner company, seeks a Case Manager - Utilization Review Specialist in the United States. The remote role focuses on admission and concurrent reviews, appeals coordination, and ensuring compliance with clinical and payer requirements. A...Remote job
- ...a Registered Nurse for Utilization Management in a remote-capable role. This position focuses on reviewing admissions and service requests for medical necessity... ...planning across the organization. The role requires Texas RN licensure and a nursing diploma, with benefits...Remote work
$69.39k - $88.61k
...Cincinnati Children’s is seeking an experienced Utilization Review professional for a remote role in the United States. The position supports case... ...requires a Bachelor’s degree in a related field, an active RN/Social Work/Clinical Counselor license, and 2+ years of related...Remote workFull time- ...Cincinnati Children e s Hospital Medical Center is seeking a Remote Utilization Review professional to perform admission and continued stay reviews using InterQual, ensuring medical necessity and appropriate level of care.The role collaborates with Admitting, Financial...Remote work
$65k - $85k
...Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning... ...looking for an experienced Utilization Review Specialist (RN) to join our remote home health team.... ...Health experience Strong knowledge of Medicare guidelines and home health regulations...Remote workMonday to FridayWeekend workWeekday work- 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... ...clinical experience are required, with remote work options available in designated...Remote job
- WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records for first-level appeal... ...and determine medical necessity under Medicare guidelines. You will collaborate with... ...communication and regulatory knowledge. Remote work is available in approved states,...Remote job
- WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first... ...-level appeal determinations under Medicare guidelines. The RN collaborates with Appeals Examiners... ...with 1+ year clinical experience. Remote work is allowed in several states with...Remote job
- WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims for first-level... ..., determining medical necessity and Medicare coverage compliance. The RN... ...timely manner. This position supports remote work in approved states, including Ohio...Remote job
- Optum is seeking a Per Diem Utilization Management Nurse to review medical records and craft defensible appeal letters. You will extract pertinent case details, adhere to HIPAA, and follow OPAS/Optum guidelines while meeting time expectations. The role offers telecommuting...Remote jobDaily paidLocal area
- ...health solutions company is seeking an Appeals Nurse to review medical records and claims for first-level... ...medical necessity and adherence to Medicare coverage guidelines. The role collaborates... ...hold an ASN/BSN with an active RN license and 1+ year of clinical experience...Remote job
- WPS Health Solutions is seeking an Appeals Nurse to review medical records for first-level appeals... ...determine medical necessity under Medicare guidelines. The RN collaborates with Appeals Examiners... ...clinical experience are required. Remote work options are available in...Remote job
- NTT DATA, Inc. is seeking a Clinical Reviewer Specialist for a fully remote position based in Florida. You will... ...necessity reviews for member and provider appeals, evaluating records and criteria to... ...NCQA compliance. The role requires RN licensure (Florida or compact), 3+...Remote job
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