Remote Clinical Appeals RN | Case Review & Resolution
University of Minnesota School of Nursing
- Remote job
UnitedHealth Group is seeking a Clinical Appeals RN to analyze appeals and grievances, acting as a clinical interface liaison with facilities, providers, and carriers. Remote work is offered across the U.S. with a M-F schedule and alternating Saturdays. Responsibilities include reviewing records for eligibility, interpreting plan language, coordinating with Medical Director, and documenting determinations while maintaining confidentiality. #J-18808-Ljbffr University of Minnesota School of Nursing
- Piper Companies is seeking a Clinical Appeals Nurse for a fully remote healthcare-based opportunity. This... ...contract role focused on clinical review, appeal resolution, regulatory compliance, and... ...involves evaluating complex appeal cases, gathering and assessing medical...Remote jobLong term contract
- WPS Health Solutions is hiring an Appeals Nurse to review medical records and claims for first-level Medicare appeal cases to determine medical necessity... ...Qualifications include an active RN license (state of practice), 1+ years clinical experience, and strong...Remote job
- ...delivering care supported by technology to help millions live healthier lives. The Clinical Appeals RN defends MassHealth prior authorization decisions and conducts pre-service reviews, working with managers and peers. Based in Massachusetts with telecommute options for...Remote job
- Healthfirst is seeking an A&G Clinical Specialist to manage clinical case development and resolution for member and provider appeals and grievances. The role ensures compliance with... ...The position offers flexibility to work remotely or on-site at NYC's 100 Church Street...Remote job
$29 - $52 per hour
...Growing together. The Clinical Claim Review RN will be responsible... .... The Sr. Recovery Resolution Analyst will present... ...and the client's case tracking system. Where... ...Auditor will support appeal and fraud investigation... ...This position is Remote in Massachusetts. You...Remote workHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work- Healthfirst is seeking an A&G Clinical Specialist to lead the development and resolution of clinical cases for member and provider appeals, ensuring compliance... .... The role can be remote or on-site at the NYC or... ...for internal and external reviews. #J-18808-Ljbffr HealthfirstRemote work
- WPS Health Solutions seeks an Appeals Nurse to review medical records and claims... ...information for first-level appeal cases to determine medical... ...to Medicare guidelines. The RN will collaborate with Appeals... ...redeterminations and compliant resolutions. Responsibilities include...Remote job
- ...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
- WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level Medicare redeterminations... ...CMS and internal policies. The role requires an RN license, ASN/BSN, and 1+ year clinical experience, with strong communication and attention...Remote job
$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... ...for clinical case development and resolution, ensuring compliance with... ...colleagues and prepare cases for review and appeals. Minimum...Remote jobFull timeMonday to FridayShift work$81.1k - $116.48k
Position Summary: The Appeals & Grievances (A&... ...or delivery of clinical and non-clinical... ...all clinical case development and case resolution while ensuring... ...position is 100% Remote. We are hiring... ...Medical Director Review ensuring that all... ...: RN, LPN OR Dental Hygienist...Remote jobContract workTemporary workWork experience placementLocal areaMonday to FridayShift work- ...Joe’s. Job Summary The Clinical Denial Appeals Coordinator supports the... ...with patients, physicians, case managers, payers, and other... ...Participate in telephone clinical reviews and multidisciplinary... ..., financial) and effective resolution strategies. Demonstrated...Remote workWork at office
$70k - $80k
...Piper Companies is seeking a Remote Clinical Appeals Analyst to provide clinical expertise in reviewing and resolving complex member and... ...North Carolina licensure as an RN, LPN, PT, or OT and have significant... ...coordination, and complex case analysis. This is a full-time contract...Remote workFull timeContract workMonday to Friday$40.5 - $64.8 per hour
...alongside some of the best clinical talent in the nation... ...**This is a remote casual position supporting Utilization Review at Catherine Gratz Griffin... ...or 6p to 6a. ** The Case Manager, RN (PT)reflects the mission... ...of Medicare discharge appeal rights within the appropriate...Remote workHourly payTemporary workWork experience placementCasual workLocal areaRelocation packageFlexible hoursRotating shiftWeekend workWeekday work- ...first 25 applicants Job Title:Clinical Review Nurse (RN) - Utilization Management... ...ensure timely, accurate case handling and serve as a key... ...provider communications and issue resolution Build and maintain positive... ...Program Coordinator RN *Remote* Clinical Program...Remote workContract work
- Providence Health & Services is seeking an Appeals RN in Case Management for a remote, per diem role working 8-hour day... ...Recovery Advocate will manage clinically-based appeals between Providence... ...with care teams to ensure timely resolution of denials, with base pay...Remote jobDaily paidDay shift
- ...Ensures completion of appropriate clinical review of all applicable patients as... ...week. This role will be remote BUT regular meetings/trainings... ...using Epic and escalating cases for status change where necessary... ...clinical support to aid in appeal process. Serves as resource...Remote workReliefWeekend work3 days per week
$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization that delivers care... ...as applicable Assists with resolution of claims as needed to support negotiations and appeals process Interacts with... ...degree ~ Active and unrestricted RN license OR LPN in the state of...Remote jobHourly payMinimum wageFull timeTemporary workWork experience placementLocal area- ...healthcare professionals in clinical and non-clinical... ...This person will be reviewing cases to make sure the correct... ...taken and denying and appealing those cases. They will... ...Generate appropriate appeal resolution communication to the... ...Information Are you a RN with Case Management...Private practiceWork at office
$32 - $48 per hour
...Overview The Utilization Review Specialist RN assumes... ...coordination and management of appeals for accounts deemed appropriate... ..., and ensure timely resolution of utilization review... ...RN Department: Case management Location:... ...of five years of clinical nursing experience in...Hourly payFull time$28.94 - $51.63 per hour
...Connecting. Growing together. The Clinical Appeals RN is responsible for... ...and grievances (analyzing, reviewing, and evaluating appeals and... ...facilities, providers, carriers, resolution of issues concerning... ...enjoy the flexibility to work remotely * from anywhere within the...Remote jobHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaWeekday work- ...service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist... ...and knowledge of Utilization Review Guidelines. The position offers...Remote work
- ...concurrent and retrospective review of inpatient,... ...level of care, including appeal requests initiated by providers... ..., etc. using approved clinical protocols. 2. Analyze... ...appropriate area for resolution. 7. Follow out-of-... ...care, discharge planning, case management, and...Contract workWork at officeLocal area
- Alaffia is seeking a Clinical Itemized Bill Reviewer to join our Appeals and Disputes team. You will review disputes tied to Payment Integrity findings, focusing... ...of CPT/ICD-10/HPCS coding guidelines. This is a remote role in the United States. #J-18808-Ljbffr NearaRemote job
- Job Title: Clinical Financial Case Mgr - RN Department: Health System Shared Services... ...Clinical Pre-Certification, Case Reviews, Pre-billing edits, in-... ..., and internal), clinical appeals and denial management.... ...Additional Information Location: Remote Location Position Type:...Remote workFlexible hoursShift workDay shift
$85k - $92k
...Solutions Group is seeking a Clinical Quality Reviewer to support a federal... ...medical records, conducting case analyses, and ensuring compliance... ...Candidates must have a valid RN or LCSW license with at least... ...experience. The position may be remote or onsite based on business...Remote workWork at officeHome office- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical... ...of care which may include cases requiring prior authorization... ...action, consent, etc.) or appeal. This may involve... ...unrestricted Registered Nurse (RN) license PREFERRED QUALIFICATIONS...Remote workPermanent employmentWork at officeLocal area
$89.76k - $127.98k
...management and concurrent review activities to ensure... ...with verbal and written appeals related to denied... ...candidates demonstrate strong clinical judgment, exceptional... ...Utilization Review and Appeals Case Manager may include the... ...Three to Five years RN experience in an Acute...Full timeWork at officeFlexible hoursWeekend workDay shiftWeekday work- Inova's Juniper Clinic is looking for a dedicated... ...Registered Nurse Case Manager to join the... ...Registered Nurse (RN) Case Manager I Job... ...rates, denials and appeals. Collects, analyzes... ...needs through review of patient information... ...assisting with conflict resolution when necessary....Full timeMonday to FridayFlexible hoursDay shift
$30 - $39 per hour
...Position Title: Clinical Review Clinician - Appeals Location: Remote Duration: 5 Months | Possibility to extend or... ...Licensure ~ Required: RN, LPN Must haves: ~... ..., iCP 9 CPD and CenPas is 20 CPD cases per day with 95% quality on all cases...Remote workPart timeWeekend work3 days per week
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