Remote Appeals RN - Clinical Decision Expert
UnitedHealth Group
- Remote job
UnitedHealth Group is seeking a Clinical Appeals RN to provide expert analysis of appeals and grievances, acting as a clinical interface liaison with facilities, providers, and carriers. The role supports equitable, efficient decisions and requires strong documentation and confidentiality adherence. The position offers remote work from anywhere in the U.S., with an M-F schedule of 8:00–4:30 and alternating Saturdays. A valid RN license and 2+ years of clinical experience are required. #J-18808-Ljbffr UnitedHealth Group
- Healthfirst is seeking an A&G Clinical Specialist to lead the development and resolution of clinical cases for member and provider appeals, ensuring compliance with applicable laws and internal policies. The role can be remote or on-site at the NYC or Lake Mary locations...Remote work
$68.97k - $113.31k
Guardian Life is seeking an RN Clinical Consultant to support disability claim decisions. You will review medical data, assess functional capacity, and collaborate... ...care and 3+ years in LTD/STD clinical consulting. Remote options nationwide are available, with salary...Remote job- ...role, you'll use your clinical knowledge outside ofthe... ...unrestricted Registered Nurse (RN) license Strong... ...populations Remote work - enjoy the convenience... ...utilization review decisions and clinical rationale... ...letters, reason codes, and appeal rights in compliance with...Remote workFull timeTemporary workWork at officeWork from home
$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 Specialist - RN, LPN or Dental Hygienist... ..., and reference internal policies. Make decisions, document cases, and manage work within...Remote jobFull timeMonday to FridayShift work- ...role, you'll use your clinical knowledge outside ofthe... ...unrestricted Registered Nurse (RN) license Strong... ...populations Remote work - enjoy the convenience... ..., utilization review decisions, and rationale in electronic... ..., reason codes, and appeal rights in accordance...Remote workFull timeTemporary workWork at office
$55 - $65 per hour
...Position: Adult Inpatient Nurses (RN) Type: Contract... ...$55–$65/hour Location: Remote Role Responsibilities Review... ...Review and evaluate AI-generated clinical outputs based on nursing... ...training datasets . Provide expert feedback on nursing assessments...Remote workContract workSummer work- ...Registered Nurse to join the cardiac device clinic team at Advocate Christ Medical Center.... ...pacemakers and ICDs, device interrogations, and remote monitoring in a high-volume environment.... ...care) with EP/Device exposure, and active RN licensure with CPR and ACLS. #J-18808-...Remote work
- A leading telehealth provider is seeking a Remote Telehealth Triage Nurse to provide telephone triage and health advice to patients across... ...should have a compact nursing license and a minimum of 3 years clinical experience. This full-time position allows for flexible...Remote jobFull timeFlexible hours
- 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... ...Nursing, 5 years inpatient clinical experience, CCS or CPC, and RN status preferred. #J-18808-Ljbffr R1 RCM, Inc.Remote job
- UnitedHealth Group is seeking a Remote Appeals Clinician in Texas. You will conduct comprehensive reviews... ...), evaluate records, and provide independent clinical judgments on medical necessity. Requirements include a Texas RN license and 2+ years in Medicaid with data-entry...Remote jobFlexible hours
$33.71 - $60.67 per hour
Centene is seeking an RN with strong appeal review experience to act as liaison for statewide appeals... ...and review organizations. This fully remote role supports members and providers... ...active RN license and have 4+ years of clinical nursing or case management experience;...Remote jobHourly payFlexible hours- A national health organization is seeking a Clinical Review Clinician - Appeals to conduct clinical reviews and manage appeals. The role requires an... ...standards and healthcare regulations. The position is fully remote and includes a comprehensive benefits package. Join us...Remote jobFlexible hours
- ...medical records and preparing clinical appeals in response to medical... ...Current and unrestricted RN license At least 5 years of... ...Expectations Comfortable with remote work arrangements and virtual... ...all associates. All employment decisions at Netsmart, including but not...Remote workFor contractorsRelief
- UnitedHealth Group is seeking a Clinical Coordinator RN for a Telecommute role in Texas. You will conduct... ...comprehensive clinical reviews of appeals, evaluate medical records, and provide... ...and collaboration within a remote team, with weekday daytime hours. Ideal...Remote jobWeekday work
- ...Clinical Appeals Specialist The Clinical Appeals Specialist completes research... ...adverse and adverse coverage decisions. The Clinical Appeals... ...appeal requests using nursing expert knowledge and all available clinical... .../Certifications: RN - Registered Nurse - State Licensure...Remote workWork at office
- UnitedHealthcare is hiring a Clinical Appeals RN for remote work Monday-Friday, with alternating Saturdays. The role analyzes appeals and grievances, acts as a clinical liaison, and supports resolution with facilities, providers, and plans. We offer a flexible schedule...Remote jobHourly payWork at officeMonday to FridayFlexible hours
$28.94 - $51.63 per hour
Improve the lives of others while Caring. Connecting. Growing together. Job Description - Clinical Appeals RN - Remote - M-F working alternating Saturdays (2369974) Clinical Appeals RN - Remote - M-F working alternating Saturdays - 2369974 At UnitedHealthcare, we’re...Remote jobHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaMonday to FridayWeekday work$32.13 - $45 per hour
...States seeks a Triage Registered Nurse to provide effective telephone triage for patients. The ideal candidate will have a BSN, strong clinical assessment skills, and at least 2 years experience in triage. Responsibilities include conducting clinical assessments, educating...Remote workFull time- Tampa General Hospital in Tampa, FL, seeks a Clinical Nurse for the Emergency Dept Clinical Decision Unit. The role requires delivering direct, patient-centered... ...seven days, located on-site at the main campus. Florida RN licensure is required; graduates of accredited...Full time
$40 - $46 per hour
...A client of Innova Solutions is immediately hiring for a RN Clinical Appeals Specialist Position type: Full time Contract to hire Duration... ...: 3-month contract Location: Philadelphia PA 19103 (Remote) As a RN Clinical Appeals Specialist you will: Manage...Remote workHourly payFull timeContract workTemporary workFor contractorsWork experience placementWork at officeImmediate startWorldwideFlexible hours- ...time Day - 08 Hour R2659562 Remote USA 108480040 TDS Population... ...of America) "This Platform Expert position will apply deep functional... ...is not mistaken for a locked decision. Ability to lead and deliver... ...based on the operational/clinical requirements of the objective...Remote workFull timeShift work
- ...review medical records, assess AI-generated clinical content for accuracy and safety, and... ...required. LOCATION:United States — Remote SENIORITY:Experienced Physician... ...written explanations supporting review decisions. Contribute to the improvement of documentation...Remote workContract work
- ...seeking an LPN/LVN with experience in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to ensure NCQA-compliant UM program operations. The role requires strong...Remote job
- UnitedHealth Group is seeking a Clinical Grievances Nurse to review retrospective cases and current cases ensuring appropriate care and... ...addressing immediate member needs. This role offers PST hours with remote work options and a Monday-Friday schedule. You will perform...Remote jobImmediate startMonday to Friday
$187.5k - $205k
...Job TitleStructural Heart Clinical Adoption Expert – CV Ultrasound (West Zone) Job Description Structural... ...Zone) This role drives clinical decision support for products and solutions... ...customer training, case study support days, remote system training, software changes,...Remote workFull timeLocal areaImmediate startWork visaRelocation package- ...workflows by answering medication-related clinical questions and reviewing AI-generated... ...accuracy, safety, and clarity. This fully remote contract offers 30-40 hours per week, weekly... ...AI researchers on real‑world clinical decision support. Applicants should bring strong...Remote jobWeekly payContract work
- ...review how AI models handle clinical psychology scenarios, and help... ...cases. AfterQuery builds the expert evaluation data that frontier... .../hr , paid weekly via Stripe Remote and fully async. No fixed hours... ...is read and gets a decision. Onboarding. Complete ID verification...Remote workWeekly payContract workTemporary workFor contractors
$70 per hour
...Compensation: $70/hour Location: Remote Commitment: 30–40 hours/week... ...Responsibilities Answer medication-related clinical questions using patient context, source... ...medications, pharmacy workflows, and clinical decision-making. Excellent understanding of...Remote workContract workSummer work- One Senior Care is seeking a Clinical Documentation Integrity Nurse to support accurate, complete provider documentation for PACE Participants... ...judgment, and independent work in a developing CDI program. Remote schedule with standard business hours. #J-18808-Ljbffr One...Remote job
$25 - $35 per hour
...Piper Companies is seeking a Clinical Appeals Nurse to join a leading health insurance organization for a contract remote opportunity located in North Carolina. The Clinical Appeals... ...include: • Active Registered Nurse (RN) license in the State of North Carolina...Remote workHourly payContract work
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