Remote Medicare Appeals Nurse | First-Level Reviews
$66k - $68kWPS—A health solutions company
- Remote job
WPS is seeking an Appeals Nurse (RN) to evaluate medical records and claims for first-level Medicare appeals, ensuring medical necessity and compliance with guidelines. You will collaborate with Appeals Examiners to finalize redeterminations promptly. The role supports remote work in approved US states, offers a salary of 66–68k USD annually, and requires ASN/BSN with an active RN license and 1+ year clinical experience. #J-18808-Ljbffr WPS—A health solutions company
- WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims for first-level appeal cases, determining medical necessity and Medicare coverage compliance. The RN... ...timely manner. This position supports remote work in approved states,...Remote job
- 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...Remote job
- WPS Health Solutions is hiring an Appeals Nurse RN to review medical records and claims for first-level appeal cases to determine medical necessity according to Medicare guidelines. This remote-friendly role supports timely redeterminations and collaborates with Appeals...Remote job
- ...Appeals Nurse The Appeals Nurse examines medical records... ...information for first-level appeal cases to determine... ...necessary and meet Medicare coverage guidelines in... ...are medically reviewed as needed and completed... ...Location: We are open to remote work in the following...Remote workFor contractorsImmediate start
$36 - $40 per hour
...forging our own path. We’re a remote-first staffing and consulting... ...coding career. If you are an Appeals and Denials Nurse looking for a new... ...letters Responsibilities: Reviews and completes continuous daily... ...visas at this time. Seniority level Seniority level Not Applicable...Remote workPermanent employmentFull timeWork visa- ...Health Solutions is seeking an Appeals Nurse (RN) to examine medical records and claims for first-level appeal cases to determine... ...medical necessity and adherence to Medicare guidelines. The role... ...redeterminations and compliant review. You will review documentation...Remote job
$80.31k - $116.19k
...Our work spans Medicare Advantage, fully integrated... ...Provide clinical review of medical claims and post service appeals. Facilitate... ...Quality of Care (QOC) Nurse, Medical Management... ...to function at this level. - Performs work... ...$55.86 per hour Remote position An annual...Remote workHourly payFull timeFor contractorsLocal area- 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
$52 - $56 per hour
...You've done UM. You've worked appeals. Now find a role that uses... ...for a New York health plan (Medicare Advantage, Medicaid and MLTC)... ...utilization management. 100% remote (U.S.) | Contract | $52$56/hr... ...intake, investigation, clinical review, decision and notification...Remote jobContract workAfternoon shift- ...Job Title Registered Nurse (RN) for Critical... ...will be responsible for reviewing and evaluating critical... ...participate in hearings, appeals, and stakeholder discussions... ...technology to support remote and hybrid work... ...influence care at a population level, contribute to...Remote workWork from home
$90k - $99k
...Your Role in Our MissionReviews provider appeals and redeterminations using approved clinical... ...clearly and concisely.Analyzes and reviews appeal documentation to ensure all aspects... ...unrestricted RN license as defined by the Nurse Licensure Compact (NLC), requiredCertified...Remote workFull timeWork from homeFlexible hours$76k
...NTT DATA is seeking a BPO Clinical Review Specialist in the United States, with remote work available for Florida residents. The role requires an active RN... ...license (Florida or Compact) and at least 3 years of appeals, utilization management, or clinical review experience...Remote work- ...of our other Medical Review Nurse roles, which may be a... ...Medical Review Clinical Appeals Auditor (RN) is responsible... ..., and client program level, as well as date range... ...work independently in remote setting with minimum... ...or excluded from the Medicare program by OIG. Must...Remote jobImmediate startFlexible hours
$95k - $110k
...Summary We are seeking a talented individual for a DRG Nurse Reviewer Appeals and Hearings to coordinate and perform all appeal related duties... ...environment. What you should expect in this role Remote (Work from Home) Up to 25% Travel for onsite hearing testimony...Remote workFull timeWork from homeRelocation packageFlexible hours$34 - $47 per hour
...UM Review Nurse Department: HS - UM Employment Type: Full Time... ...various Health Plans. This is a remote position for CA-licensed... ...Our Values: Put Patients First Empower Entrepreneurial Provider... ...will be based on job level, geographic location (current...Remote workHourly payFull timeLive inWork at officeMonday to FridayShift work$61.05k - $98.33k
...DescriptionThe Itemization Review Nurseprovidesa summary... ...charges.This is a remote position.ESSENTIAL FUNCTIONS... ...as a Registered Nurse in the state of employmentMust... ...at any time.For leveled roles (I, II, III, Senior... ...opening, whichever comes first.ABOUT CERIS:CERIS, a division...Remote workMinimum wageFull timeWork at officeLocal areaFlexible hours$75k
...Nurse, Concurrent ReviewMAJOR RESPONSIBILITIESPerforms... ...inpatient utilization review using InterQual... ...and support appropriate level-of-care decisionsCapable... ...Date: TBD Location: 100% remote Equipment: Provided (mini... ...attendance required for first 90 days.Equal Opportunity...Remote workWork at officeLocal areaMonday to FridayFlexible hoursShift work$40.12 - $62.94 per hour
...'s Utilization Review operates as a distinct... ...advisors, nurses, and support... ...is a Full-time remote position.Responsibilities... ...issuance of Medicare forms including... ...for expedited appeals and... ...coverage starting the first of the month after... ..., a designated Level II Trauma...Remote workFull time- Gainwell Technologies is seeking a Nurse Reviewer Appeals and Hearing to coordinate and perform all appeal-related duties, analyze and respond... ...documentation is complete, and participate in hearings, with remote work as default and up to 25% travel for onsite hearings. #J...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
- ...Utilization Management Concurrent Review Nurse The Utilization Management... ...guidelines for nationally recognized levels of care. In this role you will perform first level determination for... ...specific lines of business such as Medicare, Medical, or Commercial plans. You...Remote workFull timeContract workPart timeWork at officeLocal areaWork from homeHome office2 days per week
$63.1k - $94.65k
...Execute at a high level by demonstrating our... ...Virtual Utilization Review Specialist with at... ...documentation relevant to the appeal process.... ...with the physicians, nurses, multidisciplinary... ...: ~ This is a remote role which requires... ...selves. We put people first, last and always....Remote workFull timeTemporary workWork at officeLocal areaMonday to FridayShift work- ...medical information. Obtains request for reviews from and notifies determinations to BAD,... ...customers are aware of the determinations and appeal processes/rights meeting all regulatory... ...office environment with normal noise levels. Work is predominately done while standing...Remote workWork experience placementH1bLocal areaRelocationVisa sponsorship
- NTT DATA, Inc. seeks a Clinical Reviewer Specialist to perform clinical and medical necessity reviews for member and provider appeals, evaluating records against NCQA standards and Medicaid requirements. Role offers remote work within Florida, requires RN licensure, 3...Remote job
- ...seeking a Case Manager - Utilization Review Specialist for a fully remote position based in the United States.... ...medical necessity, and coordinate appeals to support patient care and financial... ...performance. You will apply clinical nursing expertise to evaluate records,...Remote job
$81.95k - $110.24k
...Execute at a high level by demonstrating our... ...The Lead Utilization Review RN is a key... ...interaction with physicians, nurses, other patient care... ...Coordinates the appeal process with the... ...required #LI-LS1 #LI-REMOTE Join an award-... ...selves. We put people first, last and always....Remote workFull timeWork at officeLocal area$30.5 - $59.47 per hour
...and experience, responsible for review of documentation to ensure... ...medical necessity and appropriate level of care utilizing MCG/... ...retrospective, and concurrent review of appeals for denied prior... ...- At least 2 years clinical nursing experience, including at least...Hourly payWork experience placementWork at office- Seeking Registered Nurse for fully remote role to perform complex medical record and claim reviews for various services and equipment (Medicare Part A and Part B) to make coverage determinations... ...and maintain an elevated level of concentration.Capable of consistency...Remote workContract workWork at officeLocal area
$77.91k - $116.86k
...mission to put the senior first. We have built a team of talented... ...is seeking an inpatient review nurse to join the remote utilization management team... ..., cost effective level of care needed to meet the... ...utilization review Knowledge of Medicare Managed Care Plans Effective...Remote jobImmediate startMonday to Friday$35 per hour
6 days ago Be among the first 25 applicants Axius Technologies Inc. provided... ...$35.00/hr - $35.00/hr Medical Review Nurse Location: Phoenix, AZ 85034 (Remote) 3+ Months Day Shift Position Description... ...with medical providers for 2nd level reviews and evaluating against...Remote workHourly payContract workTemporary workPart timeFor contractorsWork at officeShift workDay shift
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Medicare Appeals Nurse | First-Level Reviews. Be the first to apply!
- remote document review Kansas City, MO
- remote recruiter Kansas City, MO
- remote infrastructure engineer Kansas City, MO
- genetic counselor remote Kansas City, MO
- remote video game Kansas City, MO
- global remote customer service jobs Kansas City, MO
- software engineer internship remote Kansas City, MO
- remote banking Kansas City, MO
- junior designer remote Kansas City, MO
- remote tasks Kansas City, MO


