Remote Compliance Nurse - UM & Appeals Analyst
Humana
- Remote job
Humana is seeking a Compliance Nurse 2 to support utilization management activities and ensure adherence to policies, procedures, and regulations. The role involves independent judgment and data analysis to improve outcomes and prevent issues related to fraud, waste, and abuse. The position offers a four-day, 10-hour shift schedule (Wednesday–Sunday or Thursday–Sunday) with hours between 8:00 a.m. and 8:00 p.m. ET. #J-18808-Ljbffr Humana
- Humana is seeking a Compliance Nurse 2 to review utilization management activities and documentation, ensuring adherence... ...EST. You will analyze data to assess outcomes, support the UM team, and follow guidelines for QIO fast track appeals and expedited #J-18808-Ljbffr HumanaRemote jobDay shift
- ...Position: Business Analyst III - Appeals & Grievances Location: Los Angeles, CA, US (Remote) Duration: Permanent Job Description: The Business Analyst... ...; provide technical direction and ensure compliance with best practice solutions. Practice...Remote workPermanent employmentWork at office
$71.1k - $97.8k
...of our caring community The Compliance Nurse 2 reviews utilization management... ...processing QIO fast track appeals and expedited authorization requests... ...or more years of consecutive UM experience for a health plan... .... Travel: While this is a remote position, occasional travel...Remote workFull timeTemporary workApprenticeshipWork at officeHome officeFlexible hoursShift workWeekend workDay shift$70k - $80k
...Piper Companies is seeking a Remote Clinical Appeals Analyst to provide clinical expertise in reviewing and resolving complex member and provider... ...include consultation with non-clinical staff, compliance coordination, and complex case analysis. This is a full-...Remote workFull timeContract workMonday to Friday- Integra Partners is seeking a licensed Practical Nurse (LPN/LVN) experienced in managed care UM to perform pre-service and post-service utilization reviews and appeals for DMEPOS, working with our Medical Director in a NCQA-compliant UM program. You will review benefit...Remote job
- Starling Oncology is seeking a UM Authorization Analyst II to ensure timely,... ...This role can be performed remotely from anywhere in the contiguous... ..., manage denials and appeals, and collaborate with providers... ...the Utilization Management Compliance team. #J-18808-Ljbffr Oncology...Remote job
- Overview Clinical Appeals Analyst (Remote) - FTThe Clinical Appeals Analyst is responsible for assisting... ...interpret written information• Ensure compliance with HIPAA regulations, including... ...Five years’ experience as a clinical nurse in an acute care setting. Current...Remote workFull timeLocal area
- ...Validation RN to review medical records, extract pertinent details, and craft defensible appeal letters. The role involves coding knowledge, literature references, and HIPAA compliance, with a telecommute option from anywhere in the U.S. The position requires an RN...Remote job
$16.25 - $18.25 per hour
...Position: Dispute Resolution Analyst Overview: J29, Inc. (... ...and audits between areas of compliance, policy, and clinical expertise... ...routine 'Surprise Billing' appeals work. This role will serve as... ...or equivalent Location: Remote Salary: $16.25-18.25 per...Remote workHourly payWork at officeImmediate start- Humana is seeking a Compliance Nurse 2 to review utilization management activities and documentation, ensuring adherence to policies, procedures, and regulations. The role involves analyzing data to assess outcomes and operational metrics and making independent judgments...Remote jobShift work
- WPS Health Solutions is hiring an Appeals Nurse to review medical records and claims for first-level Medicare appeal cases to determine medical necessity and compliance with coverage guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations...Remote job
- Blue Cross Blue Shield of Arizona needs a clinical expert for managing member and provider appeals. This remote position requires strong accuracy, knowledge of compliance timelines, and a focus on customer service. Applicants should possess a healthcare-related degree and...Remote job
- ...law enforcement agencies; immediately freeze accounts flagged by judicial police notifications. Handle user fraud complaints and appeals; perform transaction tracing and fund flow analysis. Produce fraud case analysis reports; track the progress of frozen asset...Remote workImmediate startWork from homeOverseas
- Humana is seeking a Compliance Nurse 2 to review utilization management activities and documentation, ensuring adherence to policies and regulations... ...-day, 10-hour schedule with a Wednesday-Sunday work week, remote work options, and potential travel to Humana offices for...Remote job
$71.59k - $116.48k
...seeking an A&G Clinical Specialist to manage health member complaints and appeals. This fully remote position requires expertise in clinical case management, understanding of regulatory compliance, and the ability to effectively resolve cases independently. The ideal...Remote job$100k - $275k
...Description Summary:The Supply Chain Analyst, Principal serves as the... .... Union ranges will be in compliance with the collective bargaining... ...R&D innovation company appeals to you, apply now .Draper is... ...com.SummaryLocation: Cambridge, MA; Remote (US Only)Type: Full timeRemote workFull timeLocal area$75.53k - $116.31k
...commercial insurance products and services so businesses can thrive and face the future with confidence. If our mission statement appeals to you, come and be a part of our amazing team! We are seeking a passionate and energetic professional that is driven to succeed...Remote workWork experience placementLocal areaFlexible hoursNight shift$34 - $38 per hour
Cotiviti is seeking a Coding Validation Analyst I to perform daily audits on client data for completeness and accuracy of coding... ...to ensure proper reimbursement and respond to provider appeals. This is a remote, shift-based role across MT and ET time zones with after-training...Remote jobHourly payShift work- ...Job Title Job Description Process appeals and grievances, analyze, research, and provide comprehensive responses in accordance... ...and applying contract and regulatory provisions. This is a Remote Role Experience Experience handling a large load of work...Remote workContract workApprenticeshipLocal area
- ...Senior Business Analyst At Technatomy, we deliver innovative solutions... ...personnel, and security and compliance stakeholders, the Senior... ..., reinstatements, transfers, appeals, tasking, approvals,... ...clearance. Work Location: · Remote As part of the application...Remote workPermanent employment
$71k - $85k
...outcomes and care quality. As a UM Authorization Analyst II, you’ll play a critical... ...requests, maintaining compliance with regulations, and coordinating... .... This role can be worked remotely from anywhere in the... ...Compliance. Managing denial and/or appeal escalations and...Remote workWork at officeLocal area$35 - $39 per hour
...SUMMARY The Business Systems Analyst is a member of the office... ...successfully from a home/remote office and be able to fulfill... ...frames as directed including UC compliance training. The University of... ...misconduct; or have filed an appeal of a finding of misconduct...Remote workHourly payFull timeTemporary workPart timeFor contractorsWork at officeWork from homeMonday to FridayShift work2 days per week$35 - $63 per hour
...Review (IBR) Clinical Appeals Reviewer Optum Insight... ...flexibility to work remotely from anywhere within... ...Collaborates with existing analysts, quality and... ...Qualifications: ~ Undergraduate nursing degree ~... ...experience with regulations, compliance and composing...Remote jobHourly payMinimum wageFull timeWork experience placementLive inLocal areaMonday to Friday- UnitedHealth Group seeks a Coding Quality Analyst to review patient records, extract data, and craft defensible appeal letters using ICD-9/ICD-10, CM/PCS, CPT, and HCPCS... ...will educate clients on proper coding and compliance, and identify coding changes to impact payments...Remote job
- ...values a Coding Quality Analyst to review patient... ...and craft defensible appeal letters using ICD-9/ICD... ...references, maintaining HIPAA compliance and timely... ...supporting enterprise goals. Remote work across the U.S. is... ...808-Ljbffr University of Minnesota School of NursingRemote job
$80.6k - $172.4k
Business System Analyst – Interoperability Position Description... ..., chronic disease management, remote patient monitoring, and wellness... ...clinical, network, IT, product, compliance, and vendor teams to ensure that... ..., provider management, UM/PA, care management, and data...Remote workLocal area- ...experienced and motivated Risk Management Nurse Consultant with a strong leadership... ...improving quality of care, ensuring regulatory compliance, and reducing litigation risk across... ...problem solving skills Comfortable working remotely Flexible work from home options...Remote workFull timeFlexible hours
$137k - $150k
...Arlington Heights Rd, Itasca, IL 60143, USA Remote, 1100 N Arlington Heights Rd, Itasca, IL... ...EDUCATION AND EXPERIENCE: ASN or BSN in nursing licensed in the State of Residence; at... ..., or client visits. This includes compliance with all of the requirements of the localities...Remote workFull timeTemporary workShift work- Solis Health Plans is hiring for the Grievance and Appeals Analyst I position based in New York. This role involves reviewing member grievances and appeals, ensuring compliance with CMS and NCQA guidelines. Ideal candidates will have at least 2 years of experience in managed...Work at office
- Universal Health Services, Inc. is seeking a Market Appeals Specialist for our Central Appeals Office. This fully remote role requires expertise in utilization management... ...with facilities and payers, and participate in UM team discussions to optimize facility recoveries....Remote jobWork at office
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