Remote Clinical Appeals Nurse: Case Review & Compliance
Piper Companies
- Remote job
Piper Companies is seeking a Clinical Appeals Nurse for a fully remote healthcare-based opportunity. This Clinical Appeals Nurse position is a long-term contract role focused on clinical review, appeal resolution, regulatory compliance, and member/provider support within a complex health insurance environment. The role involves evaluating complex appeal cases, gathering and assessing medical records, preparing case summaries, and communicating findings to physician reviewers and leadership teams #J-18808-Ljbffr Piper Companies
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- ...Description: Manager of Clinical Utilization... ...Type: Hybrid (85% remote, 15% onsite in Northridge... ...- Denial Compliance. This role is pivotal... ...tasks, performance reviews, and any necessary... ...Registered Nursing Program; RN preferred... ...prior-authorization, appeals & grievance, or health...Remote workPermanent employmentFull timeTemporary workFlexible hours
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- ...Clinical Appeals Nurse - Full Time Remote - Jefferson Health Reviews payor denials and audits for potential lost revenue. Writes... ...appeal guidelines. Ensures compliance with regulatory and accrediting... ...Required ~10 years of clinical or case management/utilization review...Remote jobFull time
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...Registered Nurse Clinical Case Consultant The Registered Nurse Clinical... ...avoidable utilization, and support compliance with CalAIM ECM requirements... ...completion of clinical reviews and consultations. Compliance... ...requiring a combination of remote work, office-based work, and...Remote workTemporary workWork at officeLocal areaFlexible hoursAfternoon shift$46.25 per hour
...seeking a highly qualified Registered Nurse to serve as the Lead Non-Clinical Nurse Case Manager for the Vermont Army... ...operations within 15 days of receipt. Review MEDCOM policies and SOPs to... ...medical facilities and track compliance versus noncompliance during monthly...Remote workHourly payContract workWork at officeLocal areaMonday to FridayWeekend work- A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and collaborating with teams to meet...Remote jobContract work
- WPS Health Solutions is seeking an Appeals Nurse to review medical records for first-level appeal cases to determine medical necessity and Medicare coverage alignment... ...and adherence to CMS regulations, with remote-work options for approved states. It involves preparing...Remote job
- Healthfirst is seeking an A&G Clinical Specialist to lead the... ...resolution of clinical cases for member and provider appeals, ensuring compliance with applicable laws... .... The role can be remote or on-site at the NYC or... ...internal and external reviews. #J-18808-Ljbffr HealthfirstRemote work
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$29 - $52 per hour
...Program Integrity Clinical Compliance Auditor Optum Insight... ...compliance reviews of medical and administrative... ...and the client's case tracking system.... ...will support appeal and fraud... ...This position is Remote in Massachusetts.... ...work experience ~ Nurse licensure (RN or LPN...Remote workHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work$35 - $42 per hour
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Overview Medical Review Nurse II - Clinical Validation At Performant... .... You will work remotely in a fast paced and... ...findings during the appeals process if requested... ...vulnerabilities and/or cases subject to potential... ...contractor and subject to compliance with client...Remote workFor contractorsWork at officeWork from homeHome officeShift work- ...intelligence company. The Medical Review Nurse II audits home health claims, working remotely with a multi-location team to ensure compliance and high-quality... ...role emphasizes strong clinical judgment, coding... ...and participate in the appeals process while staying current...Remote jobWork from home
- Maximus is seeking a Clinical Nurse Consultant to join the Federal Exchange Review Process (FERP) team in a remote capacity. You will manage end-to-end medical reviews, ensure accurate... ...with clinical reviewers to complete cases within timelines. The role requires a valid...Remote jobMonday to Friday
$84.56k - $126.84k
...The Utilization Review RN participates... ..., ensure compliance, and actively participate... ...be primarily remote but there may... ...; communicates clinical review process... ...conjunction with the Case Managers... ...to assist with appeals. 7. Maintains... ...of Science in Nursing (BSN) Experience...Remote workTemporary workPart timeLive inImmediate startRelocationRelocation packageShift workWeekend workAfternoon shift- ...hiring a Physician Reviewer specializing in Orthopedic... ...Surgery. This remote role allows for flexibility... ...ensuring prompt case reviews based on... ...ll analyze insurance appeals and provide clear documentation... ...degree and strong clinical judgement, ensuring compliance with client...Remote jobFor contractors
- ...and compassionate Registered Nurse (RN) Case Manager to join our Hospice... ...patients and famiies. Ensure compliance with Medicare hospice... ...experience preferred Strong clinical assessment and critical thinking... ...) Work Location: Hybrid remote in Bingham Farms, MI 48025...Remote workWork from homeFlexible hours
- Pharmacy Careers is seeking a fully remote Appeals Pharmacist to review medication coverage appeals and provide evidence-based determinations from home. A focus on clear clinical writing and regulatory compliance helps ensure fair access for members. The role supports...Remote jobWork from home
- ...Description Job Description Title: Non-Clinical Nurse Case Manager Location: Colchester, VT (... ...care, track medical cases, and ensure compliance with Army medical readiness standards.... ...(MEB/PEB) Conduct monthly case reviews and reporting Support readiness events...Remote work
- Commence is seeking Oncology Nurse reviewers for remote, contract-based work to assess medical necessity, appropriateness, and quality... ...written determinations, and support Utilization review, Appeals, and related cases. Must be actively practicing in Oncology with a US...Remote jobContract 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... ...Minimum: Licensed Practical Nurse (LPN) or three (3) years of...Remote workWork at office
- ...23 Summary of position Case Management position coordinates... ...processes in compliance with all applicable policies... ...Assessment Annual Review Protocol once a year with... ...complaints, grievance and appeals rights, explain what... ...and self-improvement. Remote position will required...Remote workFull timeFor subcontractorWork at officeLocal areaWork from home
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