Remote RN: Clinical Appeals & Utilization Review
$76kNTT Group
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. Salary is $76,000 and benefits include health coverage, 401(k) with company match, and PTO. Work is US daytime hours with strict remote workspace requirements. #J-18808-Ljbffr
$52 - $56 per hour
...done UM. You've worked appeals. Now find a role... ...re hiring a contract RN for a New York health... ...MLTC). You'll own clinical grievances and appeals... ...you built in utilization management. 100% remote (U.S.) | Contract |... ...investigation, clinical review, decision and notification...Remote jobContract workAfternoon shift$40.12 - $62.94 per hour
...Sinai Hospital's Utilization Review operates as a distinct specialty... ...hospital stays are clinically appropriate and fully... ...This is a Full-time remote position. Responsibilities... ...Utilization Review RN reviews the medical... ...opportunities for expedited appeals and collaborates with...Remote workFull time$93.35k - $132.43k
...: Sentara Health Plans is hiring a Clinical Claims Reviewer/ RN - Remote! Status: Full-time, permanent position... ...is responsible for performing utilization management services within the scope... ...Nursing Clinical Claims Reviewer, Appeals, Denials, Utilization management, Registered...Remote workPermanent employmentFull timeTemporary workWork at officeShift work$40 - $50 per hour
...Job Description Job Description Clinical Appeals RN – 100% Remote $40-$50/hour | Part-Time & Full-Time... ...you'll use your clinical expertise to review and appeal insurance denials related... ...appeals, prior authorizations, utilization review, or case management highly desirable...Remote jobPermanent employmentFull timeTemporary workPart time$63k - $94k
...Remote Utilization Review Registered Nurse (UR RN) Are you an experienced RN looking to transition away from the bedside... ...act as a vital bridge between clinical care and hospital operations,... ...advisor referrals. Denial Management & Appeals: Coordinate the Peer-to-Peer (P2P...Remote workWork at office10 hours per weekFlexible hoursShift workWeekend workAfternoon shift3 days per week- ...LTSS department. RN will be responsible... .... May also manage appeals for services denied... ...and concurrent review. Provides monthly... ...treatment setting by utilizing the applicable medical... .... Applies clinical knowledge to work... ...Additional Info: *possible remote opportunity after...Remote workContract workMonday to FridayFlexible hours
$80k
...searching for a new RN to join our team. Our... ...flexibility to work remotely and do not have face... ...in addition to clinical experience. Please review the roles and responsibilities... ..., in selecting and utilizing evidence-based... ...in the capacity of Appeals/Grievances, Case Management...Remote workFull timeHome officeMonday to FridayWeekend work$63.1k - $94.65k
...have current compact RN license, or be willing... ...Schedule Information: Our Utilization Review team provides coverage... .... Utilizes approved clinical review criteria to... ...documentation relevant to the appeal process. Maintains... ...: This is a remote role which requires access...Remote workTemporary workPart timeWork at officeLocal areaFlexible hoursShift work$81.95k - $110.24k
...in healthcare. The Lead Utilization Review RN is a key contributor to the... ...overall financial, quality, and clinical performance of the... ...MANAGEMENT: Coordinates the appeal process with the liaison, Financial... ...required #LI-LS1 #LI-REMOTE Join an award-winning company...Remote workFull timeWork at officeLocal area$63.1k - $94.65k
...Nurse to perform hospital utilization reviews, assess medical... ...levels of care. This remote role partners with physicians... ...) using approved clinical criteria, whether working... ...Management Manage Appeals & Peer-to-Peer (P2P):... ...Current unrestricted RN license required; RN compact...Remote workTemporary workWork at officeLocal areaShift workAfternoon shift- ...'re looking for an RN who has personally... ...owned grievance and appeals cases from intake to... .... You'll handle clinical grievances, appeals and external reviews for members receiving... ...The best fit has a utilization management or case... ...at once in a fully remote setting. Nice...Remote job
- ...Description The Clinical Nurse Reviewer plays a crucial role in the... ...determinations and appeals. Document findings and... ...Qualifications Active RN license (state-... ...in case management, utilization review, or quality assurance... ...functions. This is a remote position. While...Remote workWork at office
- ...Are you an RN looking to transition into or grow your career in Utilization Review? We're seeking a clinically strong, detail-oriented Registered Nurse... ...reviews and assist with appeals and denial management. Identify... ...in a fast-paced, remote environment. Reliable high...Remote workTemporary work10 hours per weekShift workWeekend workAfternoon shift
- ...Utilization Review NurseWe are seeking a detail-oriented and experienced... ...Nurse will perform clinical reviews, ensure... ...licensed Registered Nurse (RN) with experience in... ...denial prevention, appeals, and retrospective reviews... ...management department.Remote, hybrid, or on-site...Remote workWork at office
$95k - $107.5k
...Description Title: Nurse Reviewer, Utilization Management Job Type... ..., MA office; 1 day remote FLSA Status: Exempt... ...judgment to senior clinical team members. Working... ...reconsiderations and appeals. Apply plan clinical... ...degree in Nursing (ADN/RN) required; Bachelor's...Remote workFull timeLocal area- ...Remote Full Time Days And Every Other Weekend RN Case Manager -Utilization ReviewJoin our team as a remote full time days and every... ...RN Case Manager -Utilization Review at INTEGRIS Health, Oklahoma... ...QUALIFICATIONSEXPERIENCE:2 years experience in a clinical settings (e.g. home health,...Remote workFull timeWork at officeShift workWeekend work
- ...Clinical Review Nurse - RemoteARC Group has multiple positions... ...positions are 100% remote. These are direct hire... ...coverage, medical necessity, utilization and appropriateness of... ..., consent, etc.) or appeal.This may involve... ...unrestricted Registered Nurse (RN) licensePreferred...Remote workPermanent employmentWork at officeLocal area
- ...Summary Statement The Clinical Review Nurse is responsible... ..., medical necessity, utilization and appropriateness of... ...action, consent, etc.) or appeal. This may involve... ...Registered Nurse (RN) license Preferred... ...opportunity is open to remote work in the following...Remote workPermanent employmentTemporary workWork at officeLocal areaImmediate start
- ...Cleveland Clinic Health System is seeking an experienced Utilization Management RN Reviewer to work remotely with a focus on admission, concurrent and retrospective reviews. The role supports payer communications, data collection, and clinical decision-making to ensure...Remote workWork at office
$95k - $110k
...days) to receive an alert: DRG Nurse Reviewer Appeals and Hearings- Remote Date: Aug 30, 2026 Location: Any... ...and redeterminations using approved clinical and coding guidelines and documents... ...completes required CEUs to maintain RN license and/or coding certification....Remote workFull timeWork from homeRelocation packageFlexible hours- ...Providing timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions, treatment planning... ...treatment. Key responsibilities Perform clinical assessments and evaluate patient conditions,...Remote workFull timeWork experience placement
- ...outstanding results. The Opportunity: The RN, Utilization Review performs advanced utilization review... ...with payer requirements and optimize clinical documentation for accurate... ...Healthcare 2024 Monster Top Workplace for Remote Work 2024 Great Place to Work certified...Remote workFull timeLocal area
- ...Clinical Utilization Review Nurses (RN) Based In Alabama Comagine Health is a national, mission-driven, nonprofit organization that has engaged in... ...improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our...Remote workFull timeContract work
$90k - $99k
...Your Role in Our Mission Reviews provider appeals and redeterminations using approved clinical and coding guidelines and documents... ...required CEUs to maintain RN license and/or coding certification... ...Expect in This Role Remote (Work from Home) Up to 25% Travel...Remote workFull timeWork from homeFlexible hours- ...Clinical Appeals Specialist The Clinical Appeals Specialist completes research... ...Clinical Appeals Specialist utilizes clinical skills and knowledge... ...appeal case for physician review by compiling clinical,... ...Licenses/Certifications: RN - Registered Nurse - State Licensure...Remote workWork at office
$25 - $35 per hour
...Companies is seeking a Clinical Appeals Nurse to join a... ...organization for a contract remote opportunity located in... ...the appeals team, reviewing complex cases, ensuring... ...Active Registered Nurse (RN) license in the State... ...grievance processes, utilization management, and medical...Remote workHourly payContract work$34 - $35 per hour
...Utilization Management - Clinical Nurse - Work from Home! Utilization Management... ...and concurrent review of hospitalizations and... ...conversations and communicating appeal processes Distributed... ...Qualifications RN license in an eNLC (... ...Prior Authorization Remote Registered Nurse (...Remote workFull timeWork at officeWork from homeNight shift$85k - $92k
...Equivalent: ~$41–$44/hr Location: Remote Schedule: Must work AZ hours (... ...Active, unrestricted license: RN Minimum 3+ years clinical experience (med/surg and/or behavioral... ...DESIRED) Clinical Quality / Utilization Review / Case Review experience Experience...Remote workHourly payDay shift$69.39k - $88.61k
...Cincinnati Children’s is seeking an experienced Utilization Review professional for a remote role in the United States. The position supports case... ...a Bachelor’s degree in a related field, an active RN/Social Work/Clinical Counselor license, and 2+ years of related...Remote workFull time- ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care... ...discharge planning and utilization review.Responsibilities:• Reviews admissions... ..., reimbursement and claim denials/appeals.• Assesses and coordinates...Remote work
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