Remote RN: Clinical Appeals & Utilization Review
$76kNTT Group
New York, NY
- Remote job
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 NTT Group
Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Remote RN: Clinical Appeals & Utilization Review in New York, NY vacancy
- ...Carolina seeks an experienced nurse reviewer to adjudicate appeals and retrospective reviews for... ...necessity. This full-time remote role supports Mondays-Fridays,... .... The ideal candidate has RN licensure in the US, clinical and utilization review experience, and the ability...Remote jobFull timeMonday to Friday
$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- HealthEdge is seeking a remote (US) Appeals & Grievances Specialist to independently process complex... ...and conduct medical necessity reviews across inpatient, outpatient, and ancillary... ...USRN license, 2+ years in utilization management, and strong written/verbal...Remote job
- ...NTT DATA, Inc. is seeking a Clinical Reviewer Specialist for a fully remote position based in Florida. You will perform... ...reviews for member and provider appeals, evaluating records and criteria to... ...NCQA compliance. The role requires RN licensure (Florida or compact), 3+...Remote work
NTT DATA, Inc.
Tallahassee, FL-62 - ...Integra Partners is seeking an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals in a managed care UM program. You will collaborate with the Medical Director to review benefit language, medical necessity, and appeals within NCQA...Remote work
Integra Partners
Michigan-62 - ...to research the substance of complex appeal requests, perform clinical review to determine medical necessity, and document... ...required timeframes. This full-time remote role (40 hours/week, 8 a.m.-5 p.m. local time) requires an active RN license in the United States, CMS...Remote jobFull timeLocal area
$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 timeLifeBridge Health
Owings Mills, MD-62- ...experienced LPN/LVN to conduct pre-service and post-service utilization reviews and appeals within a NCQA-compliant UM program, collaborating with... ...responsibilities including approvals, referrals, and handling appeals. Remote opportunities available and strong team culture. #J-188...Remote work
Integra Partners
Ohio-62 - ...Integra Partners is seeking an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals in a managed care UM program. This role collaborates with the Medical Director on benefit and medical necessity reviews, aligned with NCQA standards...Remote work
Integra Partners
Clifton, TX-62 $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 timeTRC Talent Solutions
Winter Park, FL6 days ago- ...Partners is looking for an LPN/LVN experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This role collaborates with our Medical Director to conduct benefit and medical necessity reviews within an...Remote job
- Lynn Rodens is seeking a skilled Clinical Reviewer/Nurse for a remote role aligned with AZ hours. The position requires active RN license, U.S. citizenship, 3+ years in med/surg and/or behavioral health, and eligibility for DoD background clearance. Ideal candidates have...Remote job
- Mass General Brigham is seeking an RN for a remote Utilization Management role in the United States. The position involves clinical review, triage, and escalation support to ensure medical necessity and regulatory compliance. The role requires 2-3 years in case management...Remote job
- ...with UM experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with the Medical... ...referring others to the Medical Director. The role supports a remote workforce across the United States and offers competitive...Remote job
$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 weekMedix
New York, NY1 day ago$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- Integra Partners seeks an experienced LPN/LVN to support utilization review in a managed care UM program. You will perform pre/... ...non-compliant cases and manage administrative appeals within NCQA-aligned guidelines. Remote opportunities across the US are available. #J-1880...Remote job
- ...experienced LPN/LVN to conduct pre-service and post-service utilization reviews and appeals in a managed care environment. You will collaborate with... ...InterQual and CMS guidelines is preferred, and we offer remote work options and a comprehensive #J-18808-Ljbffr Integra...Remote job
- ...care experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director... ...InterQual and CMS guidelines. The role supports a nationwide remote workforce with competitive compensation, benefits, and a...Remote job
$60 per hour
...in Jericho, NY is seeking a Full-time Registered Nurse Clinical Reviewer. This role requires a Baccalaureate degree in Nursing and... ...Ideal candidates will have 1-3 years of experience in utilization review or appeals and strong communication skills, contributing to...Hourly payFull time$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- ...'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
Phaxis LLC
New York, NY2 days ago $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 shiftMedix
Evendale, OH15 days ago- ...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
$63.1k - $90k
...Utilization Review Registered Nurse (RN) – Remote Salary: $63,100–$90,000 annually + Bonus + Shift Differentials Medix... ...continued hospital stays. Review clinical documentation, patient diagnoses,... ...advisor coordination, denials, appeals, or peer-to-peer review experience...Remote workCasual workWork from homeMonday to Friday10 hours per weekShift workRotating shiftAfternoon shiftMedix
Columbus, OH1 day ago- ...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
Medix
New York, NY22 hours ago - ...Health in Oklahoma City, OK is seeking an experienced RN Case Manager for Utilization Review to join our remote team. This full-time daytime role includes every-... ...Certification, with at least 2 years in a clinical setting. Strong communication and computer skills...Remote workFull timeShift work
INTEGRIS Health
Oklahoma-62 $28 - $51 per hour
About This Role The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances, analyzing, reviewing, and evaluating appeals and grievances, and acting as... ...reviews with the Medical Director Utilize clinical guidelines and criteria Accurately...Remote jobFull timeDay shift- ...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
INTEGRIS Health
Oklahoma City, OK1 day ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN: Clinical Appeals & Utilization Review. Be the first to apply!
