Remote Appeals Nurse | Medicare Case Review Pro
WPS Health Solutions
WPS Health Solutions is seeking an Appeals Nurse to examine medical records for first-level appeal cases, ensuring services meet Medicare coverage guidelines. With options for remote work, the ideal candidate will have a nursing degree and active RN license, accompanied by comprehensive clinical experience. The role requires excellent communication skills along with strong detail orientation to manage multiple cases effectively. WPS offers competitive health benefits starting DAY 1 and a supportive work environment. #J-18808-Ljbffr
- ...Health Solutions is seeking an Appeals Nurse in Michigan to examine... ...records and claims for appeal cases. This role involves collaboration... ...Examiners and entails thorough reviews to ensure regulatory... ...essential. This opportunity offers remote work options and various benefits...Remote work
- ...WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level appeal cases. This role collaborates with Appeals Examiners to ensure... ...RN license, and strong communication skills. Remote work options are available, and candidates...Remote work
- ...WPS Health Solutions is seeking an Appeals Nurse to examine medical records for appeal cases regarding Medicare coverage. This remote position requires strong clinical expertise and the ability to interpret complex medical information. Qualified candidates must hold a...Remote work
- Overview Job Title: Registered Nurse - Claims & Appeals Review Location: Remote (Anywhere in Florida) Duration: 06 Months/Can be Extended Working hours: Day... ...actions. Key Responsibilities Review appeal cases and supporting documentation to ensure completeness and...Remote workContract workDay shift
- ...WPS Health Solutions is looking for an Appeals Nurse who will examine medical records for first... ...necessary services in line with Medicare guidelines. The ideal candidate will have... ...of clinical experience. The role offers remote work options, a performance bonus, and a...Remote work
- ...solutions company is looking for an Appeals Nurse to examine medical records... ...for first-level appeal cases. The role involves collaboration... ...to assure compliance with Medicare guidelines. The ideal candidate... .... The position supports remote work and offers a range of benefits...Remote work
$90k - $99k
...DRG Nurse Reviewer Appeals and Hearings- Remote Date: Jan 9, 2026 Location: Any city, FL, US, 99999 Work Mode: Virtual (Exception only) It takes... ...appeal have been addressed properly and accurately; prepare case files and case summaries for hearings; and participate...Remote workFull timeWork from homeFlexible hours- ...Role Snapshot The Appeals Nurse examines medical records... ...for first-level appeal cases to determine whether services... ...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
- ...Are you a clinically experienced Registered Nurse looking to apply your expertise beyond direct patient care? As a Medical Review Nurse you will play a critical role in... ...determinations, and support fair, evidence-based appeal outcomes-directly impacting both business...Remote workContract workWork at officeWork from homeWork visa
$70k - $85k
...Medical Review Nurse Analyst Our Medical Review Nurse... ...limited to authorizations, appeals, and medical review... ...: We are open to remote work in the following... ...escalated or high-risk cases requiring specialized... ...beneficiaries of the Medicare program and manage benefits...Remote workContract workFor contractorsWork at officeLocal areaImmediate start$80k - $90k
...80-90k The Medical Review Clinical Appeals Auditor (RN) is responsible... ...reporting tools, and case management system/... ...independently in remote setting with minimum... ...standing and diversified nursing experience providing... ...or excluded from the Medicare program by OIG....Remote workFor contractorsImmediate startWork from homeHome officeFlexible hoursShift work$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX Agency... ...of Project: Managing a case load for healthcare members... ...and will include 80% travel. Remote role. Will require a driver... ...resolving complaints and appeals. Licensed Clinical Social...Remote workHourly payFull timeContract workImmediate startShift work3 days per week$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX Agency... ...of Project: Managing a case load for healthcare members... ...and will include 80% travel. Remote role. Will require a driver... ...resolving complaints and appeals. Licensed Clinical Social...Remote workHourly payFull timeContract workImmediate startShift work3 days per week- ...Health is looking for a highly skilled Utilization Management Nurse (RN) for a remote position. In this role, you will ensure patients receive appropriate healthcare services through reviews of clinical cases and collaboration with providers. The ideal candidate will...Remote work
$66k - $68k
...WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level appeal cases. In this role, you will collaborate with examiners to... ...medical necessity is determined in compliance with Medicare guidelines. Experience in clinical healthcare...Remote work- Forthright Case Management Llc is looking for a Nurse Case Management Sales Representative to foster partnerships across insurance and healthcare sectors. This role requires strong sales skills, relationship management, and extensive travel across multiple states. Ideal...Remote jobWork at officeWork from homeFlexible hours
$65k - $75k
...Piper Companies is seeking a Remote Utilization Management/Review Nurse to evaluate member cases, ensuring medical necessity and appropriate healthcare service utilization. The role requires clinical expertise and collaboration with providers to make high-quality care...Remote work$38.17 - $57.25 per hour
...Job Title Nurse Appeals-RN (California) Location & Remote Work Locations: Woodland Hills, CA and Costa Mesa, CA. This... ...requests from members and providers. Review prospective, inpatient, or... ...Quality of Care review experience. Case management review experience. Compensation...Remote workFull timeLocal area- ...healthcare solutions provider is seeking a Registered Nurse for Claims & Appeals Review. This remote role supports compliance and quality assurance in appeal... .... Key responsibilities include reviewing appeal cases, conducting audits, and collaborating with clinicians....Remote work
- ...About The Role The Case Manager Nurse plays a critical role in supporting... ...also supports utilization review activities when needed,... ...populations in a collaborative, remote care management environment.... ...appropriate Partner with Appeals & Denials and/or in-house providers...Remote work10 hours per weekShift workEarly shift
- ...Grievances And Appeals Nurse Pride Health is hiring a Grievances and... ...Nurse for a well-known client! (Remote Contract) Schedule: 5x8s... ...grievance and appeal issues Reviews information provided by... ...regarding grievance and appeal cases Collects and analyzes supporting...Remote workContract workWork experience placementLocal areaDay shift
- ...Brigham Incorporated is looking for a Senior Nurse Reviewer responsible for coordinating clinical charge audits and appeal processes. The role demands strong analytical... ...clinical nursing and quality assurance. This is a remote position requiring effective communication...Remote job
- ...Job Overview ShimSpine is looking for a Nurse Reviewer / Analyst to use our patented software to analyze and develop case summaries for numerous clients. Candidates should... ...professional development opportunities This is an onsite position. No remote work. #J-18808-Ljbffr...Remote workTemporary work
- ...SHR (Spectrum Healthcare Resources) is seeking a Registered Nurse Utilization Manager (RNUM) for a remote role in Phoenix, Arizona. The position involves reviewing patient cases, educating patients, and managing health care costs for eligible dependents of Active Duty...Remote workWork at officeMonday to FridayFlexible hours
- ...To support the appeals process, the full-time remote Wisconsin Licensed Appeals Nurse will examine medical records and claims... ...for first-level appeal cases, ensuring compliance with Medicare guidelines and... ...redeterminations. Key responsibilities Review and assess first-level...Remote workFull time
$90k - $99k
A leading healthcare solutions provider seeks a DRG Nurse Reviewer Appeals and Hearings to coordinate appeal duties and engage in hearings, both... ...have an active RN license and coding certification. This remote role offers flexibility and opportunities for career development...Remote jobFlexible hours- A nationwide healthcare staffing agency is looking for an experienced Long Term Care Registered Nurse to conduct remote case reviews for the Department of Veterans Affairs. This role offers a competitive compensation structure based on case type and hours worked, combined...Remote job
$78.5k - $90k
...0,000 The Medical Review Nurse - Home Health primarily... ...Payers. You will work remotely in a fast paced and... ...your findings during the appeals process if requested.... ...and/or cases subject to potential abuse... ...or excluded from the Medicare program by the OIG....Remote workFor contractorsWork at officeWork from homeHome officeShift work- ...Schedule : The position is 100% Remote, and the candidates must... ...The Temporary Grievance & Appeals Nurse (LVN) is responsible for managing... ...coordinating grievance and appeal cases in compliance policies and... ...continuity of care Review and investigate member grievances...Remote workTemporary workWork at officeImmediate start
- ...patient outcomes. Our talented remote workforce spans the country... ...seeking an RN to perform Clinical Review work and QIDP reviews work.... ...as the QIDP (.5 FTE) and as a nurse clinical reviewer (.5 FTE).... ...Advisor/ Consulting Physician all cases for which a medical necessity...Remote workContract work
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