Remote Clinical Appeals RN — Advocate for Coverage
UnitedHealthcare
- Remote job
UnitedHealthcare is hiring a Clinical Appeals RN for remote work Monday–Friday, with alternating Saturdays. The role analyzes appeals and grievances, acts as a clinical liaison, and supports resolution with facilities, providers, and plans. We offer a flexible schedule, competitive hourly pay and a comprehensive benefits package. Candidates must hold an RN license, have inpatient RN experience, and be proficient with Microsoft Office. #J-18808-Ljbffr UnitedHealthcare
$28.94 - $51.63 per hour
...Caring. Connecting. Growing together. Job Description - Clinical Appeals RN - Remote - M-F working alternating Saturdays (2369974) Clinical Appeals... ...Review pre-service appeals for clinical eligibility for coverage as prescribed by the Plan benefits Review and interpret...Remote jobHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaMonday to FridayWeekday work- UnitedHealthcare is seeking a registered nurse to join a remote, nationwide program focused on guiding and... ...well-being. The role emphasizes frontline clinical support and customer service in a fast-paced environment. Requires an active RN license, 4+ years of acute nursing, and 2+...Remote jobMonday to Friday
- LanguageLine Solutions is seeking a Personal Health Advocate, RN, to provide high-quality, member-centered clinical advocacy in a fully remote setting. You will handle inbound member calls, educate members on medical conditions and treatment options, and coordinate care...Remote job
$40 - $46 per hour
...Solutions is immediately hiring for a RN Clinical Appeals Specialist Position type: Full time... ...contract Location: Philadelphia PA 19103 (Remote) As a RN Clinical Appeals Specialist... ...involve medical necessity benefit coverage administrative processing pharmacy behavioral...Remote workHourly payFull timeContract workTemporary workFor contractorsWork experience placementWork at officeImmediate startWorldwideFlexible hours- UnitedHealth Group is seeking a Remote Appeals Clinician in Texas. You will conduct comprehensive reviews... ...), evaluate records, and provide independent clinical judgments on medical necessity. Requirements include a Texas RN license and 2+ years in Medicaid with data-entry...Remote jobFlexible hours
- UnitedHealth Group is seeking a Clinical Appeals RN to provide expert analysis of appeals and grievances, acting as a clinical interface liaison... ...and confidentiality adherence. The position offers remote work from anywhere in the U.S., with an M-F schedule of 8:00...Remote job
- Healthfirst is seeking an A&G Clinical Specialist to lead the development and resolution of clinical cases for member and provider appeals, ensuring compliance with applicable laws and internal policies. The role can be remote or on-site at the NYC or Lake Mary locations...Remote work
$33.71 - $60.67 per hour
Centene is seeking an RN with strong appeal review experience to act as liaison for statewide appeals... ...and review organizations. This fully remote role supports members and providers... ...active RN license and have 4+ years of clinical nursing or case management experience;...Remote jobHourly payFlexible hours- A national health organization is seeking a Clinical Review Clinician - Appeals to conduct clinical reviews and manage appeals. The role requires an... ...standards and healthcare regulations. The position is fully remote and includes a comprehensive benefits package. Join us...Remote jobFlexible hours
- ...Clinical Appeals Specialist The Clinical Appeals Specialist completes research, basic analysis... ...disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Specialist... .... Licenses/Certifications: RN - Registered Nurse - State Licensure And...Remote workWork at office
- UnitedHealth Group is seeking a Clinical Coordinator RN for a Telecommute role in Texas. You will conduct... ...comprehensive clinical reviews of appeals, evaluate medical records, and provide... ...and collaboration within a remote team, with weekday daytime hours. Ideal...Remote jobWeekday work
- ...for you! Nurse Advocate Position... ...This role combines clinical expertise with in-... ...medical, claims, and coverage concerns. Acting as... ...authorizations, appeals, and billing concerns... ...Registered Nurse (RN) with an active,... ...Work Options) ~ Remote work opportunities...Remote workFull timeWork at officeMonday to Friday
$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote role at Healthfirst . Position Summary: The Appeals & Grievances (A&G) unit...Remote jobFull timeMonday to FridayShift work$120k - $135k
...in the United States is seeking a Pharmacist to review clinical coverage determinations and appeals across Commercial and Medicare lines. You will assess... ...year of appeals experience, and strong communication. Remote work from a secure home office is supported; salary range...Remote jobWork from homeHome office- ...Description Job Description Title: Mobile Clinic Patient Advocate 1 Department : Mobile Status:... ...for the daily opening and closing of remote clinics. Minimum... ...locations in the event front desk staffing coverage is needed. 14. Responsible for...Remote workHourly payWork at officeLocal area
- UnitedHealth Group is seeking a Clinical Grievances Nurse to review retrospective cases and current cases ensuring appropriate care and... ...addressing immediate member needs. This role offers PST hours with remote work options and a Monday-Friday schedule. You will perform...Remote jobImmediate startMonday to Friday
- ...reviewing medical records and preparing clinical appeals in response to medical necessity denials... ...equivalent degree Current and unrestricted RN license At least 5 years of clinical... ...Expectations Comfortable with remote work arrangements and virtual collaboration...Remote workFor contractorsRelief
$25 - $35 per hour
...Piper Companies is seeking a Clinical Appeals Nurse to join a leading health insurance organization for a contract remote opportunity located in North Carolina. The Clinical Appeals... ...include: • Active Registered Nurse (RN) license in the State of North Carolina...Remote workHourly payContract work- UBC is seeking a Clinical Case Manager to support healthcare providers and... ...funded contracts. You will review coverage criteria, handle prior authorizations and appeals, and provide written communications... ...access. The role requires RN licensure, compact licenses where...Remote job
- ...Advantage HMO health insurer seeking a Nurse leader to manage Appeals & Grievances with clinical leadership and regulatory compliance. The role emphasizes... ...and strong reporting capabilities. The position is remote in the US with minimal travel; requires an LPN license and...Remote work
$69.8k - $125.9k
HCSC is seeking a dedicated RN to facilitate member and provider appeals, coordinating with Medical Directors and Customer Service to ensure compliant processes... ...and a solid foundation in healthcare operations. This remote position supports the U.S. market. Compensation ranges...Remote job- R1 RCM Inc. is seeking a Clinical Coding Appeals Nurse to review medical records and draft appeals of denied or underpaid claims. You will apply... ...ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance. This remote, production-driven role requires nursing qualifications, CCS...Remote job
- Health Care Service Corporation (HCSC) is seeking an RN to facilitate member and provider appeals. The role collaborates with Medical Directors and Customer Service to ensure adherence to guidelines and audit standards, while managing inventory through structured workflow...Remote job
$50k
...please visit As a Nurse Advocate you are responsible for... ...experience about clinical treatments and the strong... ...insurance payer to determine coverage benefits, anticipated... ...: Must have active RN licensure in current state... ...'s degree preferred. Remote work eligibility is...Remote jobFull timeTemporary workWork at officeImmediate startWork from homeHome office- ...HCSC) seeks a registered nurse to facilitate member and provider appeals, coordinating with Medical Directors and Customer Service to... ...managing inventory through established workflows. The position is remote with work hours 9 AM-5:30 PM CST, offering a competitive pay...Remote job
$2,012 - $2,240 per month
...The Registered Nurse (RN) in the Diabetes Center... .... -Lead the process to appeal denials of medications... ...with pharmacies to solve coverage issues so patients have... ...sharing with the center for remote consultations. -Upload... ...is available to the clinical team during in person...Remote workWeekly payShift work$88k - $108k
# Clinical Documentation Improvement Specialist, RNClinical... ...Specialist, RN** to strengthen the accuracy... ...hire opportunity based remotely, supporting a Texas based... ...metrics, including review coverage, query rate, response... ...validation denial appeals with supporting record...Remote workHourly payFull timeContract workMonday to Friday- A healthcare staffing company is seeking a Clinical Nurse Liaison to provide clinical expertise and support to healthcare professionals.... ...resolution and education. The ideal candidate must hold an active RN license and have at least 5 years of experience in acute care...Remote jobPart time
- ...Solutions has an exciting career opportunity available as an Clinical Appeals Nurse. This position will be Remote Work from Home. The Full Time schedule for this role... ...in the denial and appeal process preferred RN license, in good standing and maintained current throughout...Remote workFull timeWork from homeMonday to Friday
- ...with rotating on call coverage for weekends and holidays... ...searching for a new RN to join our team. Our Nurses... ...flexibility to work remotely and do not have face-to... ...skills in addition to clinical experience. Upon receipt... ...in the capacity of Appeals/Grievances, Case Management...Remote jobHome officeMonday to FridayWeekend work
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