Remote Nurse Reviewer I: Medical Necessity & Appeals
Elevance Health (Anthem)
- Remote job
Elevance Health is seeking a Nurse Reviewer I to perform preauthorization and medical necessity reviews for diagnostic imaging. The role is remote with required in-person training sessions and potential location-based adjustments. Strong emphasis on collaboration with providers and members to ensure high-quality, appropriate use of imaging services. Requirements include an active RN license in Illinois or California and relevant clinical or utilization management experience. #J-18808-Ljbffr Elevance Health (Anthem)
$95k - $110k
...Select how often (in days) to receive an alert: DRG Nurse Reviewer Appeals and Hearings- Remote Date: Aug 30, 2026 Location: Any city, FL, US, 99999 Work Mode: Virtual (Exception only) It takes great medical minds to create powerful solutions that solve some of healthcare...Remote workMedicalFull timeWork from homeRelocation packageFlexible hours- Healthcare Quality Strategies, Inc. (HQSI) is seeking a Nurse Reviewer for a remote position supporting Medical Review Services. The role requires conducting comprehensive medical necessity reviews and ensuring compliance with established guidelines. The ideal candidate...Remote jobMedical
- Palmetto GBA is seeking an Appeals Nurse Reviewer to research complex appeal or retrospective review requests and determine medical necessity according to guidelines and regulations. This full-time remote role (40 hours/week) operates Monday-Friday, 8:00 a.m. to 4:30 p....Remote jobMedicalFull timeMonday to Friday
- ...care.? Requirements The Nurse Reviewer performs complex medical record reviews of Medicare... ...clinical judgment to medical necessity, coverage, and... ...Qualifications MAC or RAC appeals review experience CPC (or... ...essential functions. This is a remote position. While performing...Remote workMedicalContract workFor contractorsLocal area
$35.54 - $55.73 per hour
...Nurse Reviewer I Nurse Reviewer I Seeking RNs that have a current... ...having limited or no previous medical review experience requiring... ...learns to conduct medical necessity clinical screenings of preauthorization... ...metrics. Validating appeal requests. Manage appeal...Remote workMedicalFull timeWork experience placementWork at officeLocal areaMonday to FridayShift workWeekend workAfternoon shift- ...A healthcare quality organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The ideal candidate will... ...participating in ongoing training. This is a part-time remote position, offering a flexible work environment with...Remote workMedicalHourly payPart timeFlexible hours
$40 per hour
...Nurse Reviewer PT (20‑30 hours week) – Remote Work Environment Non‑Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting... ...by performing comprehensive medical necessity reviews and policy reviews for Medicaid...Remote workMedicalContract workWork at officeLocal areaImmediate start- A healthcare organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The role involves examining claims... ...experience. This position offers a chance to work in a remote setup with competitive hours. Benefits include...Remote jobMedical
- Gainwell Technologies is seeking a DRG Nurse Reviewer Appeals and Hearings to coordinate and perform all appeal related duties including analyzing... ...case files and case summaries for hearings. The role offers remote (work from home) options with up to 25% travel for onsite...Remote jobWork from home
- ...Description Provide timely review and determination of medical claims, including prior authorization, appeals, and/or any other type of... ...State license as a Registered Nurse (RN),as required by contract(... ...essential for this position Remote but need to be local to 18702...Remote workMedicalContract workFor contractorsWork experience placementWork at officeLocal area
$95k - $110k
...Gainwell Technologies is seeking a DRG Nurse Reviewer Appeals and Hearings professional for remote work. You will coordinate and perform appeal duties, analyze documentation, prepare case files and participate in hearings, both virtual and on-site as needed. Required are...Remote work- Walker Healthforce, LLC seeks a Medical Claim Review Nurse for a fully remote contract based in Washington. The role focuses on retrospective medical necessity reviews, appeals, and payment integrity within Molina Healthcare of Washington. The ideal candidate holds an...Remote jobMedicalContract work
- CVS Health is recruiting an Appeals Nurse Consultant to process medical necessity for Medicare Part C appeals. The role combines independent and team work in a remote setting, with a 40-hour weekly schedule and occasional weekend/holiday rotations. Required RN licensure...Remote jobMedical
- ...DATA is seeking a BPO Clinical Review Senior Specialist in Tampa,... ...quality audits of clinical appeal reviews, ensuring compliance... ..., Medicaid regulations and medical necessity guidelines. The role demands... ...improvements. The position is remote within Florida, requiring...Remote jobMedical
- CVS Health is seeking an Appeals Nurse Consultant to evaluate medical necessity for Medicare Part C appeals. The role requires an active RN license, strong communication... ...include independent and team collaboration in a remote setting, handling multiple systems, and adherence to...Remote jobMedicalFull time
- WPS Health Solutions in Columbus, OH, is seeking an Appeals Nurse to review medical records and Medicare claims for first-level appeals to determine medical necessity and coverage alignment. The role collaborates with Appeals Examiners to prepare timely redeterminations...Remote jobMedical
- CVS Health in Colorado is seeking an Appeals Nurse Consultant to assess the medical necessity of Medicare Part C appeals for members and providers. This production... ..., and using several computer systems while working remotely. The position requires an active RN license, strong...Remote jobMedicalWeekend work
- ...in Tampa, Florida seeks a BPO Clinical Review Specialist to perform clinical and medical necessity reviews supporting member and provider appeals. You will evaluate medical records and... ...standards and Medicaid guidance. This remote Florida role offers benefits including...Remote jobMedical
- CVS Health in the United States is seeking an Appeals Nurse Consultant to evaluate Medicare Part C medical necessity for members and providers. This role blends independent action with team collaboration in a remote setting. The position features a 40-hour work week, weekend...Remote jobMedicalWeekend work
- ...hiring a Physician Assistant/Associate to join the appeals and grievances team. You will adjudicate cases with medical directors and collaborate closely with a multi-disciplinary staff to review benefits, medical necessity, and policy criteria across plans such as PPO,...Remote jobMedical
- CVS Health is seeking an Appeals Nurse Consultant to review and determine medical necessity for Medicare Part C appeals from members and providers. This production role... ..., and the ability to work independently in a remote, fast-paced environment. Typical schedule includes...Remote jobMedicalWeekend work
- ...Assistant/Associate to oversee appeals and grievances with a multidisciplinary team. You will review cases across PPO/HMO/Medicare... ...clinical criteria and medical necessity standards to determine outcomes... ...strong MS Office skills. This remote role supports US-based work hours...Remote jobMedical
- UnitedHealthcare offers a remote-friendly physician assistant role... ...United States, focusing on review and adjudication of appeals and grievances. You will collaborate with medical directors and an integrated team to assess medical necessity and benefit design. The position...Remote jobMedicalWeekday work
- CVS Health in Idaho is seeking an Appeals Nurse Consultant to process the medical necessity of Medicare Part C appeals. This full-time role requires an active RN... ...focused on safe, quality care. The role supports remote work within the U.S. time zones. #J-18808-Ljbffr CVS...Remote jobMedicalFull timeWeekend work
- ...Associates and 7 years of experience At least 3 years of experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity. Current/Active Nursing or Physical Therapy license in state of...Remote workMedicalNight shift
- ...Nurse Reviewer Contract Duration: Initial 6-months Pay: $27.50/hr on W2 Start Date: 9/8/2026 Location: Fully Remote (US Only) LPN State License must be active and in good standing... ...Overview Review applications and medical documentation received from...Remote workMedicalContract work
- ...Epiq Nurse Reviewer At Epiq, your work contributes to complex, global legal outcomes. You'll join a values-driven community where integrity... ...at scale. The Nurse Reviewer is responsible for reviewing medical claims, ensuring compliance with company policies and legal...Remote workMedicalWork at officeLocal area
$31 - $38 per hour
...Nurse Reviewer This is a remote position. Paradigm is seeking an experienced Nurse Reviewer to support our client in a detail-oriented role combining... ...$38/hour, based on experience and credentials Benefits: Medical, dental, vision, life, 401(k), PTO, and sick leave...Remote workMedicalContract workWork experience placementWork at office- ...Patient Financial Services team and lead complex clinical appeals, audits, and compliance initiatives across inpatient and outpatient settings. You will ensure medical necessity and appropriate level of care, review coding and documentation, and educate providers on...Remote jobMedical
- ...Role Snapshot The Appeals Nurse examines medical records and claims information... ...redeterminations are medically reviewed as needed and completed... ...We are open to remote work in the following approved... ...to determine the clinical necessity of services and make recommendations...Remote workMedicalContract workFor contractorsLocal areaImmediate start
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