Remote RN Appeals Specialist — Senior Clinical Admin
UnitedHealth Group
- Remote job
UnitedHealth Group is seeking a Senior Clinical Administrative RN to support Texas remote reviews of appeals and fair hearings. The role emphasizes clinical review, chart audits, and collaboration with cross-functional teams to ensure accurate determinations and compliance. In Texas, you may telecommute while handling state/federal regulatory review, audits, and external coordination. Strong attention to detail and communication are essential for success in this role. #J-18808-Ljbffr UnitedHealth Group
- A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching...Remote work
- ...Paid Time Off Job Summary The Appeal Specialist II reviews, analyzes, and resolves insurance... ...other guidelines as needed. Files other clinical appeals on in scope denial types including... .... Licenses and Certifications RN - Registered Nurse - State Licensure and...Remote workFull timeContract workWork at office
- UnitedHealthcare is seeking a Senior Clinical Administrative RN in Texas to review member appeals and fair hearings, coordinating with clinical and non-clinical staff to ensure accurate determinations. The role supports compliance with State and Federal requirements while...Remote jobSenior
- UnitedHealth Group is seeking a Senior Clinical Administrative RN to review member appeals and fair hearing requests from a Texas-based remote location. The role focuses on clinical and chart review, audits, and regulatory alignment within a managed care setting. The ideal...Remote job
$66k - $68k
WPS, a health solutions company, seeks an Appeals Nurse to review first-level appeal cases, assess... ...and adherence to CMS guidelines. Strong clinical background and communication skills are essential. The role offers remote work options across approved states, with a...Remote job- Centene is seeking a California-licensed nurse (RN or LPN/LVN) for a remote role aligned to Pacific Standard Time hours. You will facilitate medical necessity grievances, appeals, and denials, review clinical data, and determine if criteria are met under NCQA guidelines...Remote job
- WPS is seeking an Appeals Nurse to review medical records and Medicare claim information for first-level appeal... ...and compliant with CMS guidelines. Required RN license, ASN/BSN, and 1+ year clinical experience. Remote work is permitted in several states, including New...Remote job
- Phaxis is seeking an experienced registered nurse to investigate and manage clinical grievances, appeals, and external reviews from intake to resolution. The role emphasizes reviewing medical necessity, quality-of-care concerns, and coordination across settings from outpatient...Remote job
$60.2k - $107.4k
...Senior Clinical Administrative Nurse At UnitedHealthcare, we're simplifying the health care... ...determinations, including support through the appeals process Educate members on the use of... ...: ~ Current and unrestricted RN compact license ~ Ability to obtain additional...Remote workSeniorMinimum wageFull timeWork experience placementLocal areaWeekday work$30.58 - $55.09 per hour
About This Role The RN Senior Transition Specialist provides expertise in managing the coordination of member transitions in the community, ensuring... .... Highlights Pay: $30.58 - $55.09/hour Location: Remote, NH Schedule: Full Time, Day shift What You'll Do Work with...Remote workSeniorFull timeFlexible hoursDay shift- Centene Corporation is seeking a fully remote RN appeals reviewer to support processing of medical necessity reviews for appeals. You will research medical records and apply NCQA standards to determine appropriate resolutions. The role prefers an active RN license (New...Remote job
- Centene Management Company is seeking a licensed RN to perform clinical reviews for appeals, examining medical records and data to determine medical necessity in line with NCQA standards. This is a fully remote role, with a preference for an active, unrestricted New York...Remote job
- ...Corporation is seeking an Authorization Management Clinical Reviewer - Appeals and Denials to join our remote team. You will review acute and post-acute requests... ...through to resolution. The role requires an active RN license, 4-6 years of relevant experience, and strong...Remote job
- NTT DATA, Inc. seeks a Clinical Reviewer Specialist to perform clinical and medical necessity... ...reviews for member and provider appeals, evaluating records against NCQA... ...Medicaid requirements. Role offers remote work within Florida, requires RN licensure, 3 years’ experience...Remote job
$60.2k - $107.4k
...program is to provide a front line clinical resource to provide education... ...the flexibility to work remotely from anywhere within the U.S.... ...to appropriate internal specialists and programs, based on member... ...~ Current and unrestricted RN compact license ~4+ years of...Remote jobSeniorMinimum wageFull timeWork experience placementLocal areaMonday to Friday- Mosaic Life Care is seeking a CDI Specialist RN to advance clinical documentation integrity across hospital operations. You will review and code, collaborate... ...ICU/critical care experience, and strong communication. Remote work options exist for eligible states, including Utah....Remote job
- ...concurrent and retrospective reviews of clinical documentation, assign ICD-10-CM/PCS codes... ...improvement and ongoing professional development. RN licensure, CCDS and CDIP certifications... ...or pursued within specified timelines; remote work is available for eligible states...Remote job
- ...assigning ICD-10-CM/PCS, CPT, and HCPCS codes with strong attention to coding guidelines and compliance. You will work with CDI and clinical teams to ensure accurate DRG reconciliation and support high-dollar cases, while maintaining ongoing professional development...Remote jobSenior
- ...support the Enterprise Coding Department. The role emphasizes accurate ICD-10 coding, chart abstraction, and CDI collaboration in a remote setting. Ideal candidates will hold AHIMA credentials, have 4+ years in inpatient coding, and stay current with CMS and Oregon...Remote jobSenior
- ...-paced hospital setting. The role requires 7 years of inpatient coding experience, an AHIMA or AAPC certification, and a degree in Health Information Management. Remote work options may apply in approved states; full benefits available. #J-18808-Ljbffr Advocate HealthRemote workSenior
- Advocate Health is seeking an experienced inpatient coder to support complex documentation and accurate coding across multiple service lines. The role requires certification from AAPC or AHIMA, an associate degree in health information management, and at least seven years...Remote jobSenior
- ...associate degree in health information management. The position offers full-time hours with a standard 8-hour day, 40 hours per week. A remote-work option may be approved for eligible states, and you will navigate coding workflows for inpatient services and high-dollar...Remote jobSeniorFull time
- Advocate Health is seeking an experienced Inpatient Coder to join the 10407 Enterprise Revenue Cycle team. The role focuses on coding complex inpatient cases with ICD-10-CM/PCS, CPT, and HCPCS and requires several years of acute care inpatient experience. The coder will...Remote jobSenior
- Advocate Health is seeking an experienced inpatient coder to join the 10407 Enterprise Revenue Cycle team in Pennsylvania. The role focuses on coding complex inpatient cases using ICD-10-CM/PCS, CPT, and HCPCS within an EMR and CAC system. The position requires certification...Remote jobSenior
- The Ohio State University is seeking an Outpatient Medical Coder 3 to join the Health System Shared Services. This remote role supports coding for outpatient and some inpatient services, requiring ICD-10-CM/PCS and CPT-4 expertise. Minimum qualifications include an Associate...Remote jobSenior
- Advocate Health is seeking an experienced inpatient coder to join our 10407 Revenue Cycle team. You will review complex inpatient records and assign ICD-10-CM/PCS, CPT, and HCPCS codes, ensuring accurate coding and compliant reimbursement for cardiology, neurology, and ...Remote jobSenior
- ...DRG alignment and Medicare reconciliation. The role requires 7+ years inpatient coding in acute care, AHIMA/AAPC certification, and strong analytical skills. Remote work is available for eligible states, with a standard 40-hour work week. #J-18808-Ljbffr Advocate HealthRemote jobSenior
- Advocate Health is hiring for a senior inpatient coder role within the 10407 Enterprise Revenue Cycle team. The position involves thorough inpatient coding across cardiology, neurology, and oncology service lines, using ICD-10-CM/PCS, CPT, and HCPCS within an EMR/Coding...Remote jobSenior
- ...Responsibilities include auditing complex cases, collaborating with CDI and quality teams, and maintaining certification and ongoing education while meeting productivity targets. Remote work is possible for eligible states, including NM. #J-18808-Ljbffr Advocate HealthRemote jobSeniorFull time
- ...requires coding certifications (AAPC or AHIMA) and an Associate’s degree in Health Information Management, with about 7 years of inpatient coding experience in acute care. Full-time, on-site with potential remote eligibility in listed states. #J-18808-Ljbffr Advocate HealthRemote jobSeniorFull time
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