Medicare Advantage RN Review Analyst (Remote/MI)
Strategic Staffing Solutions
Strategic Staffing Solutions is seeking a Medicare Advantage RN Review Analyst based in Detroit, MI. This 12+ month W2 contract role requires a current Michigan RN license and two years of patient care experience. Responsibilities include approving or rejecting claims and utilizing data systems for clinical reviews. The ideal candidate will have critical thinking skills and knowledge of Medicare regulations. This position offers a remote work option but must be located in Michigan. #J-18808-Ljbffr
$36 per hour
...Title: Medicare Advantage RN Review Analyst Location: Detroit, MI (Remote - Must be local to Michigan) Duration: 12+ Months Role Type: W2 Contract role Max Pay Rate: $36/HR Schedule: Monday - Friday 9-5 SUMMARY Responsible for the approval or rejection of claims and/or...Remote workContract workLocal areaMonday to Friday- ...Job Description Job Description Fully remote- Must have state of MI unrestricted RN license. You will perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length...Remote workWork at officeFlexible hours
- ...Southcarolinablues is hiring an Appeals Analyst to join their team in... ...and performing clinical reviews to ensure compliance with medical... ...schedule and the option to work remotely or on-site. Ideal candidates should... ...clinical experience, a valid RN license, and strong analytical...Remote workFull time
$70k - $85k
...Medical Review Nurse Analyst Our Medical Review Nurse Analyst - Registered Nurse (RN) is responsible for reviewing medical records to... ...Work Location: We are open to remote work in the following approved... ...support for beneficiaries of the Medicare program and manage benefits...Remote workContract workFor contractorsWork at officeLocal areaImmediate start- ...Remote Nurse Position in Michigan This position will be a remote role for Nurses in Michigan. Should have a valid MI RN License. Should have utilization management experience. Should have experience completing post-acute reviews for the inpatient rehab, skilled nursing...Remote work
- ...currently hiring for an Appeals Analyst to join BlueCross BlueShield... ...complex appeal or retrospective review requests including pre-pay and... ...plans, Medicaid members, Medicare beneficiaries, healthcare providers... ...: An active, unrestricted RN license from the United States...Remote workFull timeFor contractorsCurrently hiringWork at officeLocal areaMonday to Friday
$116.3k - $264.6k
...Angeles, CA, USA Onsite or Remote Flexible Hybrid... ...Health. As a Manager for Medicare Advantage Utilization Management, you'll... ...Denial Letters Concurrent Review Continuity of Care... ...with: Current unrestricted RN licensure in CA required Bachelors...Remote workMonday to FridayFlexible hours$1,905 per week
...Registered Nurse (RN) | Progressive Care Unit Location: Saginaw, MI Agency: Atlas MedStaff... ...recognitions are fueled by real reviews by real travel nurses... ...by Staffing Industry Analysts; and we recently received... ...our team has been working remote since the pandemic), but...Remote workHourly payFull timeContract workWork at officeShift workNight shiftWeekend work- Position: Customs Analyst - Detroit, MI We are seeking a skilled Customs Analyst with extensive experience... ...for internal meetings and reviews. Engage in continuous process improvement... ...hybrid work schedule (4 days in-office, 1 remote). Flexible shift timings are available...Remote workContract workWork at officeFlexible hours
- Job Overview ShimSpine is looking for a Nurse Reviewer / Analyst to use our patented software to analyze and develop case summaries for numerous... ...Growth and professional development opportunities This is an onsite position. No remote work. #J-18808-Ljbffr ShimSpine.comRemote workTemporary work
$95.4k - $208.3k
...Location: Los Angeles, CA, USA Onsite or Remote Flexible Hybrid Work... ...Oversight & Systems, the Senior Business Systems Analyst serves as technical authority responsible... ...previous employer. Current/former UC employees are subject to a personnel file review.Remote workMonday to FridayFlexible hours$71.1k - $97.8k
...Humana is seeking a Prior Authorization RN for the Wisconsin Medicaid Market team. This remote position involves reviewing clinical appropriateness of prior authorization requests, ensuring compliance with Medicare and Medicaid. You will work with outpatient services...Remote work- ...level appeal cases related to Medicare coverage. This role includes collaborating... ...like assessing appeal cases, reviewing medical records, and preparing... ...ASN or BSN degree and active RN license with at least one year... ...benefits, including remote work options. #J-18808-LjbffrRemote work
- ...National Government Services is seeking a Clinical Review Nurse I for Medicare Part A, primarily working virtually with required in-person training... ...include an Associate's degree in nursing, an active RN license, and at least one year of clinical experience. Candidates...Remote work
- ...is seeking an Appeals Nurse to review medical records and claims for... ...and ensure compliance with Medicare guidelines for timely resolutions... ...nursing degree and an active RN license with experience in a healthcare... ...a salary range of 66-68k, remote work options, and...Remote work
- ...Confluence Health is seeking a Utilization Review Specialist to ensure compliance with state regulations and perform utilization reviews... ...thinking skills are essential. This hybrid position allows for flexibility between remote and in-office work. #J-18808-Ljbffr...Remote workWork at office
- ...with Appeals Examiners to ensure timely reviews and compliance with Medicare guidelines. The ideal candidate will have a nursing degree, active RN license, and experience in a clinical... ...setting. Benefits include competitive pay, remote work options, and health insurance...Remote work
- ...for first-level appeals. The role includes reviewing denied services and preparing appeal... ...Candidates need a degree in nursing and an active RN license, along with strong communication... ...skills. The position offers remote work options, competitive benefits including...Remote work
- ...Appeals Examiners to ensure redeterminations are medically reviewed. Candidates should hold an RN license with clinical experience, and possess excellent... ...skills. The position offers competitive pay, remote work options, and comprehensive benefits including health...Remote work
- ...MVP Health Care is seeking a remote Sub-Acute RN UM Reviewer to join its Utilization Management team. In this vital role, you will conduct clinical reviews ensuring compliance with Medicare guidelines and support high-quality patient outcomes. The role requires current...Remote work
- ...and claims for first-level appeal cases. The RN works closely with Appeals Examiners to ensure timely and medically reviewed redeterminations. The role requires a nursing... ...license, plus strong communication skills. Remote work options are available in approved states...Remote work
- ...candidate will possess a nursing degree and an active RN license, with at least one year of clinical... ...with Appeals Examiners, conducting medical record reviews, and ensuring compliance with Medicare guidelines. Remote work is available with excellent benefits including...Remote work
$60.52k - $129.62k
...solutions provider is seeking a Field Case Manager who will work remotely with 25-50% travel in Southwest Michigan. The role involves... ...healthcare providers. Qualified candidates should hold an active MI RN license and possess strong analytical and communication skills....Remote work- ...hiring an Appeals & Grievance Nurse Analyst. This remote position involves reviewing appeals from members, ensuring... ...resolutions in compliance with CMS and Medicare guidelines. The ideal candidate... ...nursing experience and a valid RN license in Tennessee. Key responsibilities...Remote workWork at office
$28 - $32 per hour
Hill Physicians Medical Group is hiring for multiple remote positions primarily focused on adjudicating full risk claims for Medicare Advantage. Candidates should have a minimum of 3 years of experience and a high school diploma or GED. The role includes ensuring accurate...Remote jobHourly pay- ...is seeking an Appeals Nurse to review medical records and claims for... ...ensure that services meet Medicare coverage guidelines while collaborating... ...should hold an active RN license and possess strong communication... ...skills. Benefits include remote work options, health insurance...Remote work
- Humana is seeking a Prior Authorization RN to join their Wisconsin Medicaid Market team. This fully remote position involves reviewing the clinical appropriateness of prior authorization... ...requests while ensuring compliance with Medicare and Medicaid guidelines. The ideal...Remote job
$71.1k - $97.8k
Humana is hiring a Prior Authorization RN to join the Wisconsin Medicaid Market (iCare) team, working remotely. You will review prior authorization requests, ensuring proper clinical appropriateness, and adhere to Medicare and Medicaid guidelines. The ideal candidate should...Remote job- ...Excelas, LLC is seeking a PRN Medical Legal Analyst to work remotely from Ohio. This role requires a Bachelor's degree in nursing with a minimum... ...in medical record analysis. The position involves reviewing medical records, extracting pertinent information, and ensuring...Remote workReliefFlexible hours
- ...accuracy and compliance in primary care clinics and Medicare Advantage health plans. This expert role involves reviewing clinical documentation and providing feedback... ...for providers. This position is mostly remote, but may require travel across various states. Ideal...Remote work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Medicare Advantage RN Review Analyst (Remote/MI). Be the first to apply!



