Remote RN: Appeals & Clinical Review for Medicaid
UnitedHealth Group
- Remote job
UnitedHealth Group is seeking a Remote Appeals Clinician in Texas. You will conduct comprehensive reviews of Medicaid-related assessments (H6516/H2060), evaluate records, and provide independent clinical judgments on medical necessity. Requirements include a Texas RN license and 2+ years in Medicaid with data-entry proficiency. The role offers M-F days, flexible hours, and a comprehensive benefits package with remote work options. #J-18808-Ljbffr UnitedHealth Group
- UnitedHealth Group is seeking a Clinical Coordinator RN for a Telecommute role in... ...comprehensive clinical reviews of appeals, evaluate medical records,... ...collaboration within a remote team, with weekday daytime... ...hours. Ideal candidates have Medicaid experience and familiarity...Remote jobWeekday work
$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization that delivers... ...to support negotiations and appeals process Interacts with internal... ...~ Active and unrestricted RN license OR LPN in the state of... ...plan benefit language, CMS (Medicaid and Medicare) and UB 04 billing...Remote jobHourly payMinimum wageFull timeTemporary workWork experience placementLocal area$29 - $52 per hour
...Program Integrity Clinical Compliance Auditor... ...performing compliance reviews of medical and... ...Auditor will support appeal and fraud... ...This position is Remote in Massachusetts.... ...Nurse licensure (RN or LPN) with a current... ...Familiarity with Medicaid program and/or billing...Remote jobHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work$90k - $99k
...Your Role in Our Mission Reviews provider appeals and redeterminations using approved clinical and coding guidelines and documents... ...required CEUs to maintain RN license and/or coding certification... ...Expect in This Role Remote (Work from Home) Up to 25% Travel...Remote workFull timeWork from homeFlexible hours- ...delivery and patient outcomes. Our talented remote workforce spans the country and plays... ...Overview We are seeking an RN to perform Clinical Review work and QIDP reviews work. Team member... ...Responsibilities Apply Alabama Medicaid program criteria and guidelines to...Remote workContract work
- ...RN Clinical Appeals Reviewer- Utilization Management Location: METROHEALTH MEDICAL CENTER Biweekly Hours: 80.00 Shift: 7a-330p The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well...Shift work
$45 per hour
SPECTRAFORCE is seeking a Clinical Appeals Specialist to handle member-generated appeal processes remotely from California. The role involves reviewing medical records and ensuring compliance with... ...communication skills. A California RN license and ADN are required. The position...Remote jobHourly pay- ...determine the viability of the claim for further review in a production environment. Primary Responsibilities: Clinical Case Reviews - 75% Perform clinical review... ...Rules and Regulations Proven knowledge of Medicaid/Medicare Reimbursement methodologies Proven...Remote jobContract workWork at officeLocal areaMonday to Friday
$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant,... ...including Medicare, Medicaid, and Commercial Healthcare... .... You will work remotely in a fast paced and dynamic... ...findings during the appeals process if requested.... ...Active unrestricted RN license in good...Remote workFor contractorsWork at officeWork from homeHome officeShift work$60 per hour
...organization in Jericho, NY is seeking a Full-time Registered Nurse Clinical Reviewer. This role requires a Baccalaureate degree in Nursing and... ...will have 1-3 years of experience in utilization review or appeals and strong communication skills, contributing to patient...Hourly payFull time- ...managers, and payors for medical necessity reviews and appeals. You will conduct concurrent peer-to-... ...client health systems. Role emphasizes clinical expertise to support quality outcomes,... ..., and cost-effective care with remote work within the U.S. Optum Insight functions...Remote job
$91.76k - $105k
...technology, services, and clinical expertise. Our... ...for a Clinical Review Advisor to join... .... The position is remote within the U.S. and... ...documentation of appealed services, citation... ...applicable State Medicaid rules, and application... ...Registered Nurse (RN) license from the...Remote workContract workFor contractorsWork at officeLocal areaHome officeMonday to Friday- ...Corporation is seeking an experienced appeals liaison to work remotely within the Eastern and Central time zones. The role focuses on review of clinical information to determine medical necessity... .... Candidates must hold an active RN or LPN/LVN license with several years...Remote job
$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... ...with colleagues and prepare cases for review and appeals. Minimum Qualifications: RN, LPN...Remote jobFull timeMonday to FridayShift work- Job Description Fully remote- Must have state of MI unrestricted RN license. You will perform prospective... ...and retrospective review of inpatient, outpatient,... ...level of care, including appeal requests initiated by... ...skills (Microsoft office) Clinical experience in ICU, ER, or...Remote workWork at officeFlexible hours
$48 - $65 per hour
...Remote Registered Nurse – Clinical Review Make sure to apply quickly in order to maximise your chances of being considered for an interview Read the complete... ...with the work What we're looking for ~ Active RN license ~ BSN preferred ~3+ years of RN experience...Remote workLong term contractWork from homeMonday to Friday- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These... ...corrective action, consent, etc.) or appeal. This may involve discussion with... ...Valid unrestricted Registered Nurse (RN) license PREFERRED QUALIFICATIONS...Remote workPermanent employmentWork at officeLocal area
- ...Description Description: The Clinical Nurse Reviewer plays a crucial role in the... ...coverage determinations and appeals. Document findings and... ...Qualifications Active RN license (state-specific).... ...essential functions. This is a remote position. While performing...Remote workWork at office
$30 - $40 per hour
...Position Title: Clinical Review Clinician - Appeals Location: Remote Duration: 6 Months | Possibility to extend or convert Schedule: 8-5 EST or CST... ...retrospective claim reviews Licensure ~ Required: RN, LPN Must haves: ~ Medicare knowledge...Remote workWeekend work$27.02 - $48.55 per hour
...have the flexibility to work remotely from their home anywhere within... ...Missouri. This team performs clinical reviews for medical and behavioral... ...our foster care members. An RN with previous prior authorization... ...Knowledge of Medicare and Medicaid regulations preferred. Knowledge...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hours- ...Summary Location: 100% Remote, Source candidates from... ...delivering timely, accurate, and clinically appropriate authorization reviews while maintaining... ...Licensure - Required: LPN/RN - Preferred: Years of... ...Knowledge of Medicare and Medicaid regulations preferred....Remote workHourly payShift workWeekend work
$2,300 per month
...The Clinical Review Nurse (RN) supports the organization’s care management function by conducting clinical reviews, ensuring appropriate utilization... ...-effective healthcare outcomes for members. This is a remote role open to candidates residing in Utah, Texas, or Arizona...Remote workWork at office- Job Title: Clinical Review Clinician - Appeals Duration: 06 months (Possibility for extension or conversion)... ...weekend rotation required. Location: Remote- Nationally sourced. However, would like... ...or higher. Licensure Required: RN, LPN Preferred: LVN Key Criteria Years...Remote workShift workWeekend work
- ...Clinical Appeals Specialist The Clinical Appeals Specialist completes research, basic analysis... ...Organizes the appeal case for physician review by compiling clinical, contractual, medical... .... Licenses/Certifications: RN - Registered Nurse - State Licensure And...Remote workWork at office
- ...TitleRegistered Nurse (RN) for Critical... ...be responsible for reviewing and evaluating... ...OBRA waivers. Your clinical expertise will be... ...participate in hearings, appeals, and stakeholder... ...to support remote and hybrid work functions... ...-based services, Medicaid waivers, and care...Remote workWork from home
$25 - $35 per hour
...Piper Companies is seeking a Clinical Appeals Nurse to join a leading... ...organization for a contract remote opportunity located in North... ...resource within the appeals team, reviewing complex cases, ensuring regulatory... ...• Active Registered Nurse (RN) license in the State of...Remote workHourly payContract work- ...Title Location: 100% Remote – Any US State Shift:... ...working with the IL and MI Medicaid products. The purpose... ...letters based on review outcomes in accordance... ...improvement. Performs clinical review of outcomes including... ...- Required: LPN or RN, active in any state -...Remote workLocal areaShift work
- ...related experience. Clinical knowledge and ability to analyze... ...Knowledge of Medicare and Medicaid regulations preferred. Knowledge... ...For Health Net of California: RN license required For... ...medical necessity and clinical reviews of authorization requests to determine...Remote work
$44 per hour
...Clinical Review Nurse - Prior Authorization Various, NV Clinical Review... ...All On-site Location: Fully Remote – Prefer Candidates reside in... ...elsewhere if they have an NV RN License. SHIFT: Training... ...Knowledge of Medicare and Medicaid regulations preferred. Knowledge...Remote workPermanent employmentContract workLive inShift work- ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical Appeals Position Overview... ...Nurse supports HBiz’s revenue cycle operations by reviewing denied claims for clinical accuracy and medical necessity...Remote work
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