Remote Clinical Appeals RN | Utilization & Grievances
UnitedHealth Group
UnitedHealth Group's UnitedHealthcare division is seeking a Clinical Appeals RN to work remotely from anywhere in the United States. You will analyze appeals and grievances, act as clinical interface liaison, and apply evidence-based criteria to determine coverage decisions.
The role follows a Monday–Friday schedule with 8:00–4:30 in the local time zone and alternating Saturdays; overtime may be required. You will collaborate with medical directors, facilities, and providers to resolve complex
#J-18808-Ljbffr$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... ...appeals & grievances, claims processing, utilization review, or case management. Understanding...Remote jobFull timeMonday to FridayShift work- HealthEdge is seeking a remote (US) Appeals & Grievances Specialist to independently process complex grievances and conduct medical necessity reviews... ...have an unrestricted USRN license, 2+ years in utilization management, and strong written/verbal communication. #J...Remote job
- ...a contract-based professional to manage complex grievances and appeals for members and providers in a remote US-based role. The candidate will review medical... ...requires a USRN license, at least 2 years in utilization management, strong communication, and the ability...Remote workContract work
- ...healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member... ...case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license... ...practice and knowledge of Utilization Review Guidelines. The position offers...Remote work
$53 per hour
...Job Description Job Description REMOTE RN OPPORTUNITY – GRIEVANCE & APPEALS / UTILIZATION REVIEW $53/hour | 100% Remote | Long-Term Contract We're... ...Managed care, Medicare/Medicaid experience Strong clinical judgment and communication skills Why Apply?...Remote jobLong term contractWork from homeMonday to FridayShift workWeekday work- ...Sentara Health Plans is seeking a Clinical Claims Reviewer/RN for remote work. The role involves evaluating utilization management, reviewing pre/post payment claims, and ensuring adherence to policy across multiple states. A BSN and active RN license are required, with...Remote work
- ...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...Remote work
$29 - $52 per hour
...Growing togetherAs a Clinical Grievances Nurse, you will be responsible... ...flexibility to work remotely* as you take on some... ...Current, unrestricted RN license in the state... ...experienceClinical appeals and grievances experienceAudit... ...to effectively utilize UHG applications, including...Remote workHourly payMinimum wageFull timeWork experience placementLive inLocal areaImmediate startMonday to Friday$52 - $56 per hour
...RN Grievance & Appeals Specialist | Remote | ContractRNs with direct, payer-side Grievance & Appeals experience... ...an RN who has personally managed clinical grievances and appeals from investigation... ...support, or inpatient-only utilization review.Position details:Pay: $52–$...Remote workAfternoon shift$52 - $56 per hour
...done UM. You've worked appeals. Now find a role that uses... ...We're hiring a contract RN for a New York health... ...Medicaid and MLTC). You'll own clinical grievances and appeals from intake... ...judgment you built in utilization management. 100% remote (U.S.) | Contract | $52–...Remote workContract workAfternoon shift$28.94 - $51.63 per hour
.... Growing together. The Clinical Appeals RN is responsible for providing... ...in clinical appeals and grievances (analyzing, reviewing, and... ...enjoy the flexibility to work remotely * from anywhere within the... ...with the Medical Director Utilize clinical guidelines and...Remote workHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaWeekday work- 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
$28 - $51 per hour
About This Role The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances, analyzing, reviewing, and evaluating appeals and grievances, and... ...reviews with the Medical Director Utilize clinical guidelines and criteria Accurately...Remote jobFull timeDay shift- ...services are covered by insurance. Reviews clinical criteria to support patient care... ...necessary information required for the appeal process when appropriate. Participates in... ...Guidelines. Current working knowledge of, utilization management, case-management, performance...Shift work
- ...Providing expertise in clinical appeals and grievances, the part-time California Licensed Clinical Appeals RN will review medical records, analyze appeals, and serve as a Clinical Interface Liaison while working remotely on a schedule of M-F with alternating Saturdays....Remote workPart timeWork at office
- ...Acting as the liaison for statewide appeals, the full-time RN Licensed Clinical Appeals Coordinator will ensure... ...member and provider appeals in a fully remote environment. Key responsibilities... ...) Experience in managed care or utilization review preferred Strong...Remote workFull time
$40 - $50 per hour
...Job Description Job Description Clinical Appeals RN – 100% Remote $40-$50/hour | Part-Time & Full-Time Opportunities Available Our team partners... ...Experience in clinical appeals, prior authorizations, utilization review, or case management highly desirable. Skills &...Remote jobPermanent employmentFull timeTemporary workPart time- ...UnitedHealth Group is seeking a Clinical Appeals RN to provide expert analysis of appeals and grievances, acting as a clinical interface liaison with facilities, providers... ...confidentiality adherence. The position offers remote work from anywhere in the U.S., with an M-F...Remote work
- ...Managing clinical appeals from intake through resolution, the full-time contract RN Clinical Appeals Specialist will review documentation... ...reviews while working remotely in Philadelphia, PA. Key responsibilities... ...nursing knowledge and utilization management principles to...Remote workFull timeContract work
- ...UnitedHealthcare is hiring a Clinical Appeals RN to provide expertise in appeals and grievances, analyze cases, and serve as a Clinical Interface Liaison with facilities... ...definitions while ensuring confidentiality. Remote work is allowed from anywhere in the U.S., with M...Remote workLocal area
- ...Healthfirst is seeking a Senior Manager, Clinical Appeals & Grievances in the New York area. The role leads... ...outcomes. The position requires RN or LPN licensure, a bachelor’s degree... ...equivalent experience, and experience with utilization management or appeals. Strong...
$55 - $60 per hour
...Phaxis is looking for a dedicated Remote RN Grievance and Appeals Specialist in Manhattan where your contributions... ...impact on patient care and overall clinic operations. We are looking for a... ...preferred Strong backgrounds: Utilization Management Prior Authorization...Remote workHourly payPermanent employmentContract workTemporary workMonday to Friday- ...Clinical Supervisor, UM Denial ComplianceLocation: Los Angeles Metropolitan... ...Position Type: Hybrid (85% remote, 15% onsite in Burbank, CA)... ...Registered Nursing Program; RN preferred.Minimum of five years in prior-authorization, appeals & grievance, or health plan compliance....Remote workPermanent employmentTemporary work
- 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,...Remote jobHourly payWork at officeMonday to FridayFlexible hours
- ...UnitedHealth Group’s Optum is seeking an Utilization Management Nurse to review medical records... ...case details, and craft defensible appeal letters under policy guidance. The role supports... ...an Associate’s degree, an unrestricted RN license, 3+ years bedside nursing in acute...Remote workWork at officeMonday to Friday
- ...UnitedHealth Group is seeking a Clinical Grievances Nurse to review retrospective cases for appropriate... ...’ immediate needs. The role embraces remote PST hours with an on-site base in Mesa,... ...requiring CA residency and an active CA RN license. You will assess care against...Remote workImmediate start
- ...Mass General Brigham Health Plan is seeking an experienced registered nurse for a remote Utilization Management role near Somerville, MA. You will triage inquiries, assess medical necessity, and collaborate with Nurse Reviewers, Medical Directors, providers, and teams...Remote work
- ...payor environments to perform pre-service and post-service utilization reviews and appeals for DMEPOS. The role collaborates with our Medical... ...refer non-qualifying cases to the Medical Director, and handle administrative and clinical appeals while #J-18808-Ljbffr...Remote work
- ...BlueCross BlueShield of South Carolina is seeking an experienced RN reviewer to perform medical reviews remotely. You will assess clinical information, document decisions, and support utilization practices while complying with privacy regulations. The role requires...Remote workWork at office
- ...Sentara Health Plans is seeking a Clinical Claims Reviewer/RN for a remote role. This full-time, 40-hour position offers remote work across multiple... ...CPC certification within a year. The role focuses on utilization management, claim reviews, and compliance with CMS/NCQA...Remote workFull time
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