Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Remote RN: Clinical Quality & Appeals Reviewer

$69.8k - $125.9k

Enterprise HCM

Richardson, TX
  • Remote job

HCSC is seeking a dedicated RN to facilitate member and provider appeals, coordinating with Medical Directors and Customer Service to ensure compliant processes while maintaining efficient workflow. The role requires strong communication and organizational abilities and a solid foundation in healthcare operations. This remote position supports the U.S. market. Compensation ranges from $69,800 to $125,900 annually, with eligibility contingent on experience and location. #J-18808-Ljbffr Enterprise HCM

Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Remote RN: Clinical Quality & Appeals Reviewer in Richardson, TX vacancy
  • $117.9k - $152.57k

     ...Documentation Integrity Specialist IV, Clinical Licensure-Risk Adjustment-RN Primary Location...  ...1444442 Worker Location: Remote Submit Interest Description: Job Summary: Reviews a moderate caseload of...  ...medical review and coding, quality standards, documentation requirements... 
    Remote work
    Quality
    Full time
    Local area
    Shift work

    Kaiser Permanente

    Pasadena, CA
    3 days ago
  • Walker Healthforce is seeking a Physician Reviewer with 5+ years of clinical experience to provide clinical review of service requests remotely. The role requires board certified MD/DO...  ...contributing to policy development and quality initiatives while supporting managed... 
    Remote job
    Quality
    Full time
    Contract work
    Immediate start
    Weekend work

    Walker Healthforce, Inc.

    Richardson, TX
    2 hours ago
  • $40 - $46 per hour

     ...is immediately hiring for a RN Clinical Appeals Specialist Position type:...  ...: Philadelphia PA 19103 (Remote) As a RN Clinical Appeals...  ...through resolution including case review outreach documentation...  ...opportunities for process improvement quality improvement provider... 
    Remote work
    Quality
    Hourly pay
    Full time
    Contract work
    Temporary work
    For contractors
    Work experience placement
    Work at office
    Immediate start
    Worldwide
    Flexible hours

    Innova Solutions

    Philadelphia, PA
    1 day ago
  •  ...HCSC) seeks a registered nurse to facilitate member and provider appeals, coordinating with Medical Directors and Customer Service to...  ...managing inventory through established workflows. The position is remote with work hours 9 AM-5:30 PM CST, offering a competitive pay... 
    Remote job
    Quality

    Health Care Service Corp.

    Richardson, TX
    4 days ago
  •  ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical Appeals...  ...'s revenue cycle operations by reviewing denied claims for clinical...  ...rate and recovery contribution Quality and clarity of appeal documentation... 
    Remote work
    Quality

    Health Business Solutions

    New York, NY
    5 days ago
  • $25 - $35 per hour

     ...Companies is seeking a Clinical Appeals Nurse to join a...  ...organization for a contract remote opportunity located in...  ...the appeals team, reviewing complex cases, ensuring...  ...Active Registered Nurse (RN) license in the State...  ...compliance, quality improvement, benefit determinations... 
    Remote work
    Quality
    Hourly pay
    Contract work

    Piper Companies

    United States
    4 days ago
  • Health Care Service Corporation is seeking an RN to facilitate member and provider appeals and collaborate with Medical Directors and Customer Service to...  ...managing inventory through appropriate workflows. This remote position offers a stable schedule with potential late... 
    Remote job
    Quality
    Rotating shift
    Afternoon shift

    hcsc

    Richardson, TX
    4 days ago
  • $70k - $80k

     ...Piper Companies is seeking a Clinical Appeals Nurse for a fully remote healthcare-based...  ...role focused on clinical review, appeal resolution, regulatory...  ...Active Registered Nurse (RN) license in the State of North...  ...Review, Grievance Resolution, Quality Assurance, Medicare,... 
    Remote work
    Quality
    Long term contract

    Zachary Piper Solutions

    Raleigh, NC
    4 days ago
  •  ...Clinical Documentation Improvement Specialist Works...  ...members to improve the quality, and completeness of documentation...  ...Provides second-level reviews of clinical...  ...Management team throughout the appeal processes. Reviews...  ...as directed by the RN CDI manager. Coordinates... 
    Quality

    Tucson Medical Center

    Tucson, AZ
    3 days ago
  • $40 - $52 per hour

     ...Clinical Data Coordinator/OASIS Review VNA Health Group Remote Per Diem This position requires residency in NJ Certification...  ...team • Opportunity to impact quality outcomes across the...  ...Qualifications • Current NJ RN License required • BSN preferred... 
    Remote work
    Quality
    Daily paid
    Work experience placement
    Work at office
    Local area

    VNA Health Group

    Neptune, NJ
    5 days ago
  •  ...Appeals Processor III - RN ~ salary ~ Unavailable ~ Hours per...  ...dedicated team in a remote capacity. The Appeals...  ...is responsible for reviewing, analyzing, and processing...  ...documentation (clinical roles may require RN...  ...documentation meets quality and compliance... 
    Remote work
    Quality
    Contract work
    For contractors
    For subcontractor
    Shift work

    Ghost RX

    Orlando, FL
    4 days ago
  •  ...Remote Hialeah, FL Miami, FL Full time R100079...  ...or staff position, please review this tip sheet ( . The Clinical Documentation Integrity (CDI...  ...resource for CDI/Coding/Quality. The CDI Second Level Reviewer...  ...and Licensing:Current RN or MD required; CCDS or CDIP... 
    Remote work
    Quality
    Full time
    Temporary work
    Work at office
    Worldwide

    University of Miami

    Miami Lakes, FL
    4 days ago
  •  ...Clinical Coordinator Under the general direction...  ...to clinical review activities. Responsibilities...  ...related to appeals following clinical...  ...performance improvement and quality assurance...  ...experience required OR RN licensed to...  ...team of clinicians Remote/desk work with- some... 
    Remote work
    Quality
    Work experience placement
    Work at office

    ForHealth Consulting - Community Service - W401950

    Southborough, MA
    16 hours ago
  • $29 - $52 per hour

     ...improving risk management, quality and revenue growth. Ready to...  ...Growing together. The Clinical Claim Review RN will be responsible for performing...  ..., the Auditor will support appeal and fraud investigation...  .... This position is Remote in Massachusetts. You will... 
    Remote work
    Quality
    Hourly pay
    Minimum wage
    Full time
    Contract work
    Work experience placement
    Live in
    Local area
    Monday to Friday
    Shift work

    UnitedHealth Group

    Boston, MA
    3 days ago
  •  ...is looking for a dedicated Remote RN Grievance and Appeals Specialist in Manhattan where...  ...patient care and overall clinic operations. We are looking...  ...contract Responsibilities Review Clinical Records: Evaluate...  ...Review Entities). Track Quality Trends: Identify recurring... 
    Remote work
    Quality
    Permanent employment
    Contract work
    Temporary work
    Monday to Friday

    Phaxis

    Manhattan, IL
    1 day ago
  •  ...Location: Remote - TX Department: Utilization Shift: First Shift (United...  ...to assure the timely provision of quality care throughout the continuum of care...  .../Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate and fiscally responsible... 
    Remote work
    Quality
    Full time
    Shift work
    Day shift

    Cook Children's Health Care System

    Texas
    2 days ago
  • $48 per hour

    Top Healthcare company is hiring a RN Clinical Document Improvement Specialist! Remote Position! ***Required Certified...  ...an experienced second-level CDI reviewer and subject matter expert,...  ...liaison for the CDI, Coding, and Quality Teams. Assists with on-going education... 
    Remote work
    Quality
    Full time
    Temporary work
    Work experience placement
    Flexible hours
    Day shift
    Weatherford, TX
    15 days ago
  • $80k - $120k

     ...Clinical Expert, Care Team Operations (RN) Remote Thesis is building the AI-powered care team platform...  ...increase access and improve quality of care by combining AI agents...  ...operations workflows: Review prior authorizations, appeals, and other clinical-administrative... 
    Remote work
    Quality

    Thesis Care, Inc.

    New York, NY
    3 days ago
  •  ...8 hours and weekends Remote Position Summary: The Clinical Documentation Specialist...  ...improvement in the overall quality, completeness and...  ...recommendations. Review inpatient adult medical...  ...experience as either an RN or Physician and 3 years... 
    Remote work
    Quality
    Shift work
    Weekend work

    ATD Technology LLC

    United States
    3 days ago
  •  ...Description Job Description LTSS Appeals Nurse (Remote) We are seeking a detail-...  ...will perform high-volume clinical reviews within the appeals process,...  .... Support departmental quality and process-improvement...  ...York Registered Nurse (NY RN) license. Residency:... 
    Remote work
    Quality
    Local area
    Monday to Friday
    Flexible hours
    Shift work

    Medix

    New York, NY
    a month ago
  • $29 - $52 per hour

     ..., and removing barriers to quality care. The work you do here...  ...have the flexibility to work remotely as you take on some tough...  ...: Conduct comprehensive clinical reviews of appealed H6516 and H2060 assessment...  ...Current unrestricted Texas RN license ~2+ years of experience... 
    Remote job
    Quality
    Hourly pay
    Minimum wage
    Full time
    Work experience placement
    Local area
    Work from home
    Monday to Friday

    United Health Group

    Sugar Land, TX
    5 days ago
  • $102.18k

     ...Lead Appeals And Grievances RN Salary Range: $102,183.00 (Min.)...  ...to provide access to quality health care for Los Angeles...  ...and Grievance (A&G) clinical unit. This position...  ...for the quality review of complex and/or escalated...  ..., holidays, a hybrid remote schedule, and... 
    Remote work
    Quality
    Shift work
    Weekend work

    Credenza Health

    Los Angeles, CA
    3 days ago
  • Clinical Reviewer Acentra Health exists to empower better health...  ...increase efficiency, quality, and impact in their...  ...requirements. ***Position is remote*** ** Required Work...  ...Registered Nurse (RN) License in any state,...  ...Experience with Medical Appeals. Ability to work in a... 
    Remote job
    Quality
    Contract work
    Relief
    Work at office
    Flexible hours
    Weekend work
    Afternoon shift

    Acentra Health

    New York, NY
    1 hour ago
  • UnitedHealth Group is seeking a Remote Appeals Clinician in Texas. You will conduct comprehensive reviews of Medicaid-related...  ...records, and provide independent clinical judgments on medical necessity...  ...Requirements include a Texas RN license and 2+ years in Medicaid... 
    Remote job
    Flexible hours

    UnitedHealth Group

    Sugar Land, TX
    11 hours ago
  •  ...AlliedTech1 is seeking a RN Clinical Documentation Integrity Specialist to work remotely in the United States. The role focuses...  ...clinical documentation meets quality and regulatory standards and supports...  ...to clarify documentation, review CDI indicators, and contribute... 
    Remote work
    Quality

    TalentBurst

    United States
    1 day ago
  •  ...UnitedHealth Group is seeking an HSS Clinical Coordinator RN to conduct clinical reviews and evaluations related to Medicaid appeals, ensuring compliance and accuracy in assessments. This remote role is ideal for experienced RNs seeking meaningful patient-care impact.... 
    Remote work
    Full time

    UnitedHealth Group

    Texas
    1 hour ago
  •  ...scalable solutions and clinical expertise help solve...  ...Supervisor, Clinical Appeals is responsible for...  ...performance management, and quality assurance. They will...  .... This is a remote position. RN license in good standing...  ..., and Documentation Review/Auditing. Qualifications... 
    Remote work
    Quality
    Full time
    Immediate start
    Work from home

    CorroHealth

    Illinois
    8 days ago
  • Health Business Solutions LLC is seeking a Clinical Appeals Nurse (RN) for a remote role. The position focuses on reviewing denied claims for clinical accuracy and medical necessity, developing appeal strategies, and drafting payer-ready documentation to overturn denials... 
    Remote job

    Health Business Solutions LLC

    New York, NY
    1 hour ago
  •  ...Clinical Documentation Improvement Specialist Work Mode: Remote Duration: 6-9 months Full-time, day shift, flexible hours...  ...nursing knowledge to improve the quality and completeness of clinical documentation...  ...: Current, valid AZ RN or LPN license or valid compact... 
    Remote work
    Quality
    Full time
    Flexible hours
    Day shift

    Axelon Services Corporation

    Phoenix, AZ
    4 days ago
  •  ..., and payors for medical necessity reviews and appeals. You will conduct concurrent peer-to...  ...health systems. Role emphasizes clinical expertise to support quality outcomes, regulatory compliance, and cost-effective care with remote work within the U.S. Optum Insight... 
    Remote job
    Quality

    UnitedHealth Group

    Newtown Square, PA
    2 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote RN: Clinical Quality & Appeals Reviewer. Be the first to apply!