Remote RN: Clinical Quality & Appeals Reviewer
$69.8k - $125.9kEnterprise HCM
- 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
$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 workQualityFull timeLocal areaShift work- 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 jobQualityFull timeContract workImmediate startWeekend work
$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 workQualityHourly payFull timeContract workTemporary workFor contractorsWork experience placementWork at officeImmediate startWorldwideFlexible hours- ...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 jobQuality
- ...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 workQuality
$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 workQualityHourly payContract work- 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 jobQualityRotating shiftAfternoon shift
$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 workQualityLong term contract- ...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
$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 workQualityDaily paidWork experience placementWork at officeLocal area- ...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 workQualityContract workFor contractorsFor subcontractorShift work
- ...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 workQualityFull timeTemporary workWork at officeWorldwide
- ...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 workQualityWork experience placementWork at office
$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 workQualityHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work- ...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 workQualityPermanent employmentContract workTemporary workMonday to Friday
- ...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 workQualityFull timeShift workDay shift
$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 workQualityFull timeTemporary workWork experience placementFlexible hoursDay shift$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 workQuality- ...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 workQualityShift workWeekend work
- ...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 workQualityLocal areaMonday to FridayFlexible hoursShift work
$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 jobQualityHourly payMinimum wageFull timeWork experience placementLocal areaWork from homeMonday to Friday$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 workQualityShift workWeekend work- 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 jobQualityContract workReliefWork at officeFlexible hoursWeekend workAfternoon shift
- 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 jobFlexible hours
- ...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 workQuality
- ...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 workFull time
- ...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 workQualityFull timeImmediate startWork from home
- 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
- ...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 workQualityFull timeFlexible hoursDay shift
- ..., 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 jobQuality
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN: Clinical Quality & Appeals Reviewer. Be the first to apply!
- pediatric icu rn Richardson, TX
- connect rn Richardson, TX
- pediatric oncology rn Richardson, TX
- davita rn Richardson, TX
- womens health rn Richardson, TX
- rn per diem nurse Richardson, TX
- hospice registered nurse Richardson, TX
- operating room rn Richardson, TX
- oncology rn Richardson, TX
- behavioral rn Richardson, TX



