Remote RN: Clinical Quality & Appeals Specialist
Health Care Service Corp.
- Remote job
Health Care Service Corporation (HCSC) seeks a registered nurse to facilitate member and provider appeals, coordinating with Medical Directors and Customer Service to ensure compliant processes. The role requires adherence to accreditation and regulatory standards and managing inventory through established workflows. The position is remote with work hours 9 AM–5:30 PM CST, offering a competitive pay range and a comprehensive rewards package. Sponsorship is not available. #J-18808-Ljbffr Health Care Service Corp.
- 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 jobRotating shiftAfternoon shift
- UnitedHealth Group is seeking a Remote Appeals Clinician in Texas. You will conduct comprehensive reviews... ...), evaluate records, and provide independent clinical judgments on medical necessity. Requirements include a Texas RN license and 2+ years in Medicaid with data-entry...Remote jobFlexible hours
- ...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
- UnitedHealth Group is seeking a Clinical Coordinator RN for a Telecommute role in Texas. You will conduct... ...comprehensive clinical reviews of appeals, evaluate medical records, and provide... ...and collaboration within a remote team, with weekday daytime hours. Ideal...Remote jobWeekday work
$69.8k - $125.9k
...facilitating member and provider appeals; working closely with Medical... ...Registered Nurse (RN) with unrestricted license in... ...weekends/holidays. This is a Remote/Work-From-Home role. Work Location... ...dedicated to expanding access to high-quality, cost-effective health care and...Remote workWork from homeMonday to FridayRotating shiftAfternoon shift$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 - 100% Remote role at Healthfirst . Position Summary: The Appeals & Grievances (A&G) unit...Remote jobFull timeMonday to FridayShift work- ...Clinical Appeals Specialist The Clinical Appeals Specialist completes research, basic analysis, and evaluation of member and provider disputes... ...disorders and addictions. Licenses/Certifications: RN - Registered Nurse - State Licensure And/or Compact State...Remote workWork at office
$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... ...• Active Registered Nurse (RN) license in the State of North... ...operations, regulatory compliance, quality improvement, benefit determinations...Remote workHourly payContract work- ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical Appeals Position Overview... ...Appeal overturn rate and recovery contribution Quality and clarity of appeal documentation Timeliness...Remote work
$70k - $80k
...Piper Companies is seeking a Clinical Appeals Nurse for a fully remote healthcare-based opportunity. This Clinical... ...Active Registered Nurse (RN) license in the State of North Carolina... ...Records Review, Grievance Resolution, Quality Assurance, Medicare, Medicaid, Physician...Remote workLong term contract- ...Senior Quality Improvement Specialist (RN) Location: NYCLAY (100% remote) Duration: 45 W, 3 D Client: Molina Healthcare 100% remote- candidates can work from anywhere... ...that require a component of near real-time clinical decision-making. These activities may include...Remote work
- A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching...Remote 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... ...effective communication skills. A California RN license and ADN are required. The position offers...Remote workHourly pay$95k - $115k
...Area Quality Specialist Registered Nurse Find your purpose giving patient... ..., depending on experience Remote/Travel: Work from home a little... ...qualifications: Active RN license in any US state At... ...Quality Specialist, Regional Clinical Quality Manager, Regional Clinical...Remote workDaily paid- ...Appeals Processor III - RN ~ salary ~ Unavailable ~ Hours per week ~40... ...join our dedicated team in a remote capacity. The Appeals Processor... ...medical documentation (clinical roles may require RN) Responsibilities... ...all documentation meets quality and compliance standards...Remote workContract workFor contractorsFor subcontractorShift work
- ...Guidehealth is seeking a Remote Clinical Quality Improvement Coordinator to help drive data‑driven quality initiatives in a fully remote setting. You will act as SME for QI measures, collect quality data, and collaborate with patients, providers and payers to close gaps...Remote work
- ...Guidehealth, a remote-first healthcare company, is hiring a Remote Clinical Quality Improvement Coordinator to drive quality initiatives and patient outreach across payers and providers. You will access EMR data, claims, and outreach to close quality gaps while collaborating...Remote work
$29 - $52 per hour
...improving risk management, quality and revenue growth. Ready to... ...together. The Clinical Claim Review RN will be responsible for performing... ..., the Auditor will support appeal and fraud investigation... ...schedule. This position is Remote in Massachusetts. You will...Remote workHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work- ...Job Description Fully remote- Must have state of MI unrestricted RN license. You will perform prospective,... ...service and level of care, including appeal requests initiated by providers,... ...computer skills (Microsoft office) Clinical experience in ICU, ER, or medical...Remote workWork at officeFlexible hours
- ...RN Appeals Writer - Remote Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels...Remote jobWork experience placement
- ...Clinical Coordinator Under the general direction of... ...to inquiries related to appeals following clinical determinations... ...improvement and quality assurance activities.... ...experience required OR RN licensed to practice in... ...team of clinicians Remote/desk work with- some statewide...Remote workWork experience placementWork at office
$80k
...role is $80,000 The CDI Specialist facilitates and obtains... ...for any patient clinical condition or procedure... ...letters and writes denial appeal letters. Collaborates... ...Education ~ Current RN Licensure Certifications... ...Top Workplace for Remote Work 2024 Great Place...Remote workLocal area$75k - $80k
...help over one million people receive quality mental healthcare? Come join our mission... ...We are looking for an experienced Clinical Quality Specialist to join our Network and Clinical Quality... ...mental healthcare. *This is a remote position based on Eastern Time with a...Remote workLocal areaMonday to FridayFlexible hours- ...Clinical Denial Management Nurse Turn clinical expertise into stronger appeals, better reimbursement, and fewer denials across the enterprise. Work Style: Remote Location Requirement: Must reside in an authorized... ...as a Registered Nurse (RN) or Licensed Practical...Remote workFull timeWork at office
- ...Description Job Description LTSS Appeals Nurse (Remote) We are seeking a detail-... ...will perform high-volume clinical reviews within the appeals... .... Support departmental quality and process-improvement... ...New York Registered Nurse (NY RN) license. Residency: Must...Remote workLocal areaMonday to FridayFlexible hoursShift work
$80k - $120k
...Clinical Expert, Care Team Operations (RN) Remote Thesis is building the AI-powered care team platform for infinitely... ...increase access and improve quality of care by combining AI agents with... ...: Review prior authorizations, appeals, and other clinical-administrative...Remote work- ...Clinical Supervisor, UM Denial Compliance Location:... ...Position Type: Hybrid (85% remote, 15% onsite in Burbank,... ...in ensuring a high-quality, efficient, and compliant... ...Nursing Program; RN preferred. Minimum of... ...in prior-authorization, appeals & grievance, or health...Remote workPermanent employmentTemporary work
$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization that delivers care, aided by technology... ...as needed to support negotiations and appeals process Interacts with internal... ...Associate's degree ~ Active and unrestricted RN license OR LPN in the state of residence...Remote jobHourly payMinimum wageFull timeTemporary workWork experience placementLocal area- ...PRN - RN Clinical Assessor (Aged & Disabled Waiver) Acentra Health exists to empower better... ...role based in West Virginia, combining remote work from home with field assessments and... ..., annual, change of status, mediation/appeals, reconsideration review, and derivative...Remote workReliefWork at officeLocal areaFlexible hours
$102.18k
...Lead Appeals And Grievances RN Salary Range: $102,183.00 (Min.) - $163,492.0... ...mission is to provide access to quality health care for Los Angeles... ...and Grievance (A&G) clinical unit. This position is responsible... ..., holidays, a hybrid remote schedule, and occasional flexibility...Remote workShift workWeekend work
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