Remote Clinical Appeals RN — Expert Coverage Reviewer
Anacalifornia
- Remote job
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, providers, and plans. The role supports benefits interpretation and program definitions while ensuring confidentiality. Remote work is allowed from anywhere in the U.S., with M-F 8:00–4:30 in the local time zone and alternating Saturdays. Overtime is required periodically; benefits include a comprehensive package and 401k. #J-18808-Ljbffr Anacalifornia
- UnitedHealth Group is seeking a Clinical Appeals RN to provide expert analysis of appeals and grievances, acting as a clinical interface liaison with... ...documentation and confidentiality adherence. The position offers remote work from anywhere in the U.S., with an M-F schedule of...Remote job
$52 - $56 per hour
...UM. You've worked appeals. Now find a role that... ...hiring a contract RN for a New York... ...MLTC). You'll own clinical grievances and appeals... ...management. 100% remote (U.S.) | Contract... ...or weekend coverage for regulatory deadlines... ...investigation, clinical review, decision and...Remote jobContract workAfternoon shift- 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
- 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/... ..., with full-time hours and weekend coverage. Start date ASAP. Responsibilities include...Remote jobFull timeContract workImmediate startWeekend work
$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 acting as... ...for clinical eligibility for coverage Review and interpret Plan language Coordinate...Remote jobFull timeDay shift- UnitedHealth Group is seeking a Clinical Appeals RN to provide expertise in clinical appeals and grievances, analyzing and evaluating appeals... ...member benefits and program definitions. The role involves reviewing medical records, pre-service eligibility, and interpreting Plan...Day shift
- New England Life Care, Inc. is seeking a Remote Clinical Review Specialist to perform utilization management reviews and provide essential clinical information to confirm patient coverage. The role emphasizes regulatory compliance, complex specialty drug knowledge, and...Remote job
$28.94 - $51.63 per hour
...Connecting. Growing together. The Clinical Appeals RN is responsible for... ...and grievances (analyzing, reviewing, and evaluating appeals and... ...enjoy the flexibility to work remotely * from anywhere within the... ...clinical eligibility for coverage as prescribed by the Plan benefits...Remote jobHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaWeekday work- ...role, you'll use your clinical knowledge outside... ...bedside setting to review and audit claims,... ...Registered Nurse (RN) license Strong... ...vulnerable populations Remote work - enjoy the... ..., and service coverage. Accurately document... ...reason codes, and appeal rights in compliance...Remote workFull timeTemporary workWork at officeWork from home
- AuraOne, Inc. seeks Medical Doctor - Physician Expert for a remote clinical-review track evaluating AI outputs touching physician practice. You will review differential reasoning, dosing logic, and adherence to guidelines, flag patient-safety issues, and document corrected...Remote jobFor contractors
- ...Registered Nurse to join the cardiac device clinic team at Advocate Christ Medical Center.... ...pacemakers and ICDs, device interrogations, and remote monitoring in a high-volume environment.... ...care) with EP/Device exposure, and active RN licensure with CPR and ACLS. #J-18808-...Remote 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... ...involve medical necessity benefit coverage administrative processing...Remote workHourly payFull timeContract workTemporary workFor contractorsWork experience placementWork at officeImmediate startWorldwideFlexible hours- A national health organization is seeking a Clinical Review Clinician - Appeals to conduct clinical reviews and manage appeals. The role requires an... ...standards and healthcare regulations. The position is fully remote and includes a comprehensive benefits package. Join us...Remote jobFlexible hours
- ...Department and the CDI Leadership. Acts as a clinical and technical resource to the CDS staff,... ...intervals; facilitates special record reviews, projects and other customer requests of... ...whether the position you are interested in is remote or on-site. Individuals who reside in...Remote workWork experience placement
$68.97k - $113.31k
Guardian Life is seeking an RN Clinical Consultant to support disability claim decisions. You will review medical data, assess functional capacity, and collaborate with providers... ...and 3+ years in LTD/STD clinical consulting. Remote options nationwide are available, with salary...Remote job- 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
- Optum in the United States is seeking a Clinical DRG RN auditor to apply MS-DRG/APR-DRG coding expertise to inpatient claims. You will validate ICD-10 coding, DRG assignments, and discharge statuses, producing clear rationales and supporting audit findings. You can telecommute...Remote job
$55 - $65 per hour
...Position: Adult Inpatient Nurses (RN) Type: Contract... ...$55–$65/hour Location: Remote Role Responsibilities Review and evaluate AI-generated clinical outputs based on nursing flowsheet... ...training datasets . Provide expert feedback on nursing...Remote workContract workSummer work- 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 independent... ...and collaboration within a remote team, with weekday daytime hours....Remote jobWeekday work
- ...Clinical Appeals Specialist The Clinical Appeals Specialist... ...adverse and adverse coverage decisions. The Clinical... ...appeal case for physician review by compiling clinical,... ...using nursing expert knowledge and all available... ...Certifications: RN - Registered Nurse -...Remote workWork at office
- Top Healthcare company is hiring a RN Clinical Document Improvement Specialist! Remote Position! ***Required Certified Clinical Documentation... ...serves as an experienced second-level CDI reviewer and subject matter expert, managing work queues and performing post-coding...Remote workFull timeTemporary workWork experience placementFlexible hoursDay shift
$64.52k - $100.96k
...While this is a primarily remote/work from home role, qualified... ...; facilitates enhancements to clinical documentation through extensive... ...retrospective medical record review (30%) Facilitate modifications... ...role ~ Current State of PA RN licensure OR Current multi-state...Remote workFull timeFor contractorsLocal areaWork from home- ...Independent Medical Examiner to review medical records for insurance appeals. This entry-level contract position allows for remote work and flexible... ...scheduling, focusing on providing expert advisory opinions on... ...certification and strong clinical expertise. #J-18808-...Remote jobContract workFlexible hours
$110 per hour
...Physician - Clinical Advisor (Women's Health Expert) Los Angeles, CA (Remote) Clinical Advisor (MD/DO) National Authority... ...and DEA-required encounters Review and manage time-sensitive patient... ...Participate in Doc of the Day coverage Fulfill physician collaboration...Remote workImmediate startShift work$40 - $50 per hour
...Clinical Appeals RN 100% Remote $40-$50/hour | Part-Time & Full-Time Opportunities Available Our team... ...you'll use your clinical expertise to review and appeal insurance denials related... ...process and advocate for appropriate coverage of medically necessary services. We...Remote workPermanent employmentFull timeTemporary workPart time$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 Job Description PRN Remote RN Subject Matter Expert (SME) Clinical Content Writer/Reviewer Are you an experienced Cardiac Cath Lab RN or Critical Care RN looking to apply your expertise in a new way? Ready to step beyond the bedside and use your...Remote workInterim roleReliefFlexible hours
- ...Liaison I for Utilization Management & Quality Review. This remote nationwide role supports clinical review activities, benefit determinations... ..., ensuring compliant, well-documented coverage decisions. The position requires an RN with an unrestricted license, 3 years of clinical...Remote job
- Note: This is a remote position. Seeking applicants who... ...and self-funded group coverage, including stop loss,... ...knowledge to evaluate clinical information using evidence... ...medical claims and/or appeal cases and associated records... ...for physician review or other external review...Remote workCasual workWork at office
$32.13 - $45 per hour
...States seeks a Triage Registered Nurse to provide effective telephone triage for patients. The ideal candidate will have a BSN, strong clinical assessment skills, and at least 2 years experience in triage. Responsibilities include conducting clinical assessments, educating...Remote workFull time
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