Remote RN - Grievance, Appeals & Utilization Review
$53 per hourPhaxis - Healthcare
Phaxis - Healthcare is hiring for a REMOTE RN opportunity focused on Grievance & Appeals and Utilization Review. The role requires candidates to reside in New York State and hold an active NY RN license.
The schedule is Monday–Friday, 9 AM–5 PM, with compensation at $53/hour on a long-term contract basis. Ideal candidates will have direct outpatient UM experience, strong utilization management background, and experience with prior authorizations and medical necessity reviews.
#J-18808-Ljbffr$53 per hour
...Phaxis - Healthcare is hiring for a REMOTE RN opportunity focused on Grievance & Appeals and Utilization Review. The role requires candidates to reside in New York State and hold an active NY RN license. The schedule is Monday–Friday, 9 AM–5 PM, with compensation at...Remote workLong term contractContract workMonday to Friday- ...-based professional to manage complex grievances and appeals for members and providers in a remote US-based role. The candidate will review medical necessity across inpatient, outpatient... ...a USRN license, at least 2 years in utilization management, strong communication, and...Remote workContract work
$52 - $56 per hour
...done UM. You've worked appeals. Now find a role... ...re hiring a contract RN for a New York health... ...You'll own clinical grievances and appeals from... ...judgment you built in utilization management. 100% remote (U.S.) | Contract |... ...investigation, clinical review, decision and...Remote workContract workAfternoon shift$76k
...NTT DATA is seeking a BPO Clinical Review Specialist in the United States, with remote work available for Florida residents. The role requires an active RN license (Florida or Compact) and at least 3 years of appeals, utilization management, or clinical review experience...Remote work- ...Centene Corporation is seeking a fully remote Appeals Nurse Reviewer to conduct clinical reviews of medical records... ...setting. Requirements include an active NY RN license (BSN preferred), 2+ years in acute care or utilization management, and knowledge of NCQA and NY...Remote workMonday to Friday
- ...Centene Corp. is seeking a fully remote RN to perform clinical reviews for appeals, evaluating medical necessity based on NCQA standards and applicable policies... ...role prefers an active NY license and emphasizes utilization management knowledge. Candidates should have 2+...Remote work
- ...healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage... ...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 a...Remote work
- ...Partners is looking for an LPN/LVN experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This role collaborates with our Medical Director to conduct benefit and medical necessity reviews within an...Remote work
- ...Integra Partners seeks an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals for DMEPOS in a managed care environment. You will collaborate with the Medical Director to ensure medical necessity reviews align with NCQA-compliant...Remote work
- ...experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical... ...those meeting criteria, and referring non-meeting cases. Remote opportunities available; competitive compensation and benefits...Remote work
- ...experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals in a managed care UM program. You will collaborate with... ..., and familiarity with InterQual and CMS guidelines. Remote opportunities are available along with a comprehensive benefits...Remote work
- ...experienced LPN/LVN to conduct pre-service and post-service utilization reviews and appeals in a managed care environment. You will collaborate with... ...of InterQual and CMS guidelines is preferred, and we offer remote work options and a comprehensive #J-18808-LjbffrRemote work
- ...experienced LPN/LVN to conduct pre-service and post-service utilization reviews and appeals within a NCQA-compliant UM program, collaborating with... ...responsibilities including approvals, referrals, and handling appeals. Remote opportunities available and strong team culture. #J-188...Remote work
- ...care experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director... ...and CMS guidelines. The role supports a nationwide remote workforce with competitive compensation, benefits, and a...Remote work
$52 - $56 per hour
...Description Job Description Now hiring: Remote UM / Grievance & Appeals RN (NY License) | Contract | $52–56/hr... ...clinical Grievance & Appeals nurse with a utilization management or case management background. You’ll review medical necessity for outpatient and community...Remote jobContract workImmediate start- ...role We're looking for an RN who has personally owned grievance and appeals cases from intake to... ...grievances, appeals and external reviews for members receiving... .... The best fit has a utilization management or case... ...cases at once in a fully remote setting. Nice to haves...Remote job
- ...Integra Partners is seeking an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals for DMEPOS within a NCQA-compliant UM program. You will collaborate with the Medical Director to assess medical necessity and benefit coverage....Remote work
- ...Integra Partners is seeking an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals in a managed care UM program. This role collaborates with the Medical Director on benefit and medical necessity reviews, aligned with NCQA standards...Remote work
$91.25k
...Grievance & Appeals Nurse, RNFind joy in serving others with IEHP! We welcome... ...Grievance & Appeals Nurse, RN (G&A Nurse, RN) is responsible... ...for initial medical review and clinical oversight of all... ...members, and regulatory entities utilizing approved templates with use...Remote workTemporary workImmediate start$53 per hour
...REMOTE RN OPPORTUNITY – GRIEVANCE & APPEALS / UTILIZATION REVIEW We're hiring experienced Registered Nurses to join a leading healthcare organization in a fully remote role! Position Details Location: Remote – Must reside in New York State Schedule: Monday–...Remote workLong term contractMonday to Friday$52 - $56 per hour
...RN Grievance & Appeals Specialist | Remote | ContractRNs with direct, payer-side Grievance & Appeals experience... ...determination letter. This is a clinical review role requiring strong medical... ...support, or inpatient-only utilization review.Position details:Pay: $52–$...Remote workAfternoon shift- ...Sentara Health Plans seeks a Clinical Claims Reviewer RN for remote work. You will perform utilization management, review pre/post payment claims and authorizations for inpatient/outpatient cases, and address provider inquiries with appropriate referrals to Medical Directors...Remote workFull time
- ...Quorum Health Corporation is seeking a remote Utilization Review Specialist (Case Manager) to support admission decisions and appeals. The role requires an RN license and strong knowledge of criteria sets to support clinical appeals and quality reviews. Responsibilities...Remote workFull time
- ...Jobgether invites applications for a remote Case Manager – Utilization Review Specialist based in the United States. You will lead admission and concurrent... ..., assess medical necessity, and develop evidence-based appeals while collaborating with physicians, case managers, and...Remote work
$30 - $38 per hour
...A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment... ...reviews for pre-certification requests, processing appeals, and working collaboratively with hospital staff. Candidates...Remote workHourly payPart time- ...Centene Corp. is seeking a remote RN/LPN/LVN with 2+ years of clinical nursing experience to facilitate medical necessity grievances, appeals and denials. The role requires California licensure and PST hours. You will review clinical data, prepare case reviews for...Remote work
- ...company, seeks an experienced Case Manager – Utilization Review Specialist to oversee admission and concurrent reviews remotely in the United States. You will evaluate... ...medical records for medical necessity, coordinate appeals, and collaborate with clinicians and payers...Remote work
- ...is seeking an experienced Registered Nurse for a fully remote Case Manager – Utilization Review Specialist position in the United States. The role focuses... ..., concurrent reviews, and developing evidence-based appeals to support appropriate patient care and financial performance...Remote work
$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... ...colleagues and prepare cases for review and appeals. Minimum... ...grievances, claims processing, utilization review, or case management....Remote jobFull timeMonday to FridayShift work$66.83k - $111.38k
...ShiftFirst (Days)Overview:Sentara Health Plansis hiring a Utilization Review Nurse/ RN for Imaging/Commercial- Remote!Status: Full-time,permanent position (40 hours)... ..., benefits, and contracts. May manage appeals for services denied. Responsible for written and/or...Remote workPermanent employmentFull timeTemporary workShift workDay shift
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