Remote Clinical Appeals Reviewer
$35 - $63 per hourUnitedHealth Group
- Remote job
UnitedHealth Group is seeking a Clinical Pre‑service/Clinical Appeals Reviewer to assess MassHealth LTSS prior authorization requests and represent clinical decisions during appeal hearings. This role is critical in maintaining operational efficiency and compliance with clinical guidelines. Enjoy the flexibility to work remotely while collaborating with a dedicated team to ensure effective delivery of health services. A comprehensive benefits package and competitive pay rates from $35.00 to $63.00 per hour are included. #J-18808-Ljbffr UnitedHealth Group
- ...Jobgether is seeking a Clinical Appeals Reviewer (Licensed Healthcare Professional) for a fully remote position based in the United States. In this role, you will conduct independent reviews of medical appeals, ensuring compliance with federal guidelines and regulations...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 ensuring compliance with clinical policies. Ideal candidates will have strong managed care and clinical...Remote workHourly pay- Medix™ is seeking a Clinical Review RN for a remote role that supports Independent Dispute Resolution (IDR) case determinations. Candidates must have at least 2 years of clinical experience and a BSN along with a New York State RN license. The position operates on EST hours...Remote job
$93k - $104k
...or an alternative application process. Clinical Reviewer DC Washington DC, DC, US 7 days ago Requisition... ...? We're are recruiting for 2 full-time remote/hybrid Clinical Reviewer positions.... ...and or review processes. Assist with appeal case preparation for medical affairs...Remote workFull timeWork from home- ...seeking a Physician Medical Reviewer (M.D. or D.O.) in McLean, Virginia... ...independent medical service appeal reviews for TennCare and... ...Candidates must have 5+ years of clinical practice, a current medical... ...The position primarily offers remote work but requires occasional...Remote job
$52.12k - $78.87k
Description * Position is Eligible for Remote / Work from Home Opportunity * Department: DME Appeals Job Grade: E11 As a condition of employment physical... ...(noridiansolutions.com) Job Title Clinical Reviewer (RN) Job Summary The Clinical Reviewer (...Remote workFor contractorsCasual workWork at officeLocal areaWork from homeFlexible hours$20 - $22 per hour
Title: Medical Records Clerk/Appeals Specialist - Behavioral Health... ...13 week Contract Location: Remote Hours: Monday through Friday... ...and confidential handling of clinical documentation for clients,... ...position supports the Utilization Review team by preparing and...Remote workContract workWork at officeImmediate startMonday to Friday$50 per hour
...RN Clinical Reviewer / IDR - Remote Location: Remote Employment Type: Full-time Hourly Rate: $50/hr About Greenlife Healthcare Staffing... ...focusing on conducting comprehensive medical-legal reviews and appeals for a respected non-profit organization. Why Join Us?...Remote workHourly payFull timePrivate practice- ...improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our... ...much more! Position Overview We are seeking a Clinical Utilization Review Nurse (RN) to assess the medical necessity and quality of...Remote workFull timeContract workWork at officeWork from home
- ...Behavioral Health Services Reviewer Are you passionate about improving access to behavioral... ...the community? Do you enjoy using your clinical expertise to evaluate needs, support... ...positioned for success on this team. This is a remote position based in Oregon and travel is...Remote workFull timeContract workWork from home
- ...Geisinger is seeking a dedicated professional to support the administration of the Appeals and Grievance process. The role involves acting as a liaison between members and the Plan regarding denied claims, services, and other concerns. Responsibilities include managing...Remote work
- ...TeamHEALTH is looking for a Denials and Appeals Representative to handle denials and appeals for patient accounts in a cooperative team environment. The ideal candidate has at least two years of experience with insurance denial processes. Responsibilities include processing...Remote work
- ...Job Title Remote- 1st preference will be local to TN to get shortlisted... ...coding guidelines, AHA Coding Clinic Ability to talk and type... ...goals. Perform projects, review and handle reports as assigned... ...Comments/Special Instructions Appeals and/or Grievance Preferred....Remote workFor contractorsWork at officeLocal area
$28.37 - $32 per hour
...position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Clinical Reviewer based in the United States. This role plays a key part in ensuring the medical appropriateness and quality of clinical determinations...Remote workHourly payContract workWeekday work- ...standards. The ideal candidate will have clinical experience, strong communication skills,... ...such as performing pre-service clinical reviews and collaborating with healthcare providers... ...competitive salary range and potential for remote work based on departmental needs. #J-1880...Remote work
- Maximus is seeking a Senior Appeals Administrator for their California Independent Medical Review team. This role is vital in ensuring timely resolutions for medical review cases while enhancing the appeals process. The ideal candidate will have an associate degree with...Remote jobWork from homeFlexible hours
- ...We are seeking a qualified SUD MD Reviewer to conduct a retrospective utilization... ...historically denied cases to determine if standard clinical criteria were appropriately applied.... ...Requirements Work is 100% remote and offers flexible hours. Benefits...Remote workTemporary workLocal areaFlexible hours
- ...physical health services in Town of De Witt, NY. The position demands extensive clinical experience and knowledge of utilization management, with responsibilities including performing clinical reviews and collaborating with providers. Applicants should possess an Associate...Remote work
$73.32k - $102.65k
...Clinical Reviewer Blue Cross of Idaho is seeking a Clinical Reviewer to support the Healthcare Operations initiatives to ensure the delivery... ...work location; potential consideration for working fully remote within a mutually acceptable location. We're Looking For A...Remote workTemporary workWork experience placementLocal area- ...Clinical Documentation Integrity (CDI) Specialist Immediate need... ...potential and is located in U.S (Remote). Key Responsibilities:... ...concurrent and retrospective reviews of inpatient medical records... ...Support denial prevention and appeals by providing clinical...Remote workContract workLocal areaImmediate start
- ...Elevance Health is seeking a Grievance/Appeals Representative I to work virtually from Grand Prairie, Texas. This position involves investigating customer grievances and appeals related to service coverage while managing communications with customers and regulatory agencies...Remote work
- ...The role requires a NYS RN license and 3+ years of clinical experience. Responsibilities include clinical reviews and collaboration with providers to ensure quality... ...skills. Competitive salary offered based on experience, and potential for remote work. #J-18808-Ljbffr...Remote work
$115k - $125k
...TapestryHealth is looking for a Nurse Practitioner Clinical Reviewer to oversee Remote Patient Monitoring (RPM), Behavioral Health Integration (BHI), and Chronic Care Management (CCM) reports. This remote role requires at least 5 active NP licenses and certifications,...Remote workMonday to Friday- ...coordinate behavioral health services for members, ensuring adherence to all necessary standards. The role involves performing clinical reviews, collaborating with healthcare providers, and advocating for member needs. Ideal candidates will have at least 3 years of...Remote work
- ...L.A. Care Health Plan is seeking an Appeals and Grievances Specialist II in Los Angeles, CA. The role involves investigating member and provider complaints, ensuring compliance with various health regulations, and preparing reports. Requirements include at least 2 years...Remote workFull time
$21.16 - $38.37 per hour
...Join to apply for the Medicare Appeals & Grievances Specialist (PST Hours) role at Molina Healthcare . This position is remote and will be working Pacific Standard hours.... ...and grievance outcomes. Requests and reviews medical records, notes, and/or detailed...Remote workHourly payFull timeContract workWork experience placementWork at office- ...Clinical Reviewer, Precertification RN Duration: 8 months contract (with possible extension)... ...processes. Assists in the screening of appeal cases to provide clinical input as... ...work schedule. *Note: Candidates can be remote but must have an active unrestricted Massachusetts...Remote workContract workWork at officeWork from home
$50 - $52 per hour
...Claims Clinical Documentation Reviewer Schedule: 5-10 hours per week. Resource can work any day of the week they are available and any time including weekends if they prefer. Remote position. Equipment is provided by facility. Base pay: $50.00/hr - $52.00/hr....Remote workPart timeWork at officeLong distance10 hours per week- ...Community HealthWorks in Sacramento is seeking a Licensed Clinical Reviewer for a per diem, non-exempt role focused on clinical documentation... ...or RN is required. This role supports underserved populations and involves remote or hybrid work as necessary. #J-18808-Ljbffr...Remote workDaily paid10 hours per weekFlexible hours
$68k - $71.03k
...Claims Clinical Documentation Reviewer Division of Fee for Service (DFSM) Job Location Address: 150 North 18th Avenue Phoenix, Arizona 85007. This... ...that affords employees flexibility, autonomy, and trust. Remote work is available within Arizona subject to prior authorization...Remote workFull timePart timeWork at officeLong distance
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