Remote Clinical Appeals Reviewer (Medicare)
Jobgether
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. You will assess complex case files and translate medical evidence into clear written decisions, contributing to healthcare fairness and accuracy. The ideal candidate should have strong clinical expertise, excellent analytical skills, and at least three years of experience in medical reviews or appeals processes. This position offers competitive compensation, opportunities for mentorship, and a mission-driven work environment. #J-18808-Ljbffr
- ...next steps. Our partner is looking for a Clinical Appeals Reviewer (Licensed Healthcare Professional)... ...in the United States. This is a fully remote clinical decision-making role focused... ...aligned with applicable federal laws, Medicare regulations, and policy guidelines. Ensure...Remote workContract workFlexible hours
$50 per hour
...A leading healthcare staffing firm is seeking an experienced RN Clinical Reviewer to work remotely. You'll conduct detailed medical-legal reviews and appeals while maintaining high accuracy and integrity. Key qualifications include a New York State RN license and at least...Remote work$90.87 - $154.33 per hour
Prime Therapeutics is seeking a Physician Clinical Reviewer for Rheumatology to join their remote utilization management team. In this role, you will review service requests, collaborate with physicians, and ensure adherence to clinical guidelines. Candidates must have...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...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 jobHourly pay- ...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
- ...Nhassociates is seeking a Clinical Reviewer responsible for reviewing prior authorization requests for compliance with Medicare rules. The position offers remote work for 20 hours per week. Applicants should be licensed clinicians with at least 5 years of healthcare experience...Remote workPart time
- ...Santa Barbara Cottage Hospital is seeking a Clinical Reviewer responsible for conducting clinical reviews of Medicare prior authorization and pre-payment requests. This remote role requires licensed clinicians with at least 5 years of experience. Responsibilities include...Remote workPart time
- ...Nhassociates is looking for a Clinical Reviewer responsible for conducting clinical reviews of... ...prior authorization requests submitted to Medicare. The ideal candidate must be a licensed... ...coverage. This position offers remote work and competitive pay, requiring excellent...Remote workPart time
$50 per hour
...Overview RN Clinical Reviewer / IDR - Remote (#25310C) Location: Remote Employment Type: Full-time Hourly Rate: $50/hr Position Overview Greenlife... ...include conducting comprehensive medical-legal reviews and appeals for a respected non-profit organization. Why Join Us?...Remote workHourly payFull timeWork at officeFlexible hours$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$90.87 - $154.33 per hour
...future of pharmacy with us. Job Title : Physician Clinical Reviewer - Rheumatology - REMOTE Job Description Key member of the utilization management... ...Provides clinical rationale for standard and expedited appeals. Provides assistance and acts as a resource to...Remote workWork at officeLocal areaVisa sponsorshipWork visa$90.87 - $154.33 per hour
...Physician Clinical Reviewer – Rheumatology (REMOTE) Key member of the utilization management team, providing timely medical review of service requests... ...Provides clinical rationale for standard and expedited appeals. Assists and serves as a resource to Initial...Remote workHourly payWork at officeLocal areaVisa sponsorshipWork visa- ...PRIME Therapeutics is seeking a Physician Clinical Reviewer – Urology for a remote position. The role involves medical review of service requests and... ...Responsibilities include reviewing cases, providing rationale for appeals, and supporting the Initial Clinical Reviewers. #J-1880...Remote work
- ...national pharmacy benefit manager is seeking a Physician Clinical Reviewer specializing in Urology for a remote position. The role involves reviewing medical... ...service requests, providing clinical rationale for appeals, and collaborating with medical staff. Candidates must...Remote work
- ...progressive pharmacy benefits manager is seeking a Physician Clinical Reviewer in Urology to join their remote utilization management team. In this critical role,... ..., interact with physicians, and provide insights for appeals. Candidates must hold a DO, MBBS, or MD and have over...Remote work
- A healthcare organization is seeking a Physician Clinical Reviewer specializing in Endocrinology, to conduct medical reviews and provide clinical rationale for appeals. This remote role requires a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO), with at least...Remote work
$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- ...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
- ...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
- ...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
- ...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
- ...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
$68k - $71.03k
...Claims Clinical Documentation Reviewer Job No: 541748 Work Type: Full-time Location: REMOTE OPTIONS, VARIOUS-STATEWIDE, PHOENIX Categories: Research, Social... ...EHR, HIE, etc • Medicaid and Medicare Federal Regulations, State Statute, Rules...Remote workFull timePart timeInternshipWork at officeWork from homeLong distanceFlexible hours- ...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
$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- ...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 - $35 per hour
...empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that... ...Job Summary and Responsibilities Acentra seeks a Clinical Reviewer to join our growing team. Job Summary: The Clinical Reviewer...Remote workContract workWork at officeLocal areaMonday to FridayFlexible hoursShift workWeekend work
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