Remote RN - Medical Review Appeals Auditor
Precision Labs
Brooklyn, NY
- Remote job
Machinify is seeking a Medical Review Clinical Appeals Auditor (RN) to conduct Appeals reviews of new evidence in medical review audits and support training and guideline materials. The role emphasizes maintaining expert knowledge of medical practice, CMS/Medicaid/Commercial rules, and a strong emphasis on quality and productivity. The candidate will document results, analyze claims data, and collaborate with leadership to improve audit outcomes, while ensuring confidentiality and adherence to #J-18808-Ljbffr Precision Labs
Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Remote RN - Medical Review Appeals Auditor in Brooklyn, NY vacancy
- UnitedHealth Group is seeking a Remote Appeals Clinician in Texas. You will conduct comprehensive reviews of Medicaid-related assessments (H6516/H... ...provide independent clinical judgments on medical necessity. Requirements include a Texas RN license and 2+ years in Medicaid...Remote jobMedicalFlexible hours
$7.25 per hour
...healthcare costs. The Medical Review Nurse II primarily... ...sector. As a MR Nurse Auditor, you will join a team... ...Payers. You will work remotely in a fast-paced and dynamic... ...findings during the appeals process if requested.... ...(active/unrestricted RN license) is required....Remote workMedicalHourly payFull timeWork at officeShift workMachinify, Inc.
La Grange, KY2 days ago- NTT DATA, Inc. seeks a Clinical Reviewer Specialist to perform clinical and medical necessity reviews for member and provider appeals, evaluating records against NCQA... ...Medicaid requirements. Role offers remote work within Florida, requires RN licensure, 3 years’ experience...Remote jobMedical
- ...a leading healthcare intelligence company. The Medical Review Nurse II audits home health claims, working remotely with a multi-location team to ensure compliance... ...claims, reference guidelines, and participate in the appeals process while staying current with coding...Remote jobMedicalWork from home
$52 - $56 per hour
...done UM. You've worked appeals. Now find a role that uses... ...'re hiring a contract RN for a New York health... ...you'll apply the same medical necessity judgment you... ...utilization management. 100% remote (U.S.) | Contract | $52... ..., clinical review, decision and notification...Remote jobMedicalContract workAfternoon shift- ...healthcare costs. The Medical Review Nurse II - Commercial... ...experienced medical auditors and coders performing... ...Payers. You will work remotely in a fast paced and dynamic... ...findings during the appeals process if requested.... ...Active unrestricted RN license in good standing...Remote workMedicalFull timeFor contractorsWork at office
- ...Nurse Auditor Have you ever looked a medical bill and immediately noticed something was wrong? Were you itching to use your expertise to fix it? We... ...containment. Join our team and maximize client savings by reviewing medical bills from a nurse perspective, including...Remote workMedicalImmediate start
Rising Medical Solutions
United States5 days ago - ...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 perform benefit and medical necessity reviews within an NCQA-compliant UM program. The...Remote jobMedical
- WPS Health Solutions in Columbus, OH, is seeking an Appeals Nurse to review medical records and Medicare claims for first-level appeals to determine medical necessity and coverage alignment. The role collaborates with Appeals Examiners to prepare timely redeterminations...Remote jobMedical
$68.57k - $104.84k
...Quality Control/Clinical Auditor. The Diagnostic... ...validation (clinical/coding) reviews of medical records and/or other... ...rules.This is a remote position.Essential Functions... ...medical director with appeals, rebuttals, etc.Notify... ...& Experience:LVN or RN license in the state of...Remote workMedicalMinimum wageFull timeLocal areaFlexible hoursCorVel
Fort Worth, TX1 day ago- ExamWorks is seeking a Utilization Review Nurse Auditor to perform quality utilization reviews and authorize medically necessary care. The role is fully remote with standard EST hours, requiring an active nursing license and coding certification. You will work with providers...Remote jobMedical
$78.91k - $105k
...Benefits : ~ Medical, Dental, Vision, Pharmacy... ...coordinator and/or auditor. # Certified... ...preferred. # RN licensure required,... ...experience in review of medical records.... ...member complaints and appeals to determine trends... ...required to support remote or hybrid work. Must...Remote workMedicalHourly payFull timeWork at officeWork from homeAfternoon shiftModa Health
Portland, ORmore than 2 months ago$47.75 - $57 per hour
Overview The Senior Auditor, Appeals is responsible for defending Cotiviti... ...(IRF), home health, durable medical equipment (DME), and hospice... ...performs an extensive review of the initial claim, the associated... ...candidate is selected.LI-Remote #LI-JJ1#senior #J-18808-Ljbffr...Remote workMedicalHourly payContract workWork at officeLocal areaImmediate startWork from homeFlexible hours$53 per hour
...Job Description Job Description REMOTE RN OPPORTUNITY – GRIEVANCE & APPEALS / UTILIZATION REVIEW $53/hour | 100% Remote | Long-Term Contract We're hiring... ...Experience with prior authorizations and medical necessity reviews Grievance & Appeals experience...Remote jobMedicalLong term contractWork from homeMonday to FridayShift workWeekday workPhaxis - Healthcare
Huntington, NY5 days ago- Utilization Review Nurse Auditor (33034)# Utilization Review Nurse Auditor (33034)Fully Remote • Mount Laurel, NJ 08054## OverviewSalary Range... ...and approving care that is medically necessary and appropriate according... ...time off, and 401k.******RN******LPN******LVN******...Remote workMedicalLocal areaMonday to Friday
- ...Management Department (Fully Remote)Job Summary:• Provides health... ...discharge planning and utilization review.Responsibilities:• Reviews... ...concurrent and retrospective medical necessity and/or compliance with... ...reimbursement and claim denials/appeals.• Assesses and coordinates...Remote workMedical
First Connect Health
Austin, TX2 days ago $52 per hour
...Hiring for RN - Appeals (Remote Role) in Somerville, MA Shift : Days 5x8 (08:00 - 17:00) Duration : 13 Weeks (Temp... ...have at least 2 years of Health Plan appeals experience ~ Works closely with our medical directors on case reviews and decisions...Remote workMedicalPermanent employmentTemporary workShift workPacer Group
United States3 days ago- Note: This is a remote position. Seeking applicants who reside with... ...the Brooklyn office. Certified Medical Coder (CPC, CCS, or equivalent... ...complex medical claims and/or appeal cases and associated records... ...medical information for physician review or other external review....Remote workMedicalCasual workWork at office
- ...seeking a motivated Utilization Review RN to join our team. You will... ...ancillary services to ensure medical necessity, length of stay and level of care, including appeals. Responsibilities include authorizing... ...and benefits. This is a remote, full-time US role. #J-18808-...Remote jobMedicalFull time
- ...Health Solutions is seeking an Appeals Clinician I to join our... ...This role conducts clinical reviews of member and provider appeals... ...determine decisions in line with medical policy and regulations. You will... .... The position supports a remote work model across Oregon, Washington...Remote jobMedical
- ...HEDIS Auditor RN/LPN Integrated Resources, Inc is a premier staffing firm recognized... ...Position is responsible for performing medical record reviews and data extraction for the HEDIS... ...There is weekly onsite meeting which candidate must attend and remote other days....Remote workMedicalContract workWork from home
Integrated Resources
Newark, NJ4 days ago - .... is seeking a highly motivated Utilization Review RN to join our team. The RN will perform prospective... ..., and ancillary services to ensure medical necessity, appropriate length of stay, and level of care, including appeals initiated by providers and members. Responsibilities...Remote jobMedicalContract work
- ...Health is seeking a Nurse Appeals professional to investigate and process medical necessity appeals for... ...providers. The role supports remote work with required in-... ...guidelines. You will review records, summarize findings... ...requires an active RN license and a HS diploma...Remote jobMedical
$53.46k
...Researches the substance of complex appeal or retrospective review requests including pre-pay... ...requested services meet medical necessity guidelines.... ...: This is a full-time, remote (40-hours/week) working an... ...An active, unrestricted RN license from the United States...Remote workMedicalFull timeFor contractorsWork experience placementLocal areaMonday to FridayShift work- ...are currently hiring for an RN Appeals Analyst to join BlueCross BlueShield... ...appeal or retrospective review requests including pre-pay... ...the requested services meet medical necessity guidelines, and document... ...EST and will be fully remote in South Carolina or Georgia....Remote workMedicalFull timeFor contractorsWork experience placementCurrently hiringWork at officeLocal areaMonday to Friday
$63.1k - $94.65k
...is looking for a Utilization Review RN based in the United States.... ...operations. In this part-time, remote role, you will apply your clinical expertise to evaluate medical necessity, review patient admissions... ...peer-to-peer discussions and appeals when assigned, track...Remote workMedicalTemporary workPart timeWork at officeWork from homeFlexible hoursShift workAfternoon shiftJobgether
United States1 day ago- ...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... ...documentation and collaboration within a remote team, with weekday daytime hours....Remote jobMedicalWeekday work
$63.1k - $94.65k
...Must have current compact RN license, or be willing... ...: Our Utilization Review team provides coverage... ...third party payers Medical Necessity Determination... ...documentation relevant to the appeal process. Maintains... ...Required: This is a remote role which requires...Remote workMedicalTemporary workPart timeWork at officeLocal areaFlexible hoursShift work$40.12 - $62.94 per hour
...Sinai Hospital's Utilization Review operates as a distinct... ...information. This is a Full-time remote position.... ...The Utilization Review RN reviews the medical record by applying utilization... ...opportunities for expedited appeals and collaborates with the Care...Remote workMedicalFull timeLIFEBRIDGE HEALTH SYSTEM
Baltimore, MD5 days ago- TalentLNX LLC seeks a remote Clinical Claims Review RN to audit hospital claims line by line against medical records, ensuring charges are ordered, documented, and supported. The role blends acute care nursing judgment with chart auditing, coding, and revenue integrity...Remote jobMedical
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN - Medical Review Appeals Auditor. Be the first to apply!
Related searches