Remote RN Utilization & Appeals Analyst
EPITEC
- Remote job
EPITEC is seeking a Review Analyst RN to perform a thorough review of inpatient, outpatient, and ancillary services to ensure medical necessity and appropriate care levels. This role is fully remote based in Michigan. The ideal candidate will have a Bachelor's degree in nursing or a related field and experience in clinical settings. Responsibilities include conducting reviews, managing appeals, and coordinating care plans. Excellent communication and analytical skills are required. #J-18808-Ljbffr EPITEC
- ## RN Appeals AnalystApplyremote type: Remotelocations: Nashville, Tennesseetime type: Full... ...**8:00am - 5:00pm** and will be **fully remote.****What You’ll Do:*** Documents the basis... ...2 years clinical experience plus 1 year utilization/medical review, quality assurance, or...Remote workFull timeFor contractorsWork experience placementWork at officeLocal areaMonday to Friday
- ...case review and authorization of services utilizing established mental health and substance... ...required. This position is full-time, fully remote (work from home) and requires some... ...unrestricted State of Michigan clinical license (RN, LMSW, LP, LPC, or LLP) required....Remote workFull timeWork from homeShift workWeekend workAfternoon shift
$70k - $80k
...Piper Companies is seeking a Remote Clinical Appeals Analyst to provide clinical expertise in reviewing and resolving complex member and provider appeals... ...must hold an active North Carolina licensure as an RN, LPN, PT, or OT and have significant clinical experience....Remote workFull timeContract workMonday to Friday- Southcarolinablues is hiring an Appeals Analyst to join their team in Nashville, Tennessee. This... ...full-time schedule and the option to work remotely or on-site. Ideal candidates should have... ...years of clinical experience, a valid RN license, and strong analytical skills. Benefits...Remote jobFull time
- ...part of BlueCross BlueShield, is hiring an Appeals Analyst. This role involves researching complex... ...time, Monday through Friday, and can be remote or on-site in Nashville, TN. Qualified... ...experience in clinical settings, and an active RN license. Benefits include 401(k) match,...Remote workFull timeMonday to Friday
- ...Overview Work remotely with a collaborative enterprise denials... ...revenue integrity, managed care, utilization review, and patient access.... ...perspective and developing effective appeal strategies. Ensures... ...nursing as a Registered Nurse (RN) or Licensed Practical Nurse...Remote workFull timeWork at office
- ...Description Job Description Fully remote- Must have state of MI unrestricted RN license. You will perform... ...service and level of care, including appeal requests initiated by providers,... ...surgical unit preferred Prefer utilization management experience Additional...Remote workWork at officeFlexible hours
- Blue Cross Blue Shield of Arizona needs a clinical expert for managing member and provider appeals. This remote position requires strong accuracy, knowledge of compliance timelines, and a focus on customer service. Applicants should possess a healthcare-related degree...Remote job
- CGS Administrators LLC is hiring an Appeals Analyst to join BlueCross BlueShield of South Carolina... .... The ideal candidate will have an RN license, a degree in a related field, and... ...position is full-time with the option to work remotely or on-site, offering comprehensive...Remote workFull time
- ...Summary We are currently hiring for an Appeals Analyst at BlueCross BlueShield of South Carolina... ...clinical experience plus one year of utilization/medical review, quality assurance, or home... ...license: an active, unrestricted RN license from the United States and in the...Full timeFor contractorsCurrently hiringWork at officeLocal areaWork from homeMonday to Friday
- ...solutions provider is seeking a Registered Nurse for Claims & Appeals Review. This remote role supports compliance and quality assurance in appeal... ...Candidates should have a Bachelor's degree in healthcare and valid RN license in Florida. Key responsibilities include reviewing...Remote job
- ...System, Inc. is seeking a Behavioral Health Utilization Manager to perform concurrent and... ...a Bachelor's in nursing, a current Texas RN license, and have experience in acute psychiatric... ...and utilization review. The position is remote, requiring strong critical thinking...Remote workWork at office
- ...Molina Healthcare is looking for a Registered Nurse (RN) to join their team in Akron, Ohio. This role... ...and appropriate care levels, while also managing appeals for denied prior authorizations. With a focus on utilization review, candidates should have at least 2 years of...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- ...clinical professional in Miami to perform utilization reviews and ensure proper coding for reimbursement... ...evaluate medical claims and facilitate appeals, contributing to quality assurance and regulatory compliance. An active RN license is essential, along with analytical...Remote work
- ...high-profile team, the full-time Clinical Analyst Appeals will manage clinical appeals and audit... ...commercial and government services in a remote setting, ensuring compliance with federal... ...or professional certifications such as RN, LPN, CPC, RT, MT, or RPH are highly desirable...Remote workFull time
- ...Utilization Management Position Provide health care services regarding admissions, case management, discharge planning and utilization... ..., precertification, reimbursement and claim denials/appeals. Assess and coordinate discharge planning needs with healthcare...Remote work
$29.05 - $67.97 per hour
...seeking a qualified Registered Nurse with clinical experience to perform utilization reviews and ensure medical necessity of claims. The role involves reviewing medical documentation, facilitating appeals for authorizations, and validating claims coding. The ideal candidate...Remote workHourly pay$29.05 - $67.97 per hour
...necessity and appropriate billing. This role includes managing appeals for authorizations, validating medical claims, and... ...have at least two years of nursing experience including utilization review, an active RN license, and strong analytical skills. This position offers...Remote workHourly pay- ...UnitedHealth Group is seeking a Senior Clinical Appeals RN to utilize expertise in MS-DRG and APR-DRG auditing to manage appeals. This position allows remote work throughout the U.S., except for Minneapolis or Washington, D.C. hires, who need to work in-office at least...Remote workWork at office
$35 - $63 per hour
...Texas Health Institute is looking for a Senior Clinical Appeals RN to utilize expertise in MS‑DRG and APR‑DRG auditing. This role involves reviewing... ...and responding to appeals while providing coaching to remote DRG Validation Specialists. The position allows remote work...Remote workHourly payWork at office$35 - $63 per hour
...Territorial Epidemiologists is hiring a Senior Clinical Appeals RN. This position utilizes expertise in MS-DRG and APR-DRG auditing to review appeals... ...years of experience in ICD-10 coding. The role allows for remote work, and candidates should be solution-oriented problem...Remote workHourly pay$35 - $63 per hour
...Optum is seeking a Senior Clinical Appeals RN to utilize expertise in MS-DRG and APR-DRG auditing for appeals management. This role involves... ...auditors, and authoring rebuttals. The job can be performed remotely across the U.S., with certain locations requiring in-office...Remote workHourly payWork at office$35 - $63 per hour
...Stryker Corporation is seeking a Senior Clinical Appeals RN to utilize clinical expertise in appealing and coding medical records. The role includes... ...have at least 2 years of coding experience with ICD-10. Remote work opportunities are available in the U.S., and the...Remote workHourly pay$93.14k - $124.8k
...Financial Services, the Clinical Analyst plays an important role in a... ...and government clinical appeals and audit processes. The Clinical... .../licenses such as RN, LPN, CPC, RT, MT, and RPH are... ...• Clinical education and/or utilization review experience is strongly...Remote workFull time- ...are seeking a highly skilled Appeals Processor III (APP III) to join our dedicated team in a remote capacity. The Appeals Processor... ...Healthcare appeals Medical claims / utilization review Insurance or Medicaid/... ...(clinical roles may require RN) Responsibilities Duties...Remote workContract work
$57.28 - $88.92 per hour
...management and communication of clinically based appeals between Providence Health and Services,... ...Track: Nursing Department: 7000 UTILIZATION MGMT CA SOCAL Address: CA Mission... ...Ctr-Mission Hills Workplace Type: Remote Pay Range: $57.28 - $88.92 The amounts...Remote workMinimum wageFull timeLocal areaShift work- ...Remote: Yes Area of Interest: Nursing FTE/Hours per pay period: .9 Department: Utilization Management Shift: Monday-Friday, 11:30am-8:00pm... ...UnityPoint Health is seeking an RN Utilization Management... ...Coordinates and monitors appeals with internal and external...Remote workDaily paidTemporary workMonday to FridayShift work
- ...Elevance Health is seeking a Grievance/Appeals Analyst I to review and process non-complex grievances and appeals in the Enterprise Grievance & Appeals Department. This entry-level position allows for virtual work but requires in-person training sessions. The ideal candidate...Remote work
- Maximus is seeking a Senior Appeals Administrator for the California Independent Medical Review team. This critical role involves ensuring fair resolutions for medical review cases and will strengthen the appeals process. The ideal candidate will have an associate degree...Remote jobWork from home
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