Remote RN: Medical Necessity Appeals Specialist
Elevance Health
- Remote job
Elevance Health is seeking an experienced RN with strong clinical and analytical skills to investigate and process medical necessity appeals from members and providers. You will review various medical records, summarize findings for the medical director, and prepare recommendations to uphold or deny the appeal. This role is 100% remote with Maryland licensure required and a hybrid workforce strategy for onsite requirements as needed. #J-18808-Ljbffr Elevance Health
$60.78k
...Appeals and Grievances Specialist II Job Category: Customer Service Department:... ...Care (DMHC), Managed Risk Medical Insurance Board (MBMIB) and... ...retroactive review) medical necessity, benefit coverage appeals... ..., holidays, a hybrid remote schedule, occasional flexibility...Remote workMedicalFull timeLocal areaShift workWeekend work- Walker Healthforce, LLC seeks a Medical Claim Review Nurse for a fully remote contract based in Washington. The... ...on retrospective medical necessity reviews, appeals, and payment integrity within Molina... ...ideal candidate holds an active RN license (LPN/LVN accepted) and 3...Remote jobMedicalContract work
- Premera is a health plan seeking a licensed RN for a Care Coordinator - Clinical Appeals role. You will review inpatient, concurrent, and retrospective requests to determine medical necessity and appropriate care across plans. You will collaborate with Medical Directors...Remote jobMedical
- A healthcare company is seeking a Nurse Appeals specialist to investigate and process medical necessity appeals from members and providers. The role involves reviewing... ...in a managed care setting, along with a current RN license. This position offers a hybrid work model...Remote jobMedical
- ...seeking a PRN Clinical Review Specialist to provide remote clinical review support. You will evaluate medical necessity, level of care, and payer... ...The role requires an active RN license (compact preferred),... ...years in Utilization Review/Appeals. Strong documentation and Epic...Remote jobMedicalRelief
- A leading healthcare staffing firm is seeking a detail-oriented individual for managing medical necessity appeals and claims reviews. The role involves reviewing cases, preparing documentation for the Medical Director, and ensuring compliance with NCQA guidelines. Candidates...Medical
- Universal Health Services (UHS) is seeking a skilled Appeals/Denials Specialist for the Western Region Consolidated Business Office. This role... ..., and collaborating with Nurse Auditors to support medical necessity appeals. You will prepare appeal documentation, conduct...MedicalWork at office
- ...ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, intensity... ...service and level of care, including appeal requests initiated by providers,... ...Company Locations 500 Renaissance Ctr, Detroit, MI, 48243, US (Remote) UST HealthProofRemote workMedicalWork at officeLocal area
- A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching...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 Specialist - RN, LPN or Dental... ...pre-existing conditions, prior approval, medical necessity, pre-certification, continued stay,...Remote jobMedicalFull timeMonday to FridayShift work$46.76 - $51.76 per hour
...experience. Responsibilities Determines medical necessity and appropriateness by referencing... .... Qualification And Education RN - Registered Nurse - State Licensure... ...Practical Nurse - State Licensure. CNS-Clinical Nurse Specialist Preferred. Cynet SystemsRemote jobMedicalWork experience placementWork at office- ...assigned levels of denials by submitting appeal letters and required documentation to insurance... ...patient to get the denial overturned. Remote: Although this position is listed as... ...patient and/or physician consent and medical records when required by the insurance plan...Remote workMedical
- ...Member Appeals Specialist Primary responsibilities would include triaging incoming appeals/grievances, categorizing them appropriately,... ...Reviewing the appeal request to determine if additional medical records are needed, and whether an Appointment of Rep form is...Remote workMedicalTraineeship
- ...Appeal Resolution Specialist The Appeal Resolution Specialist is responsible for managing complex payer deferrals, denials, and appeals to support... ..., denial reasons, authorization requirements, medical documentation, and account history to identify the underlying...Remote workMedicalWork at office
$45.9k - $78.6k
...every member feels valued. Medica’s Appeals and Grievance Specialist plays a vital role in ensuring our... ...Excel, and Outlook This position is a Remote role.To be eligible for consideration... ...package that includes competitive medical, dental, vision, PTO, Holidays, paid...Remote workMedicalWork experience placement- ...care UM to perform pre-service and post-service utilization reviews and appeals for DMEPOS, working with our Medical Director in a NCQA-compliant UM program. You will review benefit and medical necessity criteria, coordinate with clinical and non-clinical staff, and...Remote workMedical
- Providence Health & Services is seeking an Appeals RN in Case Management for a remote, per diem role working 8-hour day shifts. The Care Management Recovery Advocate will manage clinically-based appeals between Providence California Region and outside payers, focusing...Remote jobDaily paidDay shift
$60.2k - $107.4k
...of bedside nursing experience to support appeals, data extraction, and HIPAA-compliant communications. This full-time position is remote within the United States and offers a pay... ...00 annually. The role uses templates and medical literature references, requires advanced...Remote workMedicalFull timeWork at office$52 per hour
...Hiring for RN - Appeals (Remote Role) in Somerville, MAShift: Days 5x8 (08:00 - 17:00) Duration: 13 Weeks (Temp to Perm)Pay Rate: $52/hr on... ...have at least 2 years of Health Plan appeals experienceWorks closely with our medical directors on case reviews and decisions...Remote workMedicalPermanent employmentTemporary work- ...seeking an Accounts Receivable Associate Specialist for a remote role. You will follow up with... ...reimbursement. The role includes drafting appeals and supporting denial and audit activities... ...candidates have 2-4 years of medical collections experience, strong Excel skills...Remote jobMedical
$81.1k - $116.48k
Position Summary: The Appeals & Grievances (A&G) unit... .... The A&G Clinical Specialist is the subject matter... ...This position is 100% Remote. We are hiring for the... ...conditions, prior approval, medical necessity, pre-certification,... ...Qualifications: RN, LPN OR Dental Hygienist...Remote jobMedicalContract workTemporary workWork experience placementLocal areaMonday to FridayShift work$29.7 - $31.8 per hour
...80 based on experience Job Description The Acute Coding Appeals Specialist integrates medical coding principles and objectivity in the performance of... ...friction and improve patient and client experiences. This is a remote position; however, candidates must be willing and able...Remote workMedicalTemporary workWork at officeLocal area- ...Hospital is seeking a Grievance and Appeals Nurse for a remote position based in Indiana.... ...grievances and appeals, reviewing medical records for necessity, and preparing recommendations for... ...2 years in managed care and an IN RN license, with MCG experience and preferred...Remote jobMedical
$70k - $80k
...Piper Companies is seeking a Remote Clinical Appeals Analyst to provide clinical expertise in reviewing... ...active North Carolina licensure as an RN, LPN, PT, or OT and have significant clinical... ...$80,000, along with company-subsidized medical, dental, and vision benefits. Key...Remote workMedicalFull timeContract workMonday to Friday$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. Highly... ...grievance outcomes. Requests and reviews medical records, notes, and/or detailed bills as...Remote workMedicalHourly payFull timeContract workWork experience placementWork at office$60.2k - $107.4k
...organization empowering care through technology. The Utilization Management Nurse role involves reviewing medical records, extracting case details, and crafting defensible appeal letters according to process instructions and guidelines. The position offers Telecommuting within...Remote jobMedicalFull timeMonday to Friday$60.2k - $107.4k
...looking for an Utilization Management Nurse to review medical records, extract case details, and craft defensible appeal letters. The role emphasizes data extraction,... ...position requires an Associate's degree, an unrestricted RN license, 3+ years in bedside nursing, and strong...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
- ...Appeals Processor III - RN ~ salary ~ Unavailable ~ Hours per week ~40 ~ Shifts ~5/8's ~... ...III) to join our dedicated team in a remote capacity. The Appeals Processor III (APP... ...years in: ~ Healthcare appeals ~ Medical claims / utilization review ~ Insurance...Remote workMedicalContract workFor contractorsFor subcontractorShift work
- ...Utilization Management Nurse to accurately review patient medical records and craft defensible appeal letters per process instructions and department... ...supporting OPAS, Optum, and client goals. The role offers a remote work option across the United States and collaborative...Remote jobMedical
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