Remote Appeals Nurse Consultant - Medicare/Medicaid
4004 Aetna Medicaid Administrators
- Remote job
CVS Health is seeking an RN Appeals Specialist to administer review and resolution of clinical complaints and appeals for Medicare/Medicaid members. You will interpret data from records, apply clinical criteria and policies, and coordinate resolutions with internal and external teams. This remote, full-time role requires licensure, 3+ years in appeals, and ability to work within state regulations; we value accuracy and HIPAA compliance. #J-18808-Ljbffr 4004 Aetna Medicaid Administrators
- CVS Health is seeking an experienced Appeals Reviewer with an active RN license to administer review and resolution of clinical complaints and appeals across Medicare/Medicaid programs. You will interpret data from clinical records to apply applicable criteria and policies...Remote job
- ...Role Snapshot The Appeals Nurse examines medical records and claims... ...medically necessary and meet Medicare coverage guidelines in... ...Location We are open to remote work in the following approved... ...under Centers for Medicare & Medicaid Services (CMS) contract(s)....Remote workContract workFor contractorsLocal areaImmediate start
$60.52k - $129.62k
...Clinical Appeals Specialist We're building a world of health around every individual... ...and appeal requests (for integrated Medicare/Medicaid plans). Develops strategy for review... ...have active and unrestricted Registered Nurse (RN) License in their state of residence...SuggestedHourly payFull timeTemporary workWork at officeWork from home- ...Regional MDS / PDPM / CMI / RAI Consultant to provide remote reimbursement, MDS, PDPM,... ...-term care and skilled nursing facilities.This position... ...guidelines, CMI, care planning, Medicare documentation, and long-... ..., RAI, CMI, Medicare, and Medicaid case mix...Remote workHourly payNight shift
- ...MDS / PDPM / CMI / RAI Consultant We are seeking an... ...Consultant to provide remote reimbursement, MDS, PDPM... ...term care and skilled nursing facilities. This... ..., CMI, care planning, Medicare documentation, and long... ...RAI, CMI, Medicare, and Medicaid case mix processes...Remote workHourly payNight shift
- 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 job
- Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations... .... To learn more, visit .The Regional Medicaid Lead is a senior leadership role... ...meetings required 25-50%This position is remote with travel/onsite requirements. PCG is...Remote workFull timeH1bWork at officeLocal areaShift work
- ...prior authorization utilization experience. ~ Managed Care/Medicare experience preferred. Skills: MUST HAVE MEDCOMPASS... ...or ASSURECARE exp. MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. MUST HAVE UM experience, inpatient utilization...Remote work
- ...encoding and electronic submission of MDS, RUGS, Medicare, Medicaid, and OBRA documentation. Review nursing notes to ensure clarity, accuracy, and alignment with... ...pay and travel opportunities. Hybrid schedule (remote and on-site). Supportive, collaborative team environment...Remote workFull timeContract work
- Conduent is seeking a Call Center Representative for Medicaid Member Support in a remote role. You will answer calls, provide information, and guide members through the application process while delivering friendly, accurate service from a home-based setup. The role offers...Remote jobWork from homeShift work
- Public Consulting Group (PCG) is a leading public sector solutions firm that partners with health and human services agencies to advance Medicaid program integrity through project management and data analytics. The Health Consultant role supports multiple state engagements...Remote job
- Conduent is seeking a Call Center Representative for Medicaid Member Support. This remote role supports South Carolina members from Columbia-area operations, with paid training, equipment provided, and a path to full benefits. Expect a 40-hour week, 4-week training, and...Remote job
$45.76k
...cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service... ...re your trusted partner in innovation. Appeals Support Specialist ~ Rate: $22/... ...~ Training will be provided ~100% Remote Key Duties/Responsibilities/Accountabilities...Remote workContract workTemporary workFor contractorsWork at office- ...seeking an experienced ICM Case Manager to develop proactive care plans, coordinate services, and support members with Medicare/Medicaid in a remote, home-based role with 25-50% travel within Monmouth/Ocean County, NJ. The position emphasizes holistic care, collaboration...Remote jobWork from home
$100k - $115k
...Senior Consultant, Medicaid Practice Group BerryDunn is seeking a Senior Consultant to join our Medicaid Practice Group. As part of our consulting... ...stages in their project lifecycle. You will be either remotely based or out of one of our several office locations. You...Remote workWork at office- ...County, New Jersey, with standard M-F hours. The RN will assess, plan, and coordinate care for dual eligible members enrolled in Medicare and Medicaid, addressing medical and social determinants of health. The role requires 3+ years of clinical practice, NJ RN licensure, and...Remote jobWork from home
- ...Health is seeking an experienced Integrated Care Management (ICM) Care Manager to assess and coordinate care for members with Medicare/Medicaid needs. You will develop proactive plans, collaborate with healthcare teams, and leverage data to address health and social determinants...Remote jobFull timeWork from home
$27.5 per hour
...Disability Case Manager Pay Rate: $27.50 per hour Work Mode: Fully Remote Summary: ~ LPN or RN Licensure must be active and in... ...: Minimum of 3 years of experience in clinical nursing, working with an adult population. Must possess excellent verbal...Remote workHourly pay$85k
...Regional Nurse Consultant (RN) - Assisted Living Americare Senior Living is seeking an experienced Regional Nurse Consultant (RN) to support our Assisted Living communities across the Missouri Region. In this role, you'll serve as a clinical advisor, mentor...Remote workHome officeMonday to FridayNight shift$110k - $120k
...Regional Nurse Consultant (RN) - Skilled Nursing Americare Senior Living is seeking an experienced Regional Nurse Consultant (RN) to support six Skilled Nursing communities across Central Missouri . In this highly visible leadership role, you'll serve as a...Remote workHome officeMonday to FridayNight shift- Northwell Health is looking for a Registered Nurse in Syosset, NY, to provide outpatient virtual lactation consultations and comprehensive patient care. The role includes assessment, diagnosis, care planning, and collaboration with healthcare teams. Candidates should hold...Remote job
- WPS Health Solutions is hiring an Appeals Nurse to review medical records and claims for first-level Medicare appeal cases to determine medical necessity and compliance with coverage guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations...Remote job
- CLF Consultants LLC is building a telephonic care line to support Maryland patients seeking medical cannabis information. The Cannabis Clinical Nurse Consultant role is remote, part-time, information-only, with no bedside care or prescriptions. Coverage is midweek and weekends...Remote jobPart timeWeekend work
- Roshal Health is seeking a Certified Wound, Ostomy, and Continence Nurse (CWOCN) for a remote, PRN position. The role offers telehealth assessments, care planning, staff education, chart review, and quality oversight across a network of facilities. You will provide evidence...Remote jobRelief
- Humana is seeking a Compliance Nurse 2 to review utilization management activities and documentation, ensuring adherence to policies and... ...data to assess outcomes, support the UM team, and follow guidelines for QIO fast track appeals and expedited #J-18808-Ljbffr HumanaRemote jobDay shift
$52 per hour
...Hiring for RN - Appeals (Remote Role) in Somerville, MA Shift: Days 5x8 (08:00 - 17:00) Duration: 13 Weeks (Temp... ...(AHA) ~100% remote ~ Looking for a registered nurse with payor experience (Commercial and Medicaid) ~ Would like to have at least 2 years of Health...Remote jobPermanent employmentTemporary workShift work- MaziCTools is seeking a Freelance Utilization Management Nurse Consultant to work remotely in the United States. This full-time role requires an active RN licensure and 3+ years of clinical experience. Responsibilities include assessing healthcare services, communicating...Remote jobFull timeFreelanceWork at officeMonday to FridayWeekend work
- WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level Medicare redeterminations to determine medical necessity and coverage alignment. You will collaborate with Appeals Examiners/Reps to ensure timely, accurate determinations...Remote job
- CVS Health in New Jersey is hiring an Integrated Care Management (ICM) Care Manager to advocate for dually eligible Medicare/Medicaid members. This remote-friendly role requires 25-50% travel within Ocean County and surrounding areas, with standard hours Mon-Fri 8am-5pm...Remote job
- Overview Job Title: Registered Nurse - Claims & Appeals Review Location: Remote (Anywhere in Florida) Duration: 06 Months/Can be Extended Working hours: Day Shift Job Type: Subcon Pay Rate: Negotiable Position Description The Quality Analyst is responsible for ensuring...Remote workContract workDay shift
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