Remote RN Appeals and Quality of Care Investigator
Elevance Health
- Remote job
A healthcare company is seeking a Nurse Appeals specialist to investigate and process medical necessity appeals from members and providers. The role involves reviewing grievances, preparing summaries for Quality of Care cases, and ensuring timely resolution of grievances. Applicants need a high school diploma or equivalent with at least 2 years of experience in a managed care setting, along with a current RN license. This position offers a hybrid work model and a range of competitive benefits. #J-18808-Ljbffr Elevance Health
- Premera is a health plan seeking a licensed RN for a Care Coordinator - Clinical Appeals role. You will review inpatient, concurrent, and retrospective requests... ...compliant, cost-effective care while supporting quality programs and utilization management goals. #J-18808-...Remote job
- ...onboarding and skill development. The Nurse Appeals is responsible for investigating and processing medical necessity... ...reviews of member grievances and Quality of Care cases. Review medical records for... .... Current active unrestricted RN license to practice as a health professional...SuggestedFull timeTemporary workLocal area1 day per week
$60.2k - $107.4k
Optum is a global healthcare organization empowering care through technology. The Utilization Management Nurse role involves reviewing... ...records, extracting case details, and crafting defensible appeal letters according to process instructions and guidelines. The position...Remote jobFull timeMonday to Friday- ...Joint Commission is seeking an Ambulatory Care Surveyor - RN to survey ambulatory organizations... ...United States. The incumbent will work remotely from anywhere in the U.S. and will engage... ...experience plus two years in management or quality improvement; travel nationwide is #J-1...Remote job
$35.29 - $54.71 per hour
Join to apply for the RN Acute Care Virtual Quality Support role at TieTalent 1 day ago Be among the first 25 applicants Join to apply for the RN... ...position is an onsite role and does not offer a hybrid or remote option** Minimum Requirements Graduate of an accredited...Remote workShorter hoursFull timeTemporary workLocal areaRelocation packageFlexible hoursShift workNight shift$35.29 - $54.71 per hour
...Aurora - CO Department: Virtual Quality Support FTE: Full Time, 72.00... ...does not offer a hybrid or remote option Work nights, earn more... ...unit teams, assists with patient care needs, and helps identify and... ...licensure as a Registered Nurse (RN). Basic Life Support (BLS)...Remote workFull timeTemporary workLocal areaFlexible hoursShift workNight shiftRotating shiftAfternoon shift$83.1k - $120.36k
Position Summary: The Appeals & Grievances (A&G)... ...accountable for investigating and resolving... ...This is either a remote or on-site position... ...productivity and quality for each Specialist... ...Minimum Qualifications RN Preferred... ...degree Quality of Care Experience in clinical...Remote workContract workWork at officeLocal area- ...interaction with customers, health care professionals and Global Merz... ...technical support and remote troubleshooting guidance as needed... ...a timely manner. Complete investigations which may include execution... ...accordance with the Company Quality System. Qualifications BS in...Remote work
- State of Missouri is seeking a Registered Nurse to join the Section for Long-Term Care as a surveyor and complaint investigator. This professional role involves collaborating with a multidisciplinary team and may require occasional on-call duties for high-priority investigations...Remote job
$45.03 - $68.87 per hour
...Department: 2003900 SMMC 9-CRITICAL CARE - SMMC HOSP Job Description... ...00 This Registered Nurse (RN) will care for the following... ...health, recognizing that quality care is a universal right.... ...FTE: 0.75 Possible Remote/Hybrid Option: Shift Rotation...Remote workPart timeLocal areaWork from homeFlexible hoursShift workNight shiftWeekend work$47.03 - $70.87 per hour
...: 2004150 FLOAT POOL - CRIT CARE - SMMC HOSP Job Description... ...00 This Registered Nurse (RN) will care for the following Critical... ...health, recognizing that quality care is a universal right.... ...FTE: 0.75 Possible Remote/Hybrid Option: Shift Rotation...Remote workHourly payPart timeLocal areaWork from homeFlexible hoursShift workNight shiftWeekend work- ...stay, intensity of service and level of care, including appeal requests initiated by providers,... ...coordination, etc. Identify and document quality of care issues; resolve or route... ...Locations 500 Renaissance Ctr, Detroit, MI, 48243, US (Remote) UST HealthProofRemote workWork at officeLocal area
- ...provider is seeking a Registered Nurse for Claims & Appeals Review. This remote role supports compliance and quality assurance in appeal reviews. Candidates should have a Bachelor's degree in healthcare and valid RN license in Florida. Key responsibilities include reviewing...Remote job
$41.2 - $62.17 per hour
Job Description: The RN Hospital Care Manager I delivers comprehensive care management services... ...multidisciplinary teams to ensure timely, high-quality care. * Process Improvement: Leads... ...and expectations. If applying for a remote or hybrid role, this includes remote work...Remote workHourly payFull time$61.66k - $87.1k
...public health consulting firm in Albany, NY is seeking experienced professionals to conduct investigations in Adult Care Facilities. This full-time role involves both on-site and remote work after an initial period. Candidates should have strong communication skills,...Remote workFull time- Texas Health and Human Services is seeking an Unregulated Operations Investigator IV in Houston to lead complex investigations of unregulated child care facilities. This senior role emphasizes risk assessment, interviews, and enforcement actions, with telework eligible...Remote job
$38.22 - $57.33 per hour
...Responsible for organizing and providing nursing care to patients through the process of... ...facilities, is guided by the values of Quality, Hospitality, Respect, Joy, Justice, Stewardship... ...institute. FTE: 0.9 Possible Remote/Hybrid Option: Shift Rotation:...Remote workFull timeLocal areaFlexible hoursShift workNight shiftWeekend work$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... ...collaboration across departments to meet quality and productivity goals. #J-18808-Ljbffr...Remote workFull timeWork at office- ...see or reach their feet, a lack of self care and mobility challenges cost the health insurance... ...knee. As these issues arise, a team of remote nurses coordinate care with other... ...Nurse Case Manager to help deliver high-quality, member-centered care. In this role, you...Remote workFull timeWork from homeWeekend work
- Health & Human Services Commission (HHSC) in Texas seeks an Unregulated Operations Investigator IV to conduct highly complex investigations of unregulated child care facilities. Responsibilities include interviewing caregivers, parents and others, performing surveillance...Remote jobFull time
$35.29 - $54.71 per hour
...Department: Medical Acute Care Unit Work Schedule: Full Time... ...and does not offer a hybrid or remote option Work nights, earn more... ...as a Registered Nurse (RN). Basic Life Support (BLS) Healthcare... ...to secure safety and quality at the point of care Acute...Remote workFull timeTemporary workLocal areaFlexible hoursShift workNight shift- ...Overview Provides direct patient care in a high-acuity Burn Trauma... ...patient wellness, safety, and quality care. Acts as a preceptor for... ...'s degree in Nursing. Current RN licensure and Basic Life Support... ...onsite presence without remote options. values diversity and...Remote workNight shift
$35.29 - $54.71 per hour
...role and does not offer a hybrid or remote option Summary: Provides direct patient care, at a proficient level, using the... ...licensure as a Registered Nurse (RN). Basic Life Support (BLS)... ...contributions to our success in quality, patient experience, organizational...Remote workFull timeTemporary workLocal areaFlexible hoursShift workNight shift$35.29 - $54.71 per hour
...and does not offer a hybrid or remote option Work nights, earn more... ...licensure as a Registered Nurse (RN). 6 months of nursing (RN)... ...scope practice in direct patient care utilizing the nursing process... ...to secure safety and quality at the point of care Acute Care...Remote workFull timeShift workNight shift$38.22 - $57.33 per hour
...behind the scenes, who all bring high-quality, compassionate care to the patients we are privileged to serve... ...within the nursing division. NICU RN's in Fargo, ND are required to perform... .... FTE: 0.9 Possible Remote/Hybrid Option: Shift Rotation:...Remote workPart timeLocal areaFlexible hoursShift workNight shiftWeekend work$50 per hour
...Consulting RN - Client Care (PRN)Home Instead is the largest network of Home Care Agencies in... ...Client Care and ensure we are delivering quality care that enhances the lives of aging adults... ....Pay: Up to $50 per hour.Work Location: Hybrid remote in Norman, OK 73069...Remote workHourly payRelief- CVS Health in Phoenix, AZ is seeking a full-time Quality Practice Liaison for the Arizona Mercy Care Plan. The role is work-at-home, requiring presentation... ...improve member outcomes, access various EMR systems remotely, and meet volume and accuracy targets while reading...Remote jobFull timeWork from home
- ...Utilization and Medical Management for a remote, one-month opportunity. The role... ...clinical leadership team to ensure high-quality, cost-efficient care across the continuum. You will lead... ...interact with plans on benefits and appeals, guiding physician education and network...Remote job
$26.41 - $51.49 per hour
...desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.... ...education and experience. Registered Nurse (RN). License must be active and unrestricted in state...Remote workHourly payWork experience placementWork at office$23.76 - $51.49 per hour
...desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job... ...education and experience. Registered Nurse (RN). License must be active and unrestricted in state...Remote workHourly payWork experience placementWork at office
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