Remote RN Clinical Coordinator - Medicaid Appeals
United Healthcare Services Inc
UnitedHealth 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 clinical judgment on medical necessity and functional needs.
The role emphasizes thorough documentation and collaboration within a remote team, with weekday daytime hours. Ideal candidates have Medicaid experience and familiarity with H6516/H2060 assessments, plus strong computer skills and reliable
#J-18808-Ljbffr- ...UnitedHealth Group is seeking an HSS Clinical Coordinator RN to conduct clinical reviews and evaluations related to Medicaid appeals, ensuring compliance and accuracy in assessments. This remote role is ideal for experienced RNs seeking meaningful patient-care impact....Remote workFull time
- ...Acting as the liaison for statewide appeals, the full-time RN Licensed Clinical Appeals Coordinator will ensure compliance with State and NCQA requirements while... ...letters for member and provider appeals in a fully remote environment. Key responsibilities Review...Remote workFull time
- UnitedHealth Group is seeking a Remote Appeals Clinician in Texas. You will... ...comprehensive reviews of Medicaid-related assessments (H6516/H2... ...records, and provide independent clinical judgments on medical... ...Requirements include a Texas RN license and 2+ years in Medicaid...Remote jobFlexible hours
$29 - $52 per hour
...have the flexibility to work remotely as you take on some tough... ...Responsibilities:Conduct comprehensive clinical reviews of appealed H6516 and H2060 assessment... ...Current unrestricted Texas RN license2+ years of... ...:Experience in Medicaid Long-Term Services and Supports...Remote workHourly payMinimum wageFull timeWork experience placementLocal areaWork from homeMonday to Friday- ...CVS Health is seeking a Medical Director to support Medicaid appeals nationwide via a remote, work-at-home arrangement. The role centers on ensuring timely... ...appeals and grievances. The candidate will provide clinical leadership, chair Medicaid appeals meetings, and...Remote workWork from home
$33.71 - $60.67 per hour
...liaison for all statewide appeals, fair hearings, review... .... ~ Review clinical information for all appeals... ...for all appeals ~ Coordinate with Medical Director(s... ...Education/Experience: RN with 4+ years of clinical... ...approach to work with remote, hybrid, field or office...Remote workHourly payFull timePart timeWork at officeFlexible hours- ...Centene Corporation seeks an experienced appeals reviewer to evaluate clinical information for all appeals using... ...for cases that did not meet criteria and coordinate with Medical Directors for clarity. The role requires RN/LPN/LVN licensure with 4+ years of clinical...Remote work
- ...Univera Healthcare is seeking an Advocacy Clinical Review Coordinator to investigate member and provider appeals, grievances, and complaints across all business lines. You will review medical necessity requests, determine appropriateness of care, and expedite cases within...Remote work
$53 per hour
...Job Description Job Description REMOTE RN OPPORTUNITY – GRIEVANCE & APPEALS / UTILIZATION REVIEW $53/hour | 100% Remote | Long-Term... ...Appeals experience Managed care, Medicare/Medicaid experience Strong clinical judgment and communication skills Why Apply...Remote jobLong term contractWork from homeMonday to FridayShift workWeekday work- ...Clinical Denials CoordinatorFacility Name: Jackson Health... ...FL 33136Shift Details: Remote - Per Diem Days 8:00 am... ...Denials Coordinator is responsible for back... ...denials, audits, and/or appeals.At least four (4) years... ...Science in Nursing.Valid RN is preferred.Jackson Health...Remote workDaily paidShift work
$69.72k - $104.58k
...Medical Center. Requisition Number: R162977 Clinical Coordinator, RN - EM Follow Up - Franklin (Open) How... ...the Emergency Department with 1 day remote. The Clinical Coordinator uses... ...areas may require Knowledge of Medicare/Medicaid and other third-party payor regulations...Remote workFull timeWork experience placementWork at officeMonday to FridayShift work$29 - $52 per hour
About This Role The HSS Clinical Coordinator RN position at UnitedHealth Group involves conducting... ...reviews and evaluations related to Medicaid appeals, ensuring compliance and accuracy in... ...for experienced RNs looking to work remotely while making a significant impact on...Remote workFull timeWork from homeMonday to FridayDay shift$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... ...for a registered nurse with payor experience (Commercial and Medicaid)Would like to have at least 2 years of Health Plan appeals experienceWorks...Remote workPermanent employmentTemporary work$90k
RN Clinical Coordinator Job Location: US-MA-Westborough Requisition Number: 2026-50386 # of Openings... ...and respond to inquiries related to appeals following clinical determinations... ...clinicians Environmental Working Conditions: Remote/desk work with- some statewide travel...Remote workFull timeWork experience placementWork at officeShift work$52 - $56 per hour
...RN Grievance & Appeals Specialist | Remote | ContractRNs with direct, payer-side Grievance... ...has personally managed clinical grievances and appeals from... ...determination letters.Coordinate external reviews, including... ...and/or New York Medicaid/MLTC grievance and appeals...Remote workAfternoon shift$52 - $56 per hour
...'ve done UM. You've worked appeals. Now find a role that uses... ...We're hiring a contract RN for a New York health plan (Medicare Advantage, Medicaid and MLTC). You'll own clinical grievances and appeals from... ...utilization management. 100% remote (U.S.) | Contract | $52–$56...Remote workContract workAfternoon shift$53.46k
...the substance of complex appeal or retrospective review... .... Provides thorough clinical review or benefit analysis... ...This is a full-time, remote (40-hours/week)... ...Centers for Medicare and Medicaid Services (CMS) Requirement... ...An active, unrestricted RN license from the United...Remote workFull timeFor contractorsWork experience placementLocal areaMonday to FridayShift work- ...Overview Detailed review, analysis and extraction of clinical information from patient medical records and drafting of effective narratives for Medicare and Medicaid appeals documentation and briefs in support of denied cases under appeal at all levels of the government...Remote workWork experience placement
- ...Working remotely, the Licensed RN Appeals Nurse will review medical records, create clinical analyses and appeal letters, and manage accounts to overturn clinical denials from Medicare, Medicaid, and other third-party payers. Key responsibilities Review medical record...Remote work
- NTT DATA, Inc. seeks a Clinical Reviewer Specialist to perform clinical and... ...reviews for member and provider appeals, evaluating records against NCQA standards and Medicaid requirements. Role offers remote work within Florida, requires RN licensure, 3 years’ experience...Remote job
- ...Description Job Description LTSS Appeals Nurse (Remote) We are seeking a detail-... ...will perform high-volume clinical reviews within the appeals... ...York Registered Nurse (NY RN) license. Residency:... ...CDPAP). Prior experience in Medicaid managed care, health plans,...Remote workLocal areaMonday to FridayFlexible hoursShift work
- Machinify is seeking a Medical Review Clinical Appeals Auditor (RN) to conduct Appeals reviews of new evidence in medical review audits and support... ...maintaining expert knowledge of medical practice, CMS/Medicaid/Commercial rules, and a strong emphasis on quality and productivity...Remote job
- ...CorroHealth, Inc. seeks a Supervisor, Clinical Appeals to lead a denials-management team of Appeal Coordinators supporting Corro Clinical clients. This remote role requires an RN in good standing and strong leadership to mentor staff, manage workflows, and ensure quality...Remote work
- ...UnitedHealth Group is seeking a Field Based HSS Clinical Coordinator RN in Bexar County, TX. The role involves coordinating care, connecting... ..., and advocating for patient needs. Flexibility to work remotely is available within the territory; travel is expected up to...Remote work
- ...UnitedHealth Group is seeking a Field Based HSS Clinical Coordinator RN in the Weslaco/Hidalgo, TX area. This role offers the flexibility to work remotely from within commuting distance and requires coordinating care, connecting members to resources, and advocating for...Remote work
$29 - $52 per hour
...distance, you will have the flexibility to work remotely* as you take on some tough challenges.... ...QualificationsCurrent unrestricted Texas RN license2+ years of experience in a... ...residencePreferred QualificationsExperience with Medicaid, LTSS, or long-term care...Remote workHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home$29 - $52 per hour
...distance, you will have the flexibility to work remotely* as you take on some tough challenges.... ...:Current unrestricted Texas RN license2+ years of experience in a community... ...territoryPreferred Qualifications:Experience with Medicaid, LTSS, or long-term care...Remote workHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home- ...Corporation is seeking a full-time RN Case Manager to support members with Medicare/Medicaid, working from home with... ...Illinois. You will assess needs, coordinate care, and advocate for appropriate... ...license in Illinois, and 3+ years clinical experience. #J-18808-LjbffrRemote workFull timeWork from home
- ...Cambia Health Solutions is seeking an Appeals Clinician I to work from home across Oregon, Washington, Idaho or Utah. You will apply... ...emphasizes collaboration with physician advisers and educating non-clinical staff, leveraging experience in clinical care, coding, and...Remote workWork from home
$29 - $52 per hour
...health-related information to ensure quality coordinated care and services are provided... ...Qualifications:Current unrestricted Texas RN license2+ years of experience in a community... ...travel up to 75% in assigned region to visit Medicaid members in their homes and/or other...Remote workHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home
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