Remote Senior Nurse Reviewer: Audit & Appeals
Mass General Brigham Incorporated.
Mass General Brigham Incorporated is looking for a Senior Nurse Reviewer responsible for coordinating clinical charge audits and appeal processes. The role demands strong analytical skills and experience in clinical nursing and quality assurance. This is a remote position requiring effective communication with multidisciplinary teams. The ideal candidate should possess a Bachelor's Degree in Nursing, an MA State RN License, and have experience in appeal writing. #J-18808-Ljbffr
- ...The Nurse Reviewer is responsible for the coordination, facilitation, and appeal of the clinical components of charge audits and forensic review findings. This includes audits conducted at Mass... ...nursing staff. Working schedule Remote, M-F eastern standard business hours...Remote workSenior
$65k - $88.6k
Humana is seeking a Senior Grievances & Appeals Analyst to analyze and audit complaints, ensuring the integrity of claims and authorization processes. This role involves utilizing data analysis tools and performing root cause analysis of audit findings to recommend improvements...Remote jobSeniorWork from homeFlexible hours$87.12k - $137.21k
Elevance Health is seeking an Audit and Reimbursement Lead - Appeals to provide technical direction and operational support for associates. This virtual role requires extensive experience in audit/reimbursement and in-depth knowledge of CMS principles. Candidates should...Remote jobSenior$90k - $99k
...candidates. Summary We are seeking a talented individual for a DRG Nurse Reviewer Appeals and Hearings to coordinate and perform all appeal related... ...production environment. What you should expect in this role Remote (Work from Home) Up to 25% Travel for onsite hearing...Remote workFull timeWork from homeRelocation packageFlexible hours$90k - $99k
...DRG Nurse Reviewer Appeals and Hearings- Remote Date: Jan 9, 2026 Location: Any city, FL, US, 99999 Work Mode: Virtual (Exception only) It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and...Remote workFull timeWork from homeFlexible hours$90k - $99k
A leading healthcare solutions provider seeks a DRG Nurse Reviewer Appeals and Hearings to coordinate appeal duties and engage in hearings, both... ...have an active RN license and coding certification. This remote role offers flexibility and opportunities for career development...Remote workFlexible hours- ...Downtown Boulder Partnership is seeking a Nurse Reviewer for Appeals and Hearings to coordinate and perform all appeal-related duties, including... ...summaries for hearings. This position is a full-time, permanent remote role that complies with work-from-home policies. The...Remote workPermanent employmentFull timeWork from homeFlexible hours
$90k - $99k
...Santa Barbara Cottage Hospital is seeking a DRG Nurse Reviewer Appeals and Hearings. The role involves coordinating and performing all appeal-... ...ideally 5+ years of clinical experience. This position allows remote work with minimal travel and offers a pay range of $90,000 -...Remote workFlexible hours$90k - $99k
A healthcare solutions company is seeking a DRG Nurse Reviewer Appeals and Hearings to handle appeals from providers and participate in hearings. This remote position requires an active RN license and certification in coding. The ideal candidate will possess excellent communication...Remote workFlexible hours- ...Good Samaritan Society is seeking a Lead UM Specialist to manage appeals, provide oversight, and ensure quality assurance across processes. This remote position requires a nursing degree and a minimum of three years of experience. The ideal candidate will exhibit strong...Remote workSenior
- ...Stryker Corporation is seeking a Senior Manager, Quality Assurance and Audit to oversee quality programs within the Grievance & Appeals QA organization. This leadership role ensures... ...leading a team of Quality Analysts in a remote environment. A bachelor's degree and extensive...Remote workSenior
- ...L.A. Care Health Plan is seeking an Appeals and Grievances Specialist II in Los Angeles, CA. The role involves investigating member and provider complaints, ensuring compliance with various health regulations, and preparing reports. Requirements include at least 2 years...Remote workSeniorFull time
- ...Shield of CA is seeking a Medicare Appeals RN Senior in Los Angeles, CA. This role involves reviewing member appeals and grievances,... ...holds a Bachelor of Science in Nursing and a current California RN... ...hybrid virtual work, balancing remote responsibilities with in-office...Remote workSeniorWork at office
- A healthcare solutions company seeks a Manager of Clinical Appeals in New York. The role involves overseeing clinical appeals operations... ...clinical appeals and team leadership, particularly in managing remote teams. The position requires strong writing skills and a...Remote workSenior
$19 - $29 per hour
...Clinical Coder The Clinical Coder conducts outpatient post-service administrative claims or appeals coverage determinations (such as bundling reviews) for which they are empowered outside of our company's clinical unit manager program requirements. This role applies...Remote workSeniorHourly payApprenticeshipWork from home- The State of Maryland is seeking an Appeals Chief for the Department of Veterans and Military Families. The role involves assisting veterans in securing benefits and presenting their claims to relevant agencies. Key responsibilities include evaluating claims, supporting...Remote jobSenior1 day per week
- BJC HealthCare in St. Louis is seeking a Manager for Appeals, responsible for managing complex healthcare appeals and collaborating with various stakeholders. The role offers a fully remote work environment and a flexible schedule. Candidates should have 5-10 years of...Remote jobSeniorFlexible hours
- ...Job Description Job Description Audit Senior - REMOTE OPTIONS AVAILABLE We are currently seeking an Audit Senior with three to five years of public accounting experience. Our Audit Seniors work on audit related projects for both large and small clients in a wide...Remote workSenior
- ...Job Description Description: Tax Senior Associate, (Boston, MA, Hoboken, NJ) –... ...office. This position also allows for remote work. Job Responsibilities: Senior Associate... ...and local outsourcing engagements, audits and appeals and provide consulting to Fortune 500 and...Remote workSeniorWork at officeLocal areaImmediate start
$75k - $95k
...to day life. This includes: Remote working environment Full medical... ...About the Position The SALT Senior Associate is responsible for... ...practice leader Prepare or review complex SALT returns for... ...in representing clients in audits and appeals before state taxing authorities...Remote workSeniorFull timeLocal area$24.03 - $28.83 per hour
...mental health services Review and reconcile patient... ...billing issues: denials, appeals, discrepancies using... ...Experience working remotely Experience with commercial... ...Friday 9am - 5pm EST Seniority level Mid‑Senior level... ...function Accounting/Auditing and Administrative Hospitals...Remote jobSeniorContract workMonday to FridayShift work$120k - $160k
Senior Manager, Property Tax | Lead Multi-State Compliance for Fortune 500 Clients | Remote-Friendly | Growth-Focused Team This Jobot Job is hosted by Eric Kee. Are you a... ...property tax outsourcing engagements, audits, and appeals Oversee timely filing of personal property...Remote workSeniorFull timeLocal area- ...Senior Appeals Specialist Job Category: Medical Billing Full-Time Remote Middleburg Heights, OH 44130, USA +1 more locations Description Key Responsibilities... ...insurance plan. Gather updated appeal or review forms to add to form library. Create...Remote workSeniorFull time
$68.97k - $113.31k
...The Senior RN Clinical Consultant will work in partnership with Clinical and Vocational... ...expert in all lines of business (STD/LTD/Appeals) and products, action planning management... ...leadership as needed Location This is a remote position with occasional travel as needed...Remote workSeniorFull timeVisa sponsorshipWork visaFlexible hours$18.5 - $35.29 per hour
Position Summary Responsible for managing to resolution complaint/appeal scenarios for all products, which may contain multiple issues... ...special investigations, provider relations, customer service or audit experience. Preferred Qualifications Medicare experience. Claims...Remote jobSeniorHourly payFull timeLocal area$47 - $56 per hour
...Senior Auditor Quality - CCCR Job Locations US-Remote ID 2026-18251 Category Audit - Healthcare Position Type Full-Time Overview... ...audit claims review. Displays professional... ...audit role and/or the appeals role as needed. This... ...'s degree in Nursing (active / unrestricted...Remote workSeniorFull timeWork at officeImmediate startFlexible hours$50k - $70k
...A leading insurance audit team is looking for experienced premium auditors in the United States. The position offers a competitive total compensation package, including an hourly base wage plus production bonuses that can total between $50K–$70K in the first year. Key...Remote workSeniorHourly payWork from home- ...Experts is seeking qualified individuals for the role of insurance auditor, focusing on General Liability and Workers Compensation audits. This position allows you to work from home while utilizing your extensive experience in the insurance industry. Ideal candidates...Remote workSeniorFull timePart timeWork experience placementWork from homeFlexible hours
- ...Work At Home Vintage Experts is seeking experienced professionals to conduct insurance audits from home. Candidates must possess 25 years of work experience, including 10 years specifically in premium audit roles. This position allows for a flexible schedule and offers...Remote workSeniorWork experience placementWork from homeFlexible hours
- ...professionals to work from home in a flexible role. We are seeking individuals with significant insurance experience, particularly in auditing, to conduct premium audits from the comfort of their homes. Ideal candidates must have extensive experience in auditing with a...Remote workSeniorWork from homeFlexible hours
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