Remote TX: Senior Clinical Appeals RN
Optum
UnitedHealth Group's UnitedHealthcare division seeks a Senior Clinical Administrative RN to review member appeals and grievances, assess medical necessity, and prepare for Fair Hearings in Texas. The role supports consumer-oriented health benefits and requires strong documentation and regulatory expertise. Telecommuting is available in this Texas-focused position. The candidate will review determinations, coordinate with clinical and non-clinical staff, and ensure compliance with state and #J-18808-Ljbffr
$60.2k - $107.4k
About This Role The Senior Clinical Administrative RN role focuses on reviewing member appeals and fair hearing requests, including clinical... ...system while working remotely in Texas. Highlights Pay: $60,... ...7,400/year Location: Houston, TX Department/Unit: Clinical Administration...Remote jobSeniorFull timeDay shift- ...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 workSenior
- ...Medica is a nonprofit health plan serving diverse communities with a mission to provide coordinated, quality care. The Appeals and Grievances Clinical Specialist III role focuses on reviewing, investigating, and resolving member and provider appeals with clinical expertise...Remote workSenior
$60.2k - $107.4k
...Senior Clinical Administrative RN At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing... ...life's best work. The role focuses on review of member appeals and fair hearing requests - clinical review, chart review...Remote jobSeniorMinimum wageFull timeWork experience placementWork at officeLocal area- ...an experienced reviewer to research and document complex appeal cases and retrospective reviews for medical necessity determinations. This remote, full-time role requires an active RN license and solid clinical experience in home health or related settings. You will analyze...Remote workFull time
- ...NTT DATA, Inc. is seeking a Clinical Reviewer Specialist for a fully remote position based in Florida. You will perform... ...reviews for member and provider appeals, evaluating records and criteria to... ...NCQA compliance. The role requires RN licensure (Florida or compact), 3+...Remote work
- ...WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims for first-level Medicare appeal cases, assessing... ...or BSN and an active RN license, with at least 1 year of clinical experience, strong communication, and solid understanding of...Remote work
- ...-based role working in the office/field 3 days a week and remote/home 2 days a week and which is contingent upon the business... ...Caring. Connecting. Growing together. The Sr. Clinical Quality Consultant RN will drive consistency, efficient processes and share best...Remote workSeniorHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaRelocation packageNight shift2 days per week3 days per week
- ...specializing in central nervous system (CNS) diseases are hiring for a Senior Clinical Research Associate (SCRA). The SCRA will be responsible for... ...applicable SOPs/Work Instructions. This role is fully remote, with approx. 70% travel expected. We are seeking the...Remote workSenior
- Guidehealth, a data-powered healthcare company, seeks a Clinical Compliance Auditor II to ensure adherence to UM/... ...staff, and help refine audit tools within a remote-friendly, collaborative team. The role requires RN licensure, 3-5 years in utilization management or...Remote jobSenior
$40 - $50 per hour
...Job Description Job Description Clinical Appeals RN – 100% Remote $40-$50/hour | Part-Time & Full-Time Opportunities Available Our team partners with healthcare providers and hospital organizations to deliver revenue cycle and accounts receivable support services...Remote jobPermanent employmentFull timeTemporary workPart time$72.8k - $130k
...Join us to start Caring. Connecting. Growing together The Senior Clinical Quality of Care RN will be responsible for conducting quality of care (QOC)... ...Medicare members. This position is an Arizona based remote position with the option of working 40% in-office. There...Remote workSeniorMinimum wageFull timeFor contractorsWork experience placementWork at officeLocal area- UnitedHealth Group is seeking a Senior Clinical Administrative RN to review member appeals and fair hearing requests from a Texas-based remote location. The role focuses on clinical and chart review, audits, and regulatory alignment within a managed care setting. The ideal...Remote job
$60.2k - $107.4k
...Opportunities With Kelsey-Seybold Clinic Work with one of the nation's leading... .... Growing together. The ED RN Case Manager monitors real-time '... ...If you are located in Pearland, TX, you will have the flexibility to work remotely* as you take on some tough challenges...Remote jobMinimum wageFull timeWork experience placementLocal area- Providence Jobs is seeking a Care Manager RN for a remote, full-time position with day shifts in Torrance, CA. The role focuses on managing clinical appeals between Providence Health and Services and external payers, advocating for reimbursement and maintaining patient...Remote jobFull timeDay shift
$60.2k - $107.4k
...this program is to provide a front line clinical resource to provide education and support... ...You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take... ...Qualifications: ~ Current and unrestricted RN compact license ~4+ years of acute...Remote workSeniorMinimum wageFull timeWork experience placementLocal areaMonday to Friday$60.2k - $107.4k
...Senior Clinical Administrative Nurse At UnitedHealthcare, we're simplifying the health care... ...determinations, including support through the appeals process Educate members on the use of... ...: ~ Current and unrestricted RN compact license ~ Ability to obtain additional...Remote workSeniorMinimum wageFull timeWork experience placementLocal areaWeekday work$91.7k - $163.7k
...Service Coordination Manager, RN Optum is a global organization that... ...a commutable distance of El Paso, TX, you will have the flexibility to work remotely as you take on some tough challenges... ...ability to function as a clinical care team leader You'll be rewarded...Remote jobMinimum wageFull timeWork experience placementLocal area- ...UnitedHealth Group is seeking a Clinical Grievances Nurse to review retrospective cases and current cases ensuring appropriate care and... ...addressing immediate member needs. This role offers PST hours with remote work options and a Monday–Friday schedule.You will perform...Remote workImmediate startMonday to Friday
$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 Hygienist - 100% Remote role at Healthfirst . Position Summary: The Appeals & Grievances (A&G) unit...Remote jobFull timeMonday to FridayShift work- ...A leading global CRO is seeking a Senior Lead Clinical Data Manager to act as the primary client contact and oversee clinical trial databases... ...studies while collaborating with international teams. This remote position offers significant career growth and the opportunity...Remote workSenior
- ...PCI Pharma Services seeks a Senior Clinical Supply Manager for a fully remote role, guiding drug supply planning for Phase I–IV trials, Expanded Access, and global study supply chains. You will act as the primary client liaison across PCI and the client, coordinating information...Remote workSenior
- ...Pharmaceuticals, Inc. is seeking a Manager Clinical Data Manager Study Lead to oversee lead... ...data management plans. The role requires senior expertise in data management, coordination... ...startup through archiving, with up to 25% travel and a remote-work #J-18808-Ljbffr...Remote workSenior
- ...RayzeBio, a Bristol Myers Squibb subsidiary, seeks a Clinical Development Lead to oversee IND-Phase 3 plans for radiopharmaceutical assets in HCC/GI cancers. You will drive cross-functional study teams, engage with health authorities, and mentor clinical scientists to...Remote workSenior
- ...ICON is seeking a Principal Clinical Data & EDC Programmer to lead programming for CDMS/EDC systems in multinational trials. You will... ...analytics initiatives while staying current with language and tool advancements. Remote or hybrid work options apply. #J-18808-LjbffrRemote workSenior
- ...Immatics is seeking a Principal Manager, Clinical Operations Lead to support its Clinical Operations team in the US, with fully remote work. Find out more about the daily tasks, overall responsibilities, and required experience for this opportunity by scrolling down...Remote workSeniorWork from home
- ...Mathematica, Inc. seeks a Senior Clinical Advisor to apply clinical knowledge, informatics expertise, and quality measurement experience... ...solutions, including quality measures and analytics. This remote-eligible role collaborates with clients to translate needs into...Remote workSenior
- ...Ladders is seeking a Clinical Trial Manager/Senior Clinical Trial Manager to lead day-to-day clinical trial execution across studies, with a strong... ...and investigational product processes. The position is remote in the United States, requires 7+ years in clinical...Remote workSenior
- ...Corbus Pharmaceuticals Holdings, Inc. in Norwood, MA seeks a Clinical Trial Manager to lead day-to-day trial execution across phases, coordinating CROs and internal teams. The role emphasizes risk management, budgeting, and cross-functional collaboration to ensure quality...Remote workSenior
- ...MyOme, Inc. is seeking a Senior Clinical Trial Manager to drive clinical evidence generation, manage studies through CROs, and ensure on-time, on-budget delivery of analysis-ready datasets. This remote US role partners across internal teams and external vendors to translate...Remote workSenior
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote TX: Senior Clinical Appeals RN. Be the first to apply!
- aesthetic rn New York, NY
- hospice registered nurse New York, NY
- intensive care unit rn New York, NY
- travel or rn New York, NY
- med surg rn travel contract New York, NY
- cath lab registered nurse New York, NY
- emergency room rn New York, NY
- private duty rn New York, NY
- wound care rn New York, NY
- endoscopy rn New York, NY





