Remote RN Appeals Nurse - Medical Necessity Expert
Elevance Health
Elevance Health is seeking a Nurse Appeals - Licensed Nurse to work virtually from Indianapolis, IN, conducting investigations for medical necessity appeals. The role requires a current RN license and a minimum of two years in managed care healthcare. Candidates must have strong clinical experience and leadership skills. This position operates Tuesday through Saturday with an 8-hour shift within business hours from 8 am to 8 pm EST. Elevance Health promotes a culture of diversity and equal opportunity, ensuring all qualified applicants receive consideration. #J-18808-Ljbffr
- ...Elevance Health seeks a Nurse Appeals - Licensed Nurse to investigate medical necessity appeals from members and providers. This role allows associates to work virtually... .... The successful candidate must hold an active RN license and have a minimum of 2 years of...Remote workMedicalFull time
- ...Elevance Health is seeking a Nurse Appeals - Licensed Nurse to investigate medical necessity appeals from members and providers. This role allows for flexibility,... ...sessions. The ideal candidate must hold an active RN license and have experience in a managed care setting...Remote workMedicalFull time
- ...Administrators LLC is hiring an Appeals Analyst to join BlueCross... ..., and ensuring compliance with medical necessity guidelines. The ideal candidate will have an RN license, a degree in a related... ...full-time with the option to work remotely or on-site, offering comprehensive...Remote workMedicalFull time
- ...Medix™ is seeking a dedicated Appeals Nurse (RN) to join our team in a fully remote capacity. This role involves clinical reviews and appeal determinations while collaborating with Medical Review Analysts and Physician Consultants to ensure compliant outcomes. The ideal...Remote workMedical
$35 - $63 per hour
...Health Institute is looking for a Senior Clinical Appeals RN to utilize expertise in MS‑DRG and APR‑DRG auditing. This role involves reviewing medical records and responding to appeals while providing coaching to remote DRG Validation Specialists. The position allows...Remote workMedicalHourly payWork at office$35 - $63 per hour
...Stryker Corporation is seeking a Senior Clinical Appeals RN to utilize clinical expertise in appealing and coding medical records. The role includes analyzing DRG... ...least 2 years of coding experience with ICD-10. Remote work opportunities are available in the U.S., and...Remote workMedicalHourly pay$50 per hour
...A leading healthcare staffing firm is seeking an experienced RN Clinical Reviewer to work remotely. You'll conduct detailed medical-legal reviews and appeals while maintaining high accuracy and integrity. Key qualifications include a New York State RN license and at least...Remote workMedical- ...to perform clinical reviews and audits on medical records, ensuring compliance with company... ...guidelines. This role requires an active RN license and the ability to analyze claims... ...documentation and reporting within the appeals process, contributing to continuous improvement...Remote jobMedical
- ...Are you a registered nurse ready to take your... ...to analyze medical records, documentation... ...Registered Nurse (RN) license Strong... ...vulnerable populations Remote work - enjoy the... ...determine medical necessity, appropriateness, quality... ...reason codes, and appeal rights in...Remote workMedicalFull timeTemporary workWork at officeWork from home
- ...Are you a registered nurse ready to take your... ...to analyze medical records, documentation... ...Registered Nurse (RN) license Strong clinical... ...vulnerable populations Remote work - enjoy the... ..., medical necessity, appropriateness, and... ...reason codes, and appeal rights in accordance...Remote workMedicalFull timeTemporary workWork at office
- ...part of BlueCross BlueShield, is hiring an Appeals Analyst. This role involves researching... ...full-time, Monday through Friday, and can be remote or on-site in Nashville, TN. Qualified... ...experience in clinical settings, and an active RN license. Benefits include 401(k) match,...Remote workMedicalFull timeMonday to Friday
- Innovative Systems Group is seeking a Registered Nurse for remote positions in IL, TX, NM, MT, or OK. The role involves collaborating... ...healthcare providers to optimize member benefits and evaluate medical necessity, ensuring compliance with established guidelines....Remote jobMedical
- ...seeking a clinical professional for a fully remote role focused on medical management. The position requires an active New York State RN licensure and involves analyzing authorization requests to determine medical necessity. The successful candidate will coordinate with...Remote workMedicalFlexible hours
- ...seeking a Review Analyst RN to perform a thorough... ...services to ensure medical necessity and appropriate care levels... .... This role is fully remote based in Michigan. The... ...Bachelor's degree in nursing or a related field and... ...reviews, managing appeals, and coordinating care...Remote jobMedical
- ...UnitedHealth Group is seeking a Senior Clinical Appeals RN to utilize expertise in MS-DRG and APR-DRG auditing to manage appeals. This position allows remote work throughout the U.S., except for Minneapolis or Washington, D.C. hires, who need to work in-office at least...Remote workWork at office
- Southcarolinablues is hiring an Appeals Analyst to join their team in... ...to ensure compliance with medical necessity guidelines. The position offers... ...and the option to work remotely or on-site. Ideal candidates... ...clinical experience, a valid RN license, and strong analytical...Remote jobMedicalFull time
$38.17 - $57.25 per hour
Elevance Health is seeking a Nurse Appeals RN to work virtually full-time, with in-person training required. The role involves investigating medical necessity appeals requests and requires a high school diploma and 2+ years of managed care healthcare experience. Candidates...Remote jobMedicalFull time$35 - $63 per hour
...State and Territorial Epidemiologists is hiring a Senior Clinical Appeals RN. This position utilizes expertise in MS-DRG and APR-DRG... ...2 years of experience in ICD-10 coding. The role allows for remote work, and candidates should be solution-oriented problem solvers...Remote workHourly pay- The Elevance Health Companies, Inc. is seeking a Nurse Appeals-RN to manage medical necessity appeal requests. The position allows for virtual work full-time with in-person training required. Successful candidates will investigate appeals, review medical records, and provide...Remote jobMedicalFull time
$35 - $63 per hour
...Optum is seeking a Senior Clinical Appeals RN to utilize expertise in MS-DRG and APR-DRG auditing for appeals management. This role involves... ...auditors, and authoring rebuttals. The job can be performed remotely across the U.S., with certain locations requiring in-office...Remote workHourly payWork at office$35 - $63 per hour
...The University of Minnesota School of Nursing is looking for a Senior Clinical Appeals RN. This role involves reviewing and responding to appeals in MS-DRG and APR-DRG auditing and provides coaching to remote specialists. Remote work is available within the U.S., but...Remote workHourly payWork at office- Elevance Health is looking for a Nurse Appeals - Licensed Nurse based in Louisville, KY. The... ...requires conducting investigations, reviewing medical necessity appeals, and preparing recommendations... ...decisions. Candidates need a current RN license and a minimum of 2 years'...Remote jobMedicalFlexible hours
- ...staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates to reside in PA, DE,... ...involve applying criteria for medical necessity, collaborating with providers, and...Remote jobMedical
$45.29 - $84.11 per hour
...outpatient facilities, 22,000 nurses and over 20,000... ...the better. Hybrid/Remote Summary: The purpose... ...to support the medical necessity of patient admission and... ...Tracking and trending all appeals and communicating on a... ...Required: Current RN License in Connecticut...Remote workMedicalHourly payDaily paidPart timeShift workNight shiftRotating shift$88.85k
...Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Location: Los Angeles,... ...Provider Claim Disputes, medical records or other issues and... ...would be based on medical necessity reviews. Prepares... ...weekends, holidays, a hybrid remote schedule, occasional flexibility...Remote workMedicalFull timeShift workWeekend work$69.38k - $92.28k
Overview As a Clinical Appeals RN, you will review denied service authorizations... ...and claims, evaluate medical necessity, and work closely with... ...standing Graduate of an accredited nursing program (BSN preferred) 3‑5... ...a combination of office and remote settings. EEO Statement MVP...Remote workMedicalWork at office$38.17 - $57.25 per hour
Job Title Nurse Appeals-RN (California) Location & Remote Work Locations: Woodland Hills, CA and Costa Mesa, CA.... ...Responsibilities Investigate and process medical necessity appeal requests from members and... ...and serve as a subject matter expert for appeals/grievances/quality...Remote workMedicalFull timeLocal area$100 - $150 per hour
...Management / Case Management leader (RN/Physician-advisor) Type:... ...00–$150/hour Location: Remote Role Responsibilities... .... Evaluate AI-generated medical necessity determinations and clinical review... ...review requests, and denial appeals. Coordinate with clinical...Remote workMedicalContract workSummer workNight shift- Blue Cross Blue Shield of Arizona needs a clinical expert for managing member and provider appeals. This remote position requires strong accuracy, knowledge of compliance timelines, and a focus on customer service. Applicants should possess a healthcare-related degree...Remote job
- ...MVP Health Care is seeking a Clinical Appeals RN to ensure fair and timely review of healthcare service denials. This role involves analyzing medical records and clinical documentation and collaborating with medical directors to decide on appeals. The ideal candidate will...Remote workMedical
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