Remote Clinical Review Nurse - Appeals & Revenue
Ternium Revenue Cycle Management
Ternium Revenue Cycle Management is seeking a full-time Remote Clinical Review Nurse to analyze denied insurance claims, draft appeal letters, and collaborate with legal teams. The role is crucial for optimizing patient care revenue without direct patient interaction. The ideal candidate will have an RN License and over 5 years of acute hospital experience, along with knowledge of clinical criteria standards. Responsibilities include reviewing claims and working closely with legal teams to ensure effective appeals. #J-18808-Ljbffr
- ...Jefferson Health is seeking a Clinical Appeals Nurse to be a part of their team, working fully remote. This role involves reviewing payor denials, writing appeals, and coordinating with third-party payors to advocate for patient claims. Qualified candidates will hold a...Remote work
- A healthcare solutions firm is looking for a Clinical Appeals Nurse (RN) to support revenue cycle operations by reviewing denied claims. This remote position requires an active RN license and 3-5 years of clinical nursing experience. Responsibilities include assessing medical...Remote work
- ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical Appeals Position... ...Clinical Appeals Nurse supports HBiz’s revenue cycle operations by reviewing denied claims for clinical accuracy and...Remote work
$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- ...Santa Barbara Cottage Hospital is seeking a Clinical Nurse Specialist to resolve complex clinical... ...outcomes through evidence-based appeals. Your role includes analyzing denial trends... ...collaborating with teams, and improving clinical review standards. The ideal candidate will have...Remote work
- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct... ..., probe, progressive corrective action, consent, etc.) or appeal. This may involve discussion with CMS leaders and...Remote workPermanent employmentWork at officeLocal area
- ...UM Inpatient Clinical Review Nurse page is loaded## UM Inpatient Clinical Review Nurselocations: Springfield, Massachusetts: Remote Work Opportunitytime type: Full timeposted on: Posted Todayjob... ...reviews for member and provider appeals related to inpatient services*...Remote workHourly payFull timeWork at officeMonday to FridayFlexible hoursWeekend work
- ...Downtown Boulder Partnership is seeking a Nurse Reviewer for Appeals and Hearings to coordinate and... ...This position is a full-time, permanent remote role that complies with work-from-... ...candidate should have at least 5 years of clinical or medical record coding experience,...Remote workPermanent employmentFull timeWork from homeFlexible hours
- ...Healthcare in Louisville, KY, is seeking a Clinical Reviewer to utilize clinical knowledge for... ...conducting medical reviews of authorization appeals, working closely with medical directors... ...valid RN license, at least 2 years of nursing experience, and a strong understanding...
$29.05 - $67.97 per hour
Molina Healthcare is seeking a clinical nurse responsible for reviewing documentation for medical necessity and appropriate care levels. The role involves appeals facilitation, claims auditing, and ensuring accurate billing under coding regulations. The ideal candidate...Hourly pay$29.05 - $67.97 per hour
Molina Healthcare seeks a clinical professional to perform detailed reviews of medical documents ensuring compliance with state... ...medical necessity, facilitating appeals, and providing training. Applicants must be Registered Nurses with at least 2 years of experience,...Hourly pay- ...Description Job Description: Clinical Supervisor, UM Denial... ...Type: Hybrid (85% remote, 15% onsite in Burbank,... ...tasks, performance reviews, and disciplinary actions... ...accredited Registered Nursing Program; RN preferred.... ...in prior-authorization, appeals & grievance, or health...Remote workPermanent employmentTemporary work
$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... ...provider appeals and redeterminations using approved clinical and coding guidelines and documents appeal determinations...Remote workFull timeWork from homeFlexible hours- ...Blue Cross and Blue Shield of Massachusetts Inc. seeks a Clinical Appeals Nurse Reviewer to facilitate and respond to provider appeals for denied services. The candidate will work collaboratively with various teams, applying clinical, coding, and business knowledge to...
- ...Blue Cross Blue Shield of Massachusetts is looking for a Clinical Appeals Nurse Reviewer to transform healthcare by facilitating and coordinating provider appeals for denied services. Your role will involve reviewing claims and collaborating with various teams while utilizing...Full time
- ...WPS—A health solutions company is seeking an Appeals Nurse to review medical records and claims for appeal cases. You will collaborate with the... ...setting. The position offers a salary range of 66-68k, remote work options, and comprehensive health benefits starting on...Remote work
- ...Health Solutions is seeking an Appeals Nurse in Michigan to examine... ...Examiners and entails thorough reviews to ensure regulatory compliance... ...along with at least one year of clinical experience. Strong... ...essential. This opportunity offers remote work options and various benefits...Remote work
- ...WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level appeal cases. This role collaborates with... ..., an active RN license, and strong communication skills. Remote work options are available, and candidates are expected to...Remote work
$66k - $68k
...Health Solutions is seeking an Appeals Nurse to examine medical records... .... The role involves reviewing appeal cases, conducting medical... ...an RN license and relevant clinical experience. The position offers... ...8,000 and opportunities for remote work in multiple states, including...Remote work- ...health solutions company is seeking an Appeals Nurse to examine medical records and claims for... ...Examiners to ensure timely and medically reviewed redeterminations. The role requires a... ...license, plus strong communication skills. Remote work options are available in approved...Remote work
- ...health solutions company is looking for an Appeals Nurse to examine medical records for first-level appeals. The role includes reviewing denied services and preparing appeal... ...organizational skills. The position offers remote work options, competitive benefits including...Remote work
- ...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 work
- ...WPS Health Solutions is looking for an Appeals Nurse responsible for examining medical records... ...-level appeal cases. The role involves reviewing denied services and working with... ...active RN license. The position offers remote work options along with a comprehensive...Remote work
- ...Brigham Incorporated is looking for a Senior Nurse Reviewer responsible for coordinating clinical charge audits and appeal processes. The role demands strong analytical... ...clinical nursing and quality assurance. This is a remote position requiring effective communication...Remote work
$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- ...IMCS Group is seeking an experienced nurse for a 10-month contract role primarily focused on reviewing clinical data and managing member appeal requests in accordance with company policies. The position allows for remote work, preferably from Iowa, with possible on-site...Remote workContract work
- ...Southcarolinablues is hiring an Appeals Analyst to join their team in Nashville, Tennessee... ...appeal requests and performing clinical reviews to ensure compliance with medical necessity... ...full-time schedule and the option to work remotely or on-site. Ideal candidates should...Remote workFull time
$45 per hour
...SPECTRAFORCE is seeking a Clinical Appeals Specialist to handle member-generated appeal processes remotely from California. The role involves reviewing medical records and ensuring compliance with... ...strong managed care and clinical nursing experience, exceptional attention...Remote workHourly pay- ...Description About the Role Are you a clinically experienced Registered Nurse looking to apply your expertise... ...patient care? As a Medical Review Nurse you will play a critical role... ...determinations, and support fair, evidence-based appeal outcomes-directly impacting both...Remote workContract workWork at officeWork from homeWork visa
- ...our mission and join our team! As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise and judgement along with established medical... ..., and computer skills. This is a fully remote position with multiple shifts available! Responsibilities...Remote workLocal areaShift work
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