Remote RN: Clinical Review & Claims Adjudication I
Elevance Health, Inc.
Chandler, AZ
- Remote job
Elevance Health, Inc. is seeking a Clinical Review Nurse I to review claims for medical necessity and coverage within Wellpoint Federal. The role can be performed virtually with required in-person trainings and occasional office visits within a reasonable commuting distance. You will adjudicate claims using medical policy and ensure alignment with program requirements. Candidates should have an RN license, at least one year of clinical experience, and AS in nursing; a BS in nursing is preferred. #J-18808-Ljbffr Elevance Health, Inc.
Vacancy posted 13 hours ago
Similar jobs that could be interesting for youBased on the Remote RN: Clinical Review & Claims Adjudication I in Chandler, AZ vacancy
- ...Wellpoint Federal) is seeking a Clinical Review Nurse I to review medical determinations for claim benefits. This virtual-eligible... ...using medical policy and adjudicate claims, requiring ASN and at least... ...experience plus an unrestricted RN license. Residency in the US is...Remote jobClaimsWork at officeFlexible hours
- ...Brighterway builds AI-native claims software and... ...compensation medical-legal review, where our agentic document... ...them. You will be the clinical conscience of the... ...What we look for Active RN license and 5+ years of... ...opportunity employer. Location: Remote (United States)...Remote workClaimsFull timeFlexible hours
Brighterway, Inc.
New York, NY5 hours ago $36.49 - $41.49 per hour
...Overview: The Clinical Medical Review Nurse handles day to... ...and institutional claims and provider appeals... ...claims processing and/or adjudication. The candidate will... ...review experience. ~ RN - Registered Nurse -... ...skills. Remote EMR access experience...Remote workClaimsWork at officeCynet Systems
Baltimore, MD4 days ago$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting... ...applications This is a 100% remote role, and requires robust internet... ...authorization data with post-service claims validation, we're creating a transparent...Remote workClaimsFull timeFlexible hoursShift workVenturefizz Product Management Community
United States4 days ago$29 - $52 per hour
...us to start Caring. Connecting. Growing together. The Clinical Claim Review RN will be responsible for performing compliance reviews of medical... ...will be aligned with your schedule. This position is Remote in Massachusetts. You will have the flexibility to work...Remote workClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift workUnitedHealth Group
Boston, MA2 days ago$28.94 - $51.83 per hour
...Ssbv Clinical Claims Review Rn Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits...Remote jobClaimsHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal areaHome office$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization that delivers care, aided by technology... ...a comprehensive understanding of the claim review process including clinical claim... ...Associate's degree ~ Active and unrestricted RN license OR LPN in the state of residence...Remote jobClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal area$29 - $52 per hour
...Optum Clinical Claim Review Nurse Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier... ...: ~ Associate's degree ~ Active and unrestricted RN license in the state of residence ~2+ years of clinical experience...Remote jobClaimsHourly payMinimum wageFull timeContract workTemporary workWork experience placementWork at officeLocal area- ...Optum Waste and Error Claims Investigator Optum is a global organization that delivers care, aided... ...the viability of the claim for further review in a production environment. Primary Responsibilities: Clinical Case Reviews - 75% Perform clinical review of...Remote jobClaimsContract workWork at officeLocal areaMonday to Friday
- ...Provide timely review and determination of medical claims, including prior authorization... ...medical record; Adjudicate claim based on the... ...Registered Nurse (RN),as required by contract(s). 1+ years clinical experience required... ...for this position Remote #J-18808-Ljbffr...Remote workClaimsContract workFor contractorsWork experience placementWork at officeLocal area
Federal Hearings And Appeals
New York, NY4 days ago - UnitedHealth Group in the United States is seeking a SSBV Clinical Claim Review Nurse Manager - Remote to lead a team of RN reviewers in a fast-paced, production-driven environment. This role emphasizes accurate, well-documented determinations and adherence to guidelines...Remote jobClaims
- ...an integral role in the review process as they are... ...company best practices, and clinical accuracy. In addition,... ...preferred. LPN or RN license required for this... ...stipend are provided for remote workspace. ABOUT DANE... ...over 200,000 insurance claims annually for leading...Remote workClaimsTemporary workWork at officeWork from home
- ...DescriptionJob DescriptionCLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These positions... ...as to the validity of health claims and levels of payment in... ...unrestricted Registered Nurse (RN) licensePREFERRED QUALIFICATIONS...Remote workClaimsPermanent employmentWork at officeLocal area
ARC Group Inc
Jacksonville, FL1 day ago - ...Enterprise Engagement Officer Compliance Oversight Specialist (Non Clinical) Vice President, Clinical Operations - Behavioral Health UM... ...Officer Privacy & Security Enterprise Engagement Officer Director, Claims Business Implementation Manager, Payment Integrity - Financial...Remote jobClaims
- ...Broadway Ventures is seeking a dedicated Registered Nurse (RN) to join our Medical Review team in a remote role. You will conduct pre- and post-payment medical... ...have an active RN license in the U.S., two years of clinical experience, and proficiency with MS Office. #J-1880...Remote workClaims
BROADWAY VENTURES, LLC
United States2 days ago $39 - $40 per hour
...Job Position: Concurrent Review RN Location: Chicago, IL 60601... ...candidates note that this role is remote. Required Education and... ...Responsibilities: Performs clinical review of outcomes including... ...information to resolve denial claims Assists with issues and/or...Remote workClaimsLocal areaAltaStaff
Chicago, IL5 hours ago- ...Clinical Denial Management NurseTurn clinical expertise... ...enterprise.Work Style: Remote Location Requirement: Must... ...care, utilization review, and patient access.Serves... ..., reviewing denied claims from a clinical perspective... ...as a Registered Nurse (RN) or Licensed Practical...Remote workClaimsFull timeWork at office
UF Health
Jacksonville, FL1 day ago $110k - $140k
...experienced Senior Claims Analyst with deep... ...in hospital claims adjudication, stop loss... ...skills. This is a remote role. Key Responsibilities... ...Claims Analysis & Review ~ Perform... ...findings packages (clinical, contractual, and... ...Nursing background (RN) and clinical...Remote workClaimsFull timeContract work$91.7k - $163.7k
...SSBV Clinical Claim Review Nurse Manager - Remote Optum Insight is improving the flow of health data and information to create a more connected system.... ...Oversee quality assurance for onshore and offshore RN teams Complete administrative responsibilities, including...Remote jobClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaHome officeFlexible hours- Medix is seeking an RN-Coder Clinical Validation Reviewer to support payment integrity and clinical validation workflows in a hybrid setup. The role emphasizes reviewing medical records against claims to determine support for billed services, with documentation of clear...Remote jobClaimsWork at office
- ...to the LTSS department. RN will be responsible for... ...and concurrent review. Provides monthly telephonic... ...resources. Applies clinical knowledge to work with... ...appropriateness of care and accurate claims payment. May also... ...Info: *possible remote opportunity after...Remote workClaimsContract workMonday to FridayFlexible hours
HealthCare Support
New York, NY1 day ago - ...Corporation is seeking a Utilization Review Case Manager for a remote role. The ideal candidate holds an RN license and has 4+ years of clinical experience with utilization review, CPT... ...certification, and collaboration with claims staff and stakeholders. Applicants should...Remote jobClaims
- ...industry player is seeking a Medical Review Nurse to join their dynamic team in Phoenix... .... This role involves reviewing and adjudicating medical claims, ensuring compliance with industry... ...enjoying the flexibility of a primarily remote work environment. If you are passionate...Remote jobClaims
- Broadway Ventures is seeking a Medical Reviewer (1099 contract) on a remote basis for the United States. The... ...and coding, documenting outcomes with clinical rationale, and engaging with... ...accuracy and QA is required. Minimum RN licensure and 2+ years in clinical work...Remote jobClaimsContract workWork from home
- CorVel is seeking a Utilization Review Case Manager to gather demographic and clinical data for in-patient and... ...Management department’s goals. This remote role requires RN licensure and 4+ years of... ...emphasizes collaboration with claims staff, physicians, and clients...Remote jobClaims
$68.97k - $113.31k
Guardian Life is seeking an RN Clinical Consultant to support disability claim decisions. You will review medical data, assess functional capacity, and collaborate with providers... ...and 3+ years in LTD/STD clinical consulting. Remote options nationwide are available, with salary...Remote jobClaims$35 - $40 per hour
...through service offerings for clinical, case management, member... ...solutions, payment integrity, claims cost containment, and analytics. Job Title RN Utilization Management Reviewer Responsibilities Conduct timely... ...weekends. Location: Fully remote work at home role. Secure,...Remote workClaimsHourly payTemporary workMonday to FridayFlexible hoursWeekend workSagility LLC
New York, NY6 hours ago$63k - $73k
...you can achieve. Utilization Review Nurse (RN) As a nurse at Sedgwick, you... ...in a nontraditional clinical setting. Apply your RN clinical... ...and well-being of others in a remote work environment. Enjoy flexibility... ...with physicians, claims examiners, clients, vendors,...Remote workClaimsWork experience placementLocal areaFlexible hoursSedgwick
New York, NY4 days ago- The Clinical Reviewer Specialist is responsible for performing clinical and... .... Position is fully remote only in the state of Florida... ...basis for the appeal. Review claim and service appeals for reconsideration... ...reviewer to make final adjudication of claim approval or denial...Remote workClaimsTemporary workLive inImmediate startRelocationFlexible hours
- CoventBridge Integrity Systems is seeking a Medicaid Medical Review RN (Medical Reviewer III) for remote work with potential on-site audits in Grove City, OH. The role focuses on clinical reviews of medical records during fraud investigations and applies Medicare/Medicaid...Remote jobClaims
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN: Clinical Review & Claims Adjudication I. Be the first to apply!
Related searches
- outpatient rn Chandler, AZ
- ed rn Chandler, AZ
- registered nurse office Chandler, AZ
- labor & delivery rn Chandler, AZ
- registered nurse remote Chandler, AZ
- mother baby postpartum rn registered nurse Chandler, AZ
- injection rn Chandler, AZ
- gastroenterology rn Chandler, AZ
- rn iv therapy Chandler, AZ
- registered nurse healthcare Chandler, AZ