Remote DRG Nurse Reviewer - Appeals & Hearings
Gainwell Technologies
- Remote job
Gainwell Technologies is seeking a DRG Nurse Reviewer Appeals and Hearings to coordinate and perform all appeal related duties including analyzing and responding to appeals from providers; reviewing documentation to ensure all aspects of the appeal have been addressed; and preparing case files and case summaries for hearings. The role offers remote (work from home) options with up to 25% travel for onsite hearings. #J-18808-Ljbffr Gainwell Technologies
$95k - $110k
...DRG Nurse Reviewer Appeals and Hearings- Remote It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career...Remote workFull timeWork from homeRelocation packageFlexible hours$95k - $110k
Gainwell Technologies is seeking a DRG Nurse Reviewer Appeals and Hearings professional for remote work. You will coordinate and perform appeal duties, analyze documentation, prepare case files and participate in hearings, both virtual and on-site as needed. Required are...Remote job- ...product offering to include DRG Revenue Integrity services.... ...healthcare! This is a remote position ESSENTIAL DUTIES AND... .... Job Description: The DRG Appeals Specialist performs reviews of inpatient DRG payer denials... ...hands and arms, talk, and hear. Exert up to 20 pounds of force...Remote workTemporary workWork at officeLocal areaImmediate startShift work
- CorroHealth is seeking a DRG Appeals Specialist to perform reviews of inpatient DRG payer denials for hospital clients. You will validate ICD-10-CM/PCS... ...coding guidelines to maximize appropriate reimbursements. This is a remote position. #J-18808-Ljbffr CorroHealth IncRemote job
$65k - $116.75k
...RCM Inc. is seeking a Clinical Coding Appeals Nurse to review medical records, draft appeals of denied... ...claims, and ensure accurate coding of DRG revisions using ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance. This is a remote, independent, production-driven role requiring...Remote job- ...attorneys or law school graduates to serve as Hearings Officers for unemployment hearings. The... ...hours. The position supports the Appeals Department, which holds hearings in accordance... ...Act and state law, with options to work remotely from any location in Texas. #J-18808-...Remote job
$35.54 - $55.73 per hour
...Nurse Reviewer I Nurse Reviewer I Seeking RNs that have a current, unrestricted RN license in either the state of Illinois and/or California... ...department standards and performance metrics. Validating appeal requests. Manage appeal requests that come via email, fax,...Remote workFull timeWork experience placementWork at officeLocal areaMonday to FridayShift workWeekend workAfternoon shift- ...straight to better care.? Requirements The Nurse Reviewer performs complex medical record reviews... ...Preferred Qualifications MAC or RAC appeals review experience CPC (or similar) coding... ...perform the essential functions. This is a remote position. While performing the duties of...Remote workContract workFor contractorsLocal area
- ...Description Provide timely review and determination of medical claims... ...prior authorization, appeals, and/or any other type of medical... ...State license as a Registered Nurse (RN),as required by contract(s... ...essential for this position Remote but need to be local to 18702...Remote workContract workFor contractorsWork experience placementWork at officeLocal area
- ...department, the full-time Registered Nurse Clinical Reviewer will perform clinical validation by ensuring... ...within medical records, while working remotely from anywhere in the United States.... ...ICD-10 coding and basic knowledge of DRG validation and coding Ability to use...Remote workFull time
- ...Position Summary: The level 2 Denial Specialist Appeal Writer reviews and analyzes Diagnostic Related Grouper (DRG) downgrades, preparing detailed, evidence-based... ...Education Minimum: Bachelor of Science in Nursing Preferred: Master's degree or equivalent...Contract workWork at office
- ...Nurse Reviewer Contract Duration: Initial 6-months Pay: $27.50/hr on W2 Start Date: 9/8/2026 Location: Fully Remote (US Only) LPN State License must be active and in good standing for the entirety of the assignment. Be prepared to share license at the time...Remote workContract work
$60 per hour
...organization in Jericho, NY is seeking a Full-time Registered Nurse Clinical Reviewer. This role requires a Baccalaureate degree in Nursing and... ...will have 1-3 years of experience in utilization review or appeals and strong communication skills, contributing to patient...Hourly payFull time$28.94 - $51.83 per hour
...Clinical Appeals RN Optum is a global organization that delivers... ...for attending appeal hearings, defending MassHealth prior authorization... ...clinical coverage review of services. Works closely with... ...Qualifications: ~ Associate's degree in Nursing ~ Unrestricted RN license...Remote jobHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal area- Healthcare Quality Strategies, Inc. (HQSI) is seeking a Nurse Reviewer for a remote position supporting Medical Review Services. The role requires conducting comprehensive medical necessity reviews and ensuring compliance with established guidelines. The ideal candidate...Remote job
- ...Grievance & Appeals Coordinator Are you an analytical problem solver with a passion for healthcare managed care? We are seeking dedicated... ...to join our growing, collaborative team! In this fully remote role, you will analyze and resolve complex member and provider...Remote workWork from homeHome officeWeekend work
- A healthcare quality organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The ideal... ..., and participating in ongoing training. This is a part-time remote position, offering a flexible work environment with...Remote jobHourly payPart timeFlexible hours
- A healthcare organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The role involves... ...review experience. This position offers a chance to work in a remote setup with competitive hours. Benefits include medical, dental...Remote job
- ...Grievance & Appeals Coordinator Are you a detail-oriented managed care professional looking for an exciting work-from-home opportunity... ...to join our dynamic team! In this essential role, you will review incoming complaints, investigate complex authorization and claims...Remote workWork from home
- Commence is seeking a Nurse Reviewer to perform complex medical record reviews of Medicare Part A/B and DMEPOS claims. The role requires clinical... ...payment validity according to CMS guidelines. The position is remote, offering flexibility while demanding high accuracy and...Remote job
- Staffmark Group is recruiting a Registered Nurse for a remote role. Primary duties include reviewing peer review reports, ensuring evidence-based rationales, and ensuring compliance with client, contract, and regulatory standards. The ideal candidate holds an RN or LPN...Remote jobWeekly payContract work
$43 - $47 per hour
...Roles, MA, Phlebotomist, CNA|| Passionate ||… Home Health RN - Remote (CA License Required) Facility: Compassus Providence Home Health... ...Torrance, CA (5315 Torrance Blvd, Ste 169-B) Role Type: Remote Reviewer RN - Back Office Chart Review Start Date: 11/03/2025 Duration:...Remote workContract work$70k - $80k
Diagnosis Related Group (DRG) Auditor III Join to apply for the... ...team! This role offers a fully remote work experience with possible... ...comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG... ...strong uphold rates for appeals. Stay ahead of industry trends...Remote workFull timeWork experience placementReliefWork from homeHome officeRelocation package- We are seeking experienced US registered nurses to review and assess AI-generated responses from a health coaching agent, with a focus on safety... ...AI models for patient-facing health guidance. This is a remote, flexible and short-term project. Key Responsibilities:...Remote jobHourly payTemporary workPart timeFor contractorsFlexible hours
- ...diverse workforce, which is a reflection of our clients and the people they serve. Location: Remote with on‑site visits across Illinois Position Overview The Nurse Reviewer conducts provider compliance reviews to ensure adherence to state regulations, quality standards...Remote workH1bWork at officeFlexible hours
$40 per hour
PT (20-30 hours week) - Remote Work Environment Non-Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews...Remote workContract workWork at officeLocal areaImmediate start- ...Utilization Management Authorization Review Nurse Astiva Health, Inc., located in Orange,... ...healthcare services. Coordinate with the Appeals team to support the completion of appeal... ...or crawl, climb or balance, talk and hear. While performing the duties of this...
$17 - $21.5 per hour
...Appeals Coordinator Payrate: $17-$21.50 per hour, which may be below your state's minimum... ...of Administrative Law (DAL) in appeal hearings with presentations of summaries of evidence. In this remote role, you will: Review decision/denial letters on new appeals...Remote workHourly payMinimum wageCurrently hiringWork at officeLocal areaWork from homeFlexible hours$90k - $110k
...DRG Revenue Integrity Auditor Remote CareNational is looking for an experienced DRG Revenue Integrity Auditor ! Ideal candidates will have at... ...assignment and code sequencing. Maintain quality of reviews and make sure the true clinical picture is captured, along...Remote workImmediate startWork from home- ...seeking a Staff Analyst I/II or Associate Staff Analyst to administer ADA Access-A-Ride eligibility appeals. The role involves processing appeals, scheduling hearings, communicating with appellants, and generating periodic reports on suspension and conduct data, with...Remote job
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