Remote UM Nurse (LPN/LVN) - Medical Necessity & Appeals
Integra Partners
Phoenix, AZ
- Remote job
Integra Partners seeks an LPN/LVN to perform pre-service and post-service utilization reviews and appeals for DMEPOS within a managed care UM program. Collaborate with the Medical Director on benefit and medical necessity reviews. Responsibilities include approvals, referrals for non-eligible cases, and handling administrative/clinical appeals, while maintaining NCQA and CMS standards. Remote opportunities available. #J-18808-Ljbffr Integra Partners
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote UM Nurse (LPN/LVN) - Medical Necessity & Appeals in Phoenix, AZ vacancy
- ...seeking a Licensed Practical Nurse for utilization... ...service and post-service UM authorization, determining... ...non-eligible cases to the Medical Director. The position supports appeals processing and ensures compliance... ...have an active LVN/LPN license, 3+ years of nursing...Remote jobMedical
- ...an experienced LPN/LVN to perform pre-service... ...reviews and appeals within a NCQA-compliant UM program. You... ...collaborate with our Medical Director to... ...benefit and medical necessity criteria and... ...at least 3 years nursing experience, and... ...in managed care. Remote opportunities are...Remote jobMedical
- ...seeking a licensed practical nurse (LPN/LVN) experienced in the managed care... ...utilization reviews and appeals for DMEPOS. The role collaborates with the Medical Director on benefit and medical necessity decisions within an NCQA-compliant UM program. The UM Nurse will conduct...Remote jobMedical
- Integra is looking for a LPN/LVN experienced in the... ...utilization reviews and appeals for DMEPOS. This role collaborates with our Medical Director to perform benefit and medical necessity reviews within an NCQA-compliant UM program. The UM Nurse’s responsibilities include...Remote jobMedical
- ...is seeking an experienced LPN/LVN to perform pre-service and... ...service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to ensure NCQA-compliant UM programs and benefit... ...The role requires 3+ years nursing and 2+ years UM experience...Remote jobMedical
- Integra Partners is seeking an LPN/LVN with managed care UM experience to perform pre-service... ...service utilization reviews and appeals for DMEPOS, collaborating with our Medical Director within an NCQA-compliant UM program. The UM Nurse is responsible for reviews, approvals...Remote jobMedical
$60k
...Partners is seeking a LPN/LVN with UM experience to perform... ...utilization reviews and appeals for DMEPOS. This role collaborates with our Medical Director within an... ...year. Minimum 3 years nursing and 2 years UM in managed... ...You will ensure medical necessity criteria and...Remote jobMedical- Integra Partners is seeking an LPN/LVN with experience in the... ...utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to ensure NCQA-compliant UM program operations. The role... ...knowledge of medical necessity criteria, effective communication...Remote jobMedical
- ...is looking for a LPN/LVN experienced in... ...utilization reviews and appeals for DMEPOS. This... ...with our Medical Director to perform... ...and medical necessity reviews and appeals... ...NCQA-compliant UM program. The UM Nurse’s... ...wellness programs ~ Remote Opportunities...Remote workMedicalTemporary workLocal area
Integra Partners
Lorida, FL2 days ago - ...seeks an experienced LPN/LVN to perform pre-... ...and post-service UM reviews and appeals within a NCQA-... ...collaborate with the Medical Director on benefit and medical necessity reviews in a... ...requires active nursing licensure, 3+ years... ...CMS guidelines. Remote opportunities are...Remote jobMedical
- ...seeking a licensed nurse to perform pre-service... ...and post-service UM authorization... ...state mandates and medical criteria to determine medical necessity. You will approve eligible... ...Director, handle appeals, and help ensure compliance... ...benefiting from remote work options. #J-1...Remote jobMedical
$53 per hour
...Description Job Description REMOTE RN OPPORTUNITY – GRIEVANCE & APPEALS / UTILIZATION REVIEW $... ...experienced Registered Nurses to join a leading... ...license Direct outpatient UM experience. Strong... ...authorizations and medical necessity reviews Grievance & Appeals...Remote jobMedicalLong term contractWork from homeMonday to FridayShift workWeekday workPhaxis - Healthcare
Huntington, NY4 days ago$45 per hour
...Description Utilization Management Nurse Coordinator (RN or LVN) needed for a temp 6+ month, remote contract opportunity with Yoh’... ...managed care setting. The UM RN Nurse Coordinator reviews... ...authorization requests, assesses medical necessity, collaborates with...Remote workMedicalContract workTemporary workMonday to FridayWeekend workYoh, A Day & Zimmermann Company
Fairfield, CAa month ago- ...seeking an experienced LPN/LVN to perform pre-... ...utilization reviews and appeals within a NCQA-compliant UM program. The role collaborates with the Medical Director to assess benefit and medical necessity for DMEPOS. The... ...compensation with benefits, remote opportunities across...Remote jobMedical
- Integra Partners seeks a licensed LVN/LPN with managed care UM experience to perform pre-... ...service utilization reviews and appeals for DMEPOS, collaborating with the Medical Director within an NCQA-... ...evaluating requests against medical necessity, applying InterQual and CMS...Remote jobMedical
- ...Hospital Utilization Management (UM) Nurse, you are the primary link... ...administrative compliance. Unlike remote roles, this position relies... ...admission and concurrent medical record reviews to ensure patients... ...does not support medical necessity or the current level of care....Remote workMedicalFull timeImmediate startShift work
Wellstar Health Systems, Inc.
Marietta, GAa month ago $28 per hour
LPN Utilization Management Nurse Reviewer Miami, FL (Work from Home position... ...and Durable medical equipment and supplies... ...established medical necessity/appropriateness criteria... ...and retrospective UM related functions: 1... ...Required) Work Location: Remote #J-18808-Ljbffr...Remote workMedicalHourly payFull timeWork at officeLocal areaWork from homeRelocationHome officeWeekday work- Elevance Health is seeking a Nurse Appeals professional to investigate and process medical necessity appeals for members and providers. The role supports remote work with required in-person training and adherence to commuting guidelines. You will review records, summarize...Remote jobMedical
- ...Description The Telehealth Nursing Department has an... ...Licensed Practical Nurse (LPN) to work Hybrid located... ...members of the nursing and medical staff and other hospital... .... Competent in remote patient monitoring and using... ...welcome.miami.edu/about-um to learn more about our...Remote workMedicalPart timeWorldwide
University of Miami
Avenue, MD5 days ago - ...Description Role Snapshot The Appeals Nurse examines medical records and claims information for first-... ...experience. **Work Location We are open to remote work in the following approved states... ...reviews to determine the clinical necessity of services and make recommendations...Remote workMedicalFor contractorsImmediate start
Wisconsin Physicians Service Insurance Corporation
Grove City, OH2 days ago - WPS Health Solutions in Columbus, OH, is seeking an Appeals Nurse to review medical records and Medicare claims for first-level appeals to determine medical necessity and coverage alignment. The role collaborates with Appeals Examiners to prepare timely redeterminations...Remote jobMedical
$25 - $35 per hour
...is seeking a Clinical Appeals Nurse to join a leading... ...organization for a contract remote opportunity located in... ...• Obtain and assess medical documentation from... ...Carolina licensure as an LPN, Physical Therapist (PT... ..., and medical necessity reviews. • Experience...Remote workMedicalHourly payContract workPiper Companies
United States4 days ago- ...Clinical Appeals Specialist The Clinical Appeals Specialist completes... ...clinical, contractual, medical policy and claims information... ...prioritize appeal requests using nursing expert knowledge and all... ...skills to assess the medical necessity and appropriateness of patient...Remote workMedicalWork at office
Ageatia Global Solutions
United States2 days ago $26.01 - $56.14 per hour
About This Role The UM Nurse Consultant at CVS Health is a remote position ideal for experienced inpatient Registered Nurses looking to leverage their... ...Evaluate clinical documentation and determine medical necessity using established guidelines Collaborate with hospitals...Remote workMedicalFull timeMonday to Friday$26.01 - $56.14 per hour
About This Role The Concurrent Review UM Nurse Consultant role at CVS Health is... ...: $26.01 - $56.14/hour Location: Remote, LA Residency: Louisiana residency... ...requests across a broad range of medical specialties. Evaluate medical necessity using clinical records, evidence-based...Remote workMedicalFull time- ...exciting career opportunity available as an Clinical Appeals Nurse. This position will be Remote Work from Home. The Full Time schedule for this role... ..., and/or government entities/auditors related to medical necessity and/or level of care. Essential Duties And Responsibilities...Remote workMedicalFull timeWork from homeMonday to Friday
- ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical Appeals Position Overview... ...denied claims for clinical accuracy and medical necessity, developing evidence-based appeal strategies, and...Remote workMedical
Health Business Solutions LLC
Cooper, FL22 days ago - ...LLC delivers innovative medical claims solutions through... ...role of Precertification Nurse is to perform Pre-... ...determining the medical necessity of requested services for... ...Precertification Nurse - LPN/RN Full time: Monday to Friday Location: Remote. Will need to be in Hamilton...Remote jobMedicalFull timeWork at officeMonday to Friday
$40k
...to offer an Inpatient Licensed Practical Nurse (LPN) a $10,000 sign on bonus for eligible... ...working at Geisinger: ~ Full benefits (medical, dental and vision) starting on day one... ...acute to complex medical conditions with remote telemetry and dialysis capability....Remote workMedicalFull timeTemporary workPart timeRelocation packageFlexible hoursShift workNight shiftWeekend workAfternoon shiftGeisinger
Wilkes Barre, PA8 days ago$21.45 - $29.11 per hour
Building Location: St Josephs Medical Center Department: 4004200... ...the supervision of a Registered Nurse (RN), you will work... ...Key Responsibilities of this LPN: * Deliver high-quality nursing... ...activities. FTE: 0.7 Possible Remote/Hybrid Option: Shift Rotation...Remote workMedicalPermanent employmentLocal areaImmediate startWork from homeFlexible hoursShift workWeekend workAfternoon shiftEssentia Health
Brainerd, MN14 hours ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote UM Nurse (LPN/LVN) - Medical Necessity & Appeals. Be the first to apply!
Related searches