Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Remote Utilization Review RN - Medical Claims & Appeals

Molina Healthcare, Inc.

New York, NY
  • Remote job

Molina Healthcare, Inc. is hiring a full-time Licensed Medical Review Nurse to conduct reviews of medical documentation while working remotely. This role involves managing appeals and validating claims to ensure medical necessity and compliance with guidelines. Ideal candidates will have at least 2 years of clinical nursing experience, including utilization review, and a valid RN license in Florida or Kentucky. Strong analytical skills and proficiency in coding are preferred. #J-18808-Ljbffr Molina Healthcare, Inc.

Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Remote Utilization Review RN - Medical Claims & Appeals in New York, NY vacancy
  •  ...Utilization Management Position Provide health care services regarding...  ...planning and utilization review. Review admissions...  ...and retrospective medical necessity and/or compliance...  ...precertification, reimbursement and claim denials/appeals. Assess and coordinate... 
    Remote work
    Medical
    Claims

    St. Vincent's Health System

    United States
    2 days ago
  • $45.9 - $71.4 per hour

    Description Utilization Review RN - Remote. The RN Care Coord‑Qual Med Mgmt will provide administration of medical management programs that include prior...  ...skilled nursing review, appeals and grievance, delegation...  ...development and medical claims audits. These programs are... 
    Remote job
    Medical
    Claims
    Hourly pay
    Local area

    Providence Health & Services

    Renton, WA
    1 day ago
  •  ...Medical Review Clinical Appeals Auditor (RN) In October 2025, Machinify acquired Performant...  ...conducts research, analyzes claims data, applies knowledge...  .... Experience with utilization management systems or clinical...  ...to work independently in remote setting with minimum... 
    Remote work
    Medical
    Claims
    Flexible hours

    Performant Healthcare, Inc.

    United States
    1 day ago
  • $84.06k - $118.67k

     ...a Licensed Registered Nurse for a remote position in Utilization Management. The role involves providing...  ...discharge planning, conducting reviews for medical necessity, and assisting with coding and claims issues. Candidates must hold an RN license from the Texas Board of... 
    Remote job
    Medical
    Claims

    Ascension

    Austin, TX
    1 day ago
  • $47.06k - $70.24k

     ...solutions provider is seeking a Utilization Review Nurse in Fort Worth, TX. This remote role involves analyzing medical bill appropriateness, documenting...  ..., and communicating with claims examiners. Candidates must have a current RN license and at least four years... 
    Remote job
    Medical
    Claims

    Care Options for Kids

    Fort Worth, TX
    3 days ago
  • $80k - $99.2k

     ...Nurse Reviewer Appeals and Hearings- Remote It takes great medical minds to create powerful solutions that...  ...required CEUs to maintain RN license and/or coding...  ...perform reviews of multiple claim types to provide a...  ...required. 3+ years of utilization review experience or claims... 
    Remote work
    Medical
    Claims
    Full time
    Flexible hours

    Gainwell Technologies

    United States
    1 day ago
  • $29.05 - $67.97 per hour

     ...Healthcare in Omaha, NE is seeking a Utilization Review Nurse to ensure medical necessity and the appropriate level of...  ...reviewing documentation, facilitating appeals, and validating claims. The ideal candidate will have an active RN license, at least 2 years of nursing experience... 
    Medical
    Claims
    Hourly pay

    Molina Healthcare

    Omaha, NE
    15 hours ago
  •  ...a qualified Registered Nurse to conduct reviews of medical documentation to ensure compliance with healthcare...  ...nursing experience, including a year in utilization review. Responsibilities include facilitating medical reviews of claims, resolving utilization management... 
    Medical
    Claims

    Molina Healthcare

    Tampa, FL
    15 hours ago
  •  ...seeking a Registered Nurse for clinical review in Miami, Florida. This role involves ensuring medical necessity for claims, handling appeals, and validating medical records...  ...clinical nursing, including experience in utilization review. Skills in coding and regulatory... 
    Medical
    Claims

    Molina Healthcare

    Miami, FL
    1 day ago
  •  ...in Albany, NY, is seeking a clinical review specialist to ensure medical necessity and appropriate care levels...  ...nursing experience and hold an active RN license. Responsibilities include reviewing medical claims, facilitating appeal processes, and resolving issues... 
    Medical
    Claims
    Work at office

    Molina Healthcare

    Albany, NY
    1 day ago
  • $28.94 - $51.63 per hour

     ...Association Inc is seeking a Clinical Appeals RN to manage appeals and grievances effectively...  ...with Microsoft Office. You will review medical records, assess clinical eligibility for...  ...compliance with all regulations while working remotely from anywhere in the U.S. Attractive... 
    Remote job
    Medical
    Hourly pay
    Work at office

    Wisconsin Psychiatric Association Inc

    Cypress, CA
    1 day ago
  •  ...a full-time Michigan Licensed Medical Review Nurse to manage the review of documentation in a remote capacity. This role involves ensuring...  ...records, and overseeing claims for accurate reimbursement. The...  ...experience and possess an active RN license in Michigan. Knowledge... 
    Remote job
    Medical
    Claims
    Full time

    Molina Healthcare, Inc.

    New York, NY
    3 days ago
  • A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and... 
    Remote job
    Medical
    Claims
    Full time

    Innovative Systems Group

    Richardson, TX
    2 days ago
  • $67.7k

    A specialized consulting firm is seeking a Medical Claims Reviewer to conduct medical reviews and provide guidance on claims. This remote role requires an active RN license, a bachelor's degree in nursing, and at least five years of clinical experience. Ideal candidates... 
    Remote job
    Medical
    Claims
    Full time
    Monday to Friday

    Broadway Ventures LLC

    New York, NY
    2 days ago
  •  ...Appeals Processor III - RN ~ salary ~ Unavailable ~ Hours per week...  ...our dedicated team in a remote capacity. The Appeals Processor...  ...III) is responsible for reviewing, analyzing, and...  ...Healthcare appeals ~ Medical claims / utilization review ~ Insurance or... 
    Remote work
    Medical
    Claims
    Contract work
    For contractors
    For subcontractor
    Shift work

    Ghost RX

    Orlando, FL
    5 days ago
  •  ...Job Title: Utilization Review Nurse Location: Remote in IL, TX, NM, MT or OK Duration: 6+...  ...member benefits, evaluate medical necessity and promote effective...  ...• Current unrestricted RN license. Multi-State License...  .../ICD-10), and overall claims process a plus • Knowledge... 
    Remote work
    Medical
    Claims
    Contract work
    Local area

    Innovative Systems Group

    Chicago, IL
    15 hours ago
  •  ...Job Title: Utilization Review Nurse Location: Remote in IL, TX, NM, MT or OK Duration: 6+...  ...member benefits, evaluate medical necessity and promote effective...  ...• Current unrestricted RN license. Multi-State License...  .../ICD-10), and overall claims process a plus • Knowledge... 
    Remote work
    Medical
    Claims
    Contract work
    Local area

    Innovative Systems Group

    Richardson, TX
    2 days ago
  • $57.24k - $62.18k

     ...benefits, including medical, dental, vision,...  ...-life balance. ~ Remote/hybrid setting (once...  ...This individual will utilize clinical knowledge...  ...to a second level reviewer. This individual interfaces...  ..., benefit and claim concerns, and...  ...is not limited to RN, LMSW, LMHC. # Must... 
    Remote work
    Medical
    Claims
    Temporary work
    Work at office
    Work from home
    Monday to Friday
    Flexible hours

    Hines and Associates

    Rockford, IL
    2 days ago
  •  ...in Phoenix, Arizona, to oversee medical review processes ensuring appropriateness...  ...Applicants should possess an active RN license and have at least 2 years...  ...detailed evaluations of medical claims and provide clinical resources for utilization management. A background in... 
    Medical
    Claims

    Molina Healthcare

    Phoenix, AZ
    1 day ago
  • $30.64 - $45.8 per hour

     ...Job Description The Utilization Review Nurse gathers demographic...  ..., certifies the medical necessity and assigns...  ...CorVel. This is a remote position. ESSENTIAL...  ...concern to the appropriate claims staff/customer Collects...  ...operation required; RN is required unless... 
    Remote work
    Medical
    Claims
    Hourly pay
    Minimum wage
    Full time
    Work at office
    Local area
    Flexible hours

    CorVel Healthcare Corporation

    Rancho Cucamonga, CA
    12 days ago
  •  ...Rising Medical Solutions has an opening for a Utilization Review Nurse , and we want to hear from you! We're a bill review...  ...reducing the cost of healthcare claims through bill review, case management...  ...Hold an active and unencumbered RN license in one or more states... 
    Remote work
    Medical
    Claims
    Full time
    Temporary work
    Flexible hours

    Rising Medical Solutions

    United States
    4 days ago
  •  ...Position Summary The Utilization Review Nurse works as is responsible...  ...high quality, cost efficient medical outcomes for those enrollees...  ...authorization requests as well as claims disputes. The...  ...clinical nursing experience as an RN, preferably in a hospital setting... 
    Remote work
    Medical
    Claims
    Work at office

    Martins Point Health Care

    United States
    3 days ago
  •  ...Louisville, KY, is seeking a Clinical Reviewer to utilize clinical knowledge for validating medical claims and ensuring compliance with...  ...reviews of authorization appeals, working closely with medical directors...  ...should possess a valid RN license, at least 2 years of nursing... 
    Medical
    Claims

    Molina Healthcare

    Louisville, KY
    4 days ago
  • $29.05 - $67.97 per hour

     ...San Antonio, Texas, is seeking a Utilization Review Nurse responsible for assessing medical documentation ensuring appropriateness...  .... The role includes reviewing claims for pre-authorization, conducting...  ...will possess an active RN license and 2 years of nursing experience... 
    Medical
    Claims
    Hourly pay

    Molina Healthcare

    San Antonio, TX
    15 hours ago
  • $29.05 - $67.97 per hour

     ...Healthcare is seeking a Clinical Review Nurse in Dallas, Texas to oversee the medical review process and...  ...possess a current RN license and have clinical...  ...experience, particularly in utilization review. This role...  ...reviews, and validating claims to ensure appropriate reimbursement... 
    Medical
    Claims
    Hourly pay

    Molina Healthcare

    Dallas, TX
    15 hours ago
  • $90k - $99k

    It takes great medical minds to create powerful solutions...  ...for a DRG Nurse Reviewer Appeals and Hearings to coordinate...  ...CEUs to maintain RN license and/or coding...  ...perform reviews of multiple claim types to provide a...  ...expect in this role Remote (Work from Home) Up to... 
    Remote work
    Medical
    Claims
    Full time
    Work from home
    Relocation package
    Flexible hours

    Santa Barbara Cottage Hospital

    New York, NY
    2 days ago
  • $29.05 - $67.97 per hour

     ...clinical nurse responsible for reviewing documentation for medical necessity and appropriate...  ...levels. The role involves appeals facilitation, claims auditing, and ensuring...  ...experience, specifically in utilization review, and must hold an active RN license. Key skills... 
    Medical
    Claims
    Hourly pay

    Molina Healthcare

    Cincinnati, OH
    4 days ago
  • $35 - $45 per hour

     ...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX...  ...and will include 80% travel. Remote role. Will require a driver...  ...and resolving complaints and appeals. Licensed Clinical Social...  ...top-tier hospitals and medical institutions nationwide, helping... 
    Remote work
    Medical
    Hourly pay
    Full time
    Contract work
    Immediate start
    Shift work
    3 days per week

    TravelNurseSource

    Corpus Christi, TX
    15 days ago
  • $29.05 - $67.97 per hour

     ...Healthcare in Austin, TX, is seeking a qualified Registered Nurse to handle clinical reviews. This role involves assessing medical necessity, validating claims, and facilitating appeals. Candidates should have a minimum of 2 years of clinical nursing experience. The... 
    Medical
    Claims
    Hourly pay

    Molina Healthcare

    Austin, TX
    1 day ago
  • $29.05 - $67.97 per hour

     ...Healthcare in Bellevue, Washington, is looking for a Registered Nurse (RN) with at least 2 years of clinical nursing experience. You will utilize your clinical knowledge to review documentation for medical necessity and appropriate levels of care. The position involves... 
    Medical
    Claims
    Hourly pay

    Molina Healthcare

    Bellevue, WA
    1 day ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Utilization Review RN - Medical Claims & Appeals. Be the first to apply!