Remote Utilization Review RN - Medical Claims & Appeals
Molina Healthcare, Inc.
- 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.
- ...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 workMedicalClaims
$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 jobMedicalClaimsHourly payLocal area- ...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 workMedicalClaimsFlexible hours
$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 jobMedicalClaims$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 jobMedicalClaims$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 workMedicalClaimsFull timeFlexible hours$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...MedicalClaimsHourly pay- ...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...MedicalClaims
- ...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...MedicalClaims
- ...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...MedicalClaimsWork at office
$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 jobMedicalHourly payWork at office- ...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 jobMedicalClaimsFull time
- 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 jobMedicalClaimsFull time
$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 jobMedicalClaimsFull timeMonday to Friday- ...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 workMedicalClaimsContract workFor contractorsFor subcontractorShift work
- ...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 workMedicalClaimsContract workLocal area
- ...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 workMedicalClaimsContract workLocal area
$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 workMedicalClaimsTemporary workWork at officeWork from homeMonday to FridayFlexible hours- ...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...MedicalClaims
$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 workMedicalClaimsHourly payMinimum wageFull timeWork at officeLocal areaFlexible hours- ...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 workMedicalClaimsFull timeTemporary workFlexible hours
- ...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 workMedicalClaimsWork at office
- ...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...MedicalClaims
$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...MedicalClaimsHourly pay$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...MedicalClaimsHourly pay$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 workMedicalClaimsFull timeWork from homeRelocation packageFlexible hours$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...MedicalClaimsHourly pay$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 workMedicalHourly payFull timeContract workImmediate startShift work3 days per week$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...MedicalClaimsHourly pay$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...MedicalClaimsHourly pay
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