Remote Clinical Review Nurse - Denials & UM Improvement
Accede Solutions Inc (accedesolution.com)
Accede Solutions Inc. is hiring a Remote Clinical Review Nurse (Concurrent Review) for a 12-month contract. The role focuses on NCQA-aligned clinical reviews and drafting correspondence letters related to denial determinations for Medicaid products in IL and MI.
You will collaborate with the correspondence team to maintain letter templates, investigate denials through clinical documentation, and coordinate with state, local, and federal agencies to resolve issues in a timely manner.
#J-18808-Ljbffr- ...Job Description: Clinical Supervisor, UM Denial Compliance Location... ...Position Type: Hybrid (85% remote, 15% onsite in... ...tasks, performance reviews, and disciplinary actions... ...strategies for improvement. 11. Review performance... ...Registered Nursing Program; RN preferred...Remote workPermanent employmentTemporary work
- ...Pre-Service Clinical Review Nurse (Per Diem) Must Live in WA or... ...-SERVICE CLINICAL UR/UM ** ** PRIOR UTILIZATION... ...ways to address improvement opportunities for team... ...necessity and benefit denials across the continuum... ...Standard Worker Location: Remote Employee Status:...Remote workDaily paidTemporary workWork experience placementLive inLocal areaShift work
- University of California - Los Angeles Health is seeking an UM Denial Nurse Reviewer to support cost-effective care by applying clinical knowledge, policies, and regulatory guidelines to review denials and ensure accurate, timely notifications. The role collaborates with...Suggested
- ...Position Title Clinical Review Nurse - Prior Authorization Work Location Remote - PST and CST (No CA and NY candidates please)... ...medical care. Background & Context UM is highly focused on how we can... ...of creativity and continuous improvement. Key Responsibilities Routinely...Remote workFlexible hoursShift work
- ...Authorization Management Clinical Reviewer – Appeals and Denials This job is... ...opportunities for process improvement to reduce... ...utilization review nurses, and hospital stakeholders... ...formal appeals. UM/CM Knowledge of ICD... ...time. #LI-PG1 #LI-Remote WellSky is where...Remote workFull timeWork experience placementWork at office
- ...Position Title Clinical Review Nurse - Concurrent Review Work Location Remote-MS CST Assignment Duration 3 Months Contract to Hire Work Schedule... ...Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity...Remote workContract workFlexible hoursWeekend work
$27.02 - $48.55 per hour
...Remote Prior Authorization Reviewer Position Purpose: Analyzes all prior authorization... ...medical necessity and clinical reviews of authorization requests... ...on opportunities to improve the authorization review process... ...: Bachelor's degree in Nursing (BSN) or graduation from...Remote workHourly payFull timePart timeWork at officeMonday to FridayFlexible hours- ...Title: Clinical Review Nurse- Concurrent Reviews Location: Remote- KY or Compact state license Duration: 6 months with possible extension or conversion... ...years of related experience. Disqualifiers: no UM background- must be tech savvy Additional qualities...Remote workShift work
$65k - $75k
.... Job Description The Clinical Review Nurse makes prospective medical necessity... ...This is a full-time, fully remote, production-based role.... ...quality-of-care concerns to UM Leadership. Participates... ...calibration, and applies feedback to improve accuracy. Keeps current...Remote workHourly payFull timeWork at officeLocal areaMonday to Friday- ...Position Title: Clinical Review Nurse - Concurrent Review Work Location: Remote, Compact Nursing License Required, Central Time Zone Work Schedule Assignment... ...Provides feedback to leadership on opportunities to improve appropriate level of care and medically...Remote workContract workWeekend work
$70k - $120k
...inclusion. Our company is fully remote and offers a flexible work... ...The position of UM Outpatient Review Nurse reports to the Director, Case... ...team and is responsible for clinical, quality, and patient outcomes... ...necessity criteria. Process denials within established...Remote workFull timeWork at officeFlexible hoursWeekend work- ...SCAN is seeking a California-licensed registered nurse to provide clinical review of medical claims and post-service appeals. You will... ..., and collaborating with the Medical Director on denials and appeals. This is a remote position with competitive pay and benefits. #J-...Remote work
$80k - $100k
...Clinical Reviewer – Registered Nurse (RN) Comagine Health | Washington State | Remote / Work From Home Department: Care Management Contract: Washington Labor & Industries... ...Comagine Health, we are passionate about improving the quality, safety, and value of...Remote workFull timeContract workLocal areaWork from homeHome office- ...Utilization Management (UM) Nurse, you are the... ...link between the clinical floor and administrative... .... Unlike remote roles, this position... ...concurrent medical record reviews to ensure patients... ...notices (MOON).o Denial Prevention:... ...continuous performance improvement initiatives based...Remote workFull timeImmediate startShift work
$27.02 - $48.55 per hour
Business Area: Clinical & Care Management Job Type: Full... ...: Performs concurrent reviews, including determining... ...Details: This role is fully remote/work from home. The... ...experience. RN compact nursing licensure is preferred... ...leadership on opportunities to improve appropriate level of...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hoursWeekend work- Work Mode: 100% Remote, Source candidates from EST preferred... ...: Perform concurrent reviews of members for... ...leadership on opportunities to improve appropriate level of... ...necessity based on clinical policies and guidelines... ...an Accredited School of Nursing or Bachelor’s degree in...Remote workWeekend work
- ...oversight of staff UM RNs to ensure... ...expected that all RN Clinical Nurses are licensed, knowledgeable... .... Unlike remote roles, this position... ...Medical Necessity Reviews: Use criteria like... ...notices (MOON).o Denial Prevention: Proactively... ...performance improvement inclusive of all stakeholders...Remote workFull timeImmediate startShift work
$44.42 per hour
...and Responsibilities: Review requests for services... ...stays for adherence to clinical criteria, state and federal... .... Issue approvals, denials or recommendations based... ...Current Registered Nurse (RN) license valid in the... ...Previous experience working remotely Prior experience...Remote workMinimum wageContract workTemporary workWork experience placementWork at officeWork from homeHome office$93.4k - $116.8k
...interdepartmental Quality Improvement (QI) initiatives... ...member care. Serves as a clinical and operational... ...Performs clinical reviews with network providers... ...Registered Professional Nurse in New York State or New... ...members on any given day. Remote working/work at home options...Remote workWork experience placementFlexible hours- HCSC is seeking a QOC Nurse to review and investigate potential quality of care issues under the QOC Manager. You will conduct quality improvement activities in accordance with CMS, NCQA, and state regulations, interfacing with staff, members, and providers. Strong communication...Remote job
- ...to join our talented Team.Job Title: Clinical Medical Review Nurse.Location: Owings Mills, MD.SummaryThe... ...gaps in care, and opportunities for improved health outcomes.Provide clinical expertise... ...and a collaborative mindset.Remote work environment with minimal physical...Remote work
- ...Miramar, FL 33025, USA Remote Travel Required : No Clinical Care Coordination HH... ...we have been dedicated to improving lives by delivering the highest... ...a Utilization Management Nurse, you will ensure that... ...compliance. By continuously reviewing and auditing patient...Remote workFull timeTemporary work
- ...oversight of staff UM RNs to ensure... ...'s goals, process improvements, policies and procedures... ...that all RN Clinical Nurses are licensed, knowledgeable... .... Unlike remote roles, this position... ...Medical Necessity Reviews: Use criteria like... ...notices (MOON). o Denial Prevention: Proactively...Remote workImmediate startShift work
$70.2k - $120.4k
...Accessibility Accomodation for Applicants page. Clinical Quality Review Nurse III Posted on October 26, 2026 Locations Showing 1 location Remote Remote Health Services Full-Time... ...and coding expertise to identify improvement opportunities and ensure the reliability...Remote workFull timeWork experience placement- ...Job Title: Clinical Review Nurse - Concurrent Review - J00933 Address: Various, SC Job Description Perform concurrent reviews to assess members... ...Information*** Schedule: Monday–Friday, 8:00 AM–5:00 PM EST Remote: 100% Remote Hours: Full-time, 40 hours per week Weekend...Remote workFull timeMonday to FridayWeekend work
- ...pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate... ...necessity reviews within a NCQA-compliant UM program. Responsibilities include... ...criteria, and referring non-meeting cases. Remote opportunities available; competitive compensation...Remote work
- Description The Clinical Nurse Reviewer plays a crucial role in the healthcare industry by evaluating... ...care provided, identifying areas for improvement and adherence to best practices.... ...perform the essential functions. This is a remote position. While performing the duties...Remote workWork at office
- ...seeking detail-oriented English speakers to review AI-generated media. You will hold live... ...video pairs, and explain what’s off, all remotely and on your own schedule. Work from home... ..., provide written explanations, and help improve AI systems, with free access to leading LLMs...Remote jobWeekly payWork from homeFlexible hours
$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. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise...Remote jobMinimum wageFull timeWork experience placementWork at officeLocal areaHome officeFlexible hours- ...LVN to conduct pre-service and post-service utilization reviews and appeals within a NCQA-compliant UM program, collaborating with our Medical Director.... ...including approvals, referrals, and handling appeals. Remote opportunities available and strong team culture. #J-...Remote work
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