23 Clinical Appeals Review jobs

New York, United States (Remote)

$27.00 – $49.00 / hour

Position Purpose: Performs clinical reviews needed to resolve and process appeals by reviewing medical records and clinical data to determine medical…

Washington, United States (Remote)

$34.00 – $61.00 / hour

Position Purpose: Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals.

Colorado, United States + 16 more (Remote)

$66–68K / year

Role Snapshot The Appeals Nurse examines medical records and claims information for first-level appeal cases to determine whether services provided…

United States (Remote)

$73–125K / year

Job Description A bit about this role: The Clinical Readmission Manager is responsible for conducting prepayment and post-payment clinical reviews of…

United States (Remote)

Overview HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an…

Oregon, United States + 1 more (Remote)

$102.3–125.1K / year

Registered Nurse - Utilization Management I --------------------------------------------------------------- The Registered Nurse - Utilization…

United States (Remote)

$82.7–96.5K / year

Job Description A bit about this role: The Clinical Guide Part A will be part of the Utilization Management team, responsible for inpatient,…

United States (Remote)

As a Senior Review Coordinator RN , you will be responsible for conducting utilization review/medical management for all services, including…

Alabama, United States (Remote)

Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or…

United States (Remote)

$34.00 – $61.00 / hour

Position Purpose: Analyze, develop and monitor clinical QI activities to ensure compliance with customer expectations and lead clinical quality initiatives.

Harrisburg, Pennsylvania, US (Hybrid)

Category: Health Care Location: Harrisburg Pennsylvania United States Seeking a Registered Nurse (RN) – Expert Medical Examination Consultant to…

Oklahoma, United States (Remote)

$75.3–135.4K / year

Position Purpose: Supervises Prior Authorization, Concurrent Review, Retrospective Review Clinical Review and/or Appeals team to ensure appropriate…

United States (Remote)

This is a remote position.

Oklahoma, United States (Remote)

$87–161.3K / year

Position Purpose: Manages Prior Authorization, Concurrent Review, Retrospective Review Clinical Review and/or Appeals team to ensure appropriate care to members.

Pennsylvania, United States (Remote)

Imagine a career at one of the nation's most advanced health networks.

Massachusetts, US (Hybrid)

$100–105K / year

Job Description: Candidates must live in Massachusetts and hold an active, unrestricted Massachusetts RN license at the time of hire.

Harrisburg, Pennsylvania, US (Hybrid)

Category: Health Care Location: Harrisburg Pennsylvania United States Are you a registered nurse ready to take your career in an exciting new…

Virginia, United States + 28 more (Remote)

$93.2–136.9K / year

City/State Norfolk, VA Work Shift First (Days) Overview: Sentara Health Plans is hiring a Utilization Review Nurse/ RN for Imaging/Commercial- Remote!

California, United States (Remote)

As a pharmaceutical support industry leader, UBC is devoted to empowering health solutions for a better tomorrow.

South Carolina, United States + 3 more (Remote)

Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or…