193 clinical appeals jobs at 107 companies in United States
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Clinical Appeals Coord
Philadelphia, Pennsylvania, United States
RemoteFull Time
5+ YOEActive unrestricted RN license, 5+ years clinical healthcare experience, experience with utilization management/appeals, strong written communication, audit readiness, and proficiency with Microsoft Office and clinical systems.
InterQual, MCG, Microsoft Office, Microsoft Authenticator
2w
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Clinical Appeals Manager MN
Yonkers, New York, United States
$80k-$100k/yr OnsiteFull Time
Manage clinical appeals, analyze denials, interface with health plans, and supervise appeals staff; requires bachelor's in healthcare or related field, clinical background (RN/PA/HIM) and managed care/utilization management experience.
1w
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Clinical Appeals Specialist
Miami, Florida, United States
OnsiteFull Time
2+ YOEBachelor's in health field,2 years clinical appeals or claims experience,EHR and claims software proficiency,medical terminology knowledge,excellent written/verbal communication;Spanish preferred.
EHR, claims management software
1mo
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Clinical Appeals Coordinator
Monongalia County, West Virginia, United States
RemoteFull Time
3+ YOECurrent RN or LPN license (or multi-state via eNLC), 3+ years clinical claims and appeals experience, 2 years customer service, proficiency with InterQual and/or Milliman Care Guidelines and Microsoft Office.
InterQual, Milliman Care Guidelines, Microsoft Office
1mo
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Clinical Appeals Coordinator
Monongalia County or United States
RemoteFull Time
3+ YOECurrent RN or LPN licensure (or multi-state compact), 3+ years clinical claims and appeals experience, 2+ years customer service, proficiency with InterQual/Milliman Care Guidelines and Microsoft Office, strong communication and problem-solving.
InterQual, Milliman Care Guidelines, Microsoft Office
1mo
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Clinical Appeals Senior Consultant
United States
RemoteFull Time
7+ YOEActive RN/BSN or clinically relevant licensure, CCS/CPC certification, 7+ years appeals/denials/chart audit experience, strong clinical documentation and analytical skills, EHR proficiency.
EHR
2w
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Clinical Appeals Specialist II-Hybrid
Rochester, Minnesota, United States
$88k-$124k/yr HybridFull Time
3+ YOEAssociates degree and active unrestricted RN license, 3+ years nursing experience, knowledge of ICD-10/DRG and clinical validation, experience with denials/appeals, Epic and Microsoft Office skills.
Epic, Microsoft Office Suite, Milliman Care Guidelines, InterQual Criteria, ICD-10-CM/PCS, DRG
1mo
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Appeals Clinical Specialist
San Diego, California, United States
$52-$94/hr OnsiteFull Time
3+ YOEPharmD (or equivalent) with 3+ years' experience and 1 year SME, current unrestricted US pharmacist license, strong clinical pharmacy knowledge, ability to evaluate records and make clinical determinations, Microsoft Office proficiency.
Microsoft Office, Microsoft Outlook
1w
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Clinical Appeals & CDI Manager
Long Beach or United States
$95k-$142k/yr RemoteFull Time
3+ MgmtRN or Physician required; 3+ years supervisory experience in CDI/appeals/coding; CCDS or CDIP required; CCS preferred; strong DRG, appeals, communication, leadership, and Microsoft Office proficiency.
Microsoft Office
1mo
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Medicare Clinical Appeals Reviewer III
United States
RemoteFull Time
2+ YOEActive clinical license (RN, PT, RT, OT),2+ years medical review or appeals experience,ability to write determinations,proficiency with Microsoft 365/Excel/Word,and ability to pass background,verification, and drug screening.
Microsoft 365, Microsoft Excel, Microsoft Word
1w
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Clinical Appeals Coord in Work From Home
Philadelphia, Pennsylvania, United States
RemoteFull Time
5+ YOEActive unrestricted RN license, 5+ years clinical nursing experience, experience with utilization management/appeals, knowledge of NCQA/state/federal appeal requirements, strong communication and analytical skills.
Microsoft Office, Microsoft Authenticator, InterQual, MCG, CMS
2d
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Clinical Appeals Coordinator
Oregon or Kansas or Wisconsin or Arizona or South Dakota or North Dakota or Washington or Nevada or Montana or Idaho or New Mexico or Utah or Iowa or Wyoming or Colorado or Missouri or Texas or Minnesota
$34-$61/hr RemoteFull Time
4+ YOERN with 4+ years of clinical nursing or case management experience, or LPN/LVN with 5+ years; applicable state license required. Managed care or utilization review experience preferred.
NCQA
2w
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Clinical Appeals Specialist II-Hybrid
Rochester, Minnesota, United States
$88k-$124k/yr HybridFull Time
3+ YOEAssociate degree, active unrestricted Ohio RN license, 3+ years nursing experience, knowledge of coding/DRG/appeals, familiarity with Milliman/InterQual/Epic, strong communication and analytical skills.
Milliman Care Guidelines, InterQual, Epic, Microsoft Office Suite
1mo
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IBR Clinical Appeals Analyst - Remote
United States
$35-$63/hr RemoteFull Time
2+ YOEActive RN with undergraduate nursing degree, 2+ years appeals/coding or auditing experience, CPT-4/NCCI/ICD-10 knowledge, strong writing and critical thinking, Microsoft Excel proficiency.
Microsoft Excel, Word, Adobe
1mo
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Clinical Denials and Appeals Specialist
United States
RemoteFull Time
5+ YOEActive RN license, 5+ years clinical nursing, 3–5 years denials/appeals experience, strong clinical review and persuasive writing, knowledge of medical necessity, DRG, ICD-10, CPT/HCPCS, Medicare/Medicaid, and payer policies.
InterQual, MCG, Microsoft Word, Epic
3w
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Appeals and Grievances Clinical Specialist
New York City or Lake Mary or New York or New Jersey or Connecticut
$73k-$120k/yr RemoteFull Time
Active RN required; BLS/CPR required, ACLS preferred; experience in clinical practice and appeals & grievances or utilization review; knowledge of Utilization Review guidelines; proficiency with Word/Excel and care management systems.
Microsoft Word, Microsoft Excel, Macess, CCMS, TruCare, Hyland, InterQual, Milliman
1w
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Appeals and Grievances Clinical Specialist III
Arkansas or Arizona or Florida or Georgia or Iowa or Illinois or Kansas or Kentucky or Michigan or Minnesota or Missouri or North Dakota or Nebraska or Oklahoma or South Dakota or Tennessee or Texas or Virginia or Wisconsin
$70k-$105k/yr RemoteFull Time
5+ YOEActive unrestricted RN license, 5+ years clinical experience, experience in appeals/grievances or managed care preferred, BLS/ACLS preferred, knowledge of CMS/NCQA and STARs, strong clinical decision-making and communication.
Microsoft Office
2mo
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Appeals Professional
Austin or United States
RemoteFull Time
1+ YOEAssociate's degree (or 60+ credits) in healthcare or related, or equivalent experience; 1+ year Medicare appeals/medical review/clinical or healthcare compliance experience; ability to review medical records, make independent decisions, and research regulations.
2mo
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Appeals Professional
Austin or United States
RemoteFull Time
1+ YOEAssociate's degree or 60+ credits in healthcare (or equivalent experience), 1+ year Medicare appeals/medical review/clinical/regulatory experience, US residency 3 of last 5 years, ability to review records and write impartial decisions.
1mo
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Clinical Appeals Nurse (Remote | Must have California LVN / RN License)
United States or California
$78k-$117k/yr RemoteFull Time
2+ YOEActive California LVN or RN license, minimum 2 years clinical nursing experience, 1 year utilization management/appeals experience preferred, knowledge of clinical criteria and coding (ICD-10, CPT), proficiency with Milliman/InterQual/Apollo, EMR, Word, Excel, and Outlook.
Milliman, InterQual, Apollo, ICD-10, CPT, Word, Microsoft Excel, Microsoft Outlook, Access Express, N-coder, EHR
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