Top 435 Medicare appeals Jobs in Remote

Utilization Management Physician Reviewer (Weekends)
Toney HealthCare Consulting, LLC —Remote
- $175 - $200 an hour
- Part-time
- Remote
- Medicine
- 3 years
- Senior level
- Health insurance
Quick Apply
14d
Physician Reviewer (Hematology / Oncology / ENT / Orthopedics / Radiology / Urology)
TMF Health Quality Institute —Remote
- $10 - $150 an hour
- Contract
- Remote
- Medicine
- BC/BE
- Senior level
Quick Apply
Remote Clinical Pharmacist – Medicare (PBM Experience)
A-Line Staffing Solutions —Remote
- $53 - $55 an hour
- 8 hour shift
- Computer literacy
- Mid-level
- Bachelor's degree
- Health insurance
- Dental insurance
Quick Apply
1d
Associate Director, Market Access & Reimbursement - Alpharetta, GA or Remote
Avanos Medical —Alpharetta, GA
- $160,000 - $185,000 a year
- Full-time
- Remote
- Windows
- Analysis skills
- Bachelor's degree
- Health insurance
- 401(k) matching
Tribal Health Revenue Cycle Optimization Specialist
Encompass Health Solutions —Remote
- $55,769.11 - $60,162.80 a year
- Full-time
- Hybrid work
- Up to 50% travel
- HIPAA
- 3 years
- Health savings account
- Health insurance
Quick Apply
Appeals and Grievances Specialist
Curana Health —Remote
- Full-time
- Microsoft Excel
- Mid-level
- 3 years
2d
FULLY REMOTE - Billing Specialist (Must have hospital experience)
Legacy Health LLC —Remote
- Full-time
- Remote
- Computer literacy
- English
- Mid-level
- Health savings account
- Health insurance
Quick Apply
7d
ISNP Utilization Management Nurse
Longevity Health —Remote
- $81,000 - $99,000 a year
- Full-time
- Nursing
- Clean driving record
- RN License
Quick Apply
13d
Appeals Specialist (Part C)
TMF Health Quality Institute —Remote
- Full-time
- Remote
- Writing skills
- Research
- Mid-level
- AD&D insurance
- Disability insurance
Reimbursement Specialist - Appeals
Naveris —Remote
- Full-time
- Remote
- HIPAA
- Mid-level
- Bachelor's degree
13d
RCM Billing Specialist
MyCare Medical —Remote
- Remote
- Microsoft Outlook
- HIPAA
- Mid-level
Quick Apply
6d
Appeals Professional III (Weekend Work) (Part C)
TMF Health Quality Institute —Remote
- Weekends as needed
- Remote
- Writing skills
- Research
- Mid-level
- 401(k)
- Tuition reimbursement
Patient Acc Rep Medicare BF (Remote)
TEXASCONNECT INC —Remote
- Multiple hires
- Remote
- Microsoft Word
- High school diploma or GED
- Math
2d
Medicare Account Resolution Specialist - Digitech - Remote
Sarnova —Remote
- Full-time
- Remote
- Microsoft Outlook
- Word processing
- Computer literacy
- 401(k)
Quick Apply
Dispute Resolution Analyst
TMF Health Quality Institute —Remote
- Full-time
- Remote
- Administrative experience
- High school diploma or GED
- Business Administration
- AD&D insurance
- Disability insurance
AR Specialist | Medicare
Infinx —Remote
- $19 - $23 an hour
- Full-time
- Remote
- Microsoft Outlook
- Research
- Mid-level
- Paid holidays
- Paid time off
Quick Apply
Revenue Cycle Associate
Access Healthcare —Remote
- Full-time
- Remote
- HIPAA
- Research
- Mid-level
Quick Apply
6d
Clinical Analyst Appeals (Remote)
Beth Israel Lahey Health —Charlestown, MA
- $93,142 - $124,800 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Customer service
Claims - Examiner, Claims
Wellcove —Remote
- Full-time
- Remote
- Background check
- Anatomy knowledge
- Basic math
Quick Apply
Patient Account Rep I
Radiology Partners —Remote
- $19 - $22 an hour
- Full-time
- HIPAA
- Mid-level
- 3 years
- Paid holidays
- Health insurance
Quick Apply

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medicare appeals jobs near remote

Utilization Management Physician Reviewer (Weekends)

Toney HealthCare Consulting, LLC -
Remote

Quick Apply

Job Details

Part-time | Contract
$175 - $200 an hour
14 days ago

Benefits

Health insurance

Qualifications

Teamwork
Medicare
Electronic health records (EHR) management
Utilization management
Quality improvement
Resource utilization in healthcare
Medical License
Documentation review

Full Job Description

Job Overview

The Physician Reviewer serves as a clinical subject matter expert in the Utilization Management (UM) department. This role is responsible for conducting clinical reviews of medical necessity, appropriateness of care, and service requests based on evidence-based guidelines, medical policy, and regulatory requirements. The Physician Reviewer collaborates with UM nurses, medical directors, and other healthcare professionals to ensure appropriate, timely, and cost-effective care for members.

Key Responsibilities:

Conduct physician-level reviews of prior authorization, concurrent review, and retrospective review cases across multiple lines of business (e.g., commercial, Medicaid, Medicare).
Apply nationally recognized clinical criteria (e.g., MCG, InterQual), internal medical policies, and applicable regulations (CMS, NCQA, URAC) to review determinations.
Render clinical decisions in a timely manner consistent with regulatory timeframes and health plan policies.
Collaborate with medical directors, case managers, and care teams to support optimal care pathways.
Participate in audits, appeals, and grievance processes as needed.
Maintain current knowledge of clinical best practices, industry trends, and regulatory changes.
Participate in peer-to-peer discussions with attending physicians to communicate UM decisions and promote evidence-based care.
Analyze clinical data and documentation to support accurate determinations and appeals.
Contribute to the development and refinement of clinical policies and UM protocols specific to specialized care.
Provide guidance on clinical appropriateness, benefit coverage, and policy interpretation.
Provide education and clinical support to internal teams and external providers regarding best practices and clinical pathways.
Ensure compliance with regulatory, accreditation, and legal requirements in all UM activities.
Ensure adherence to all HIPAA, confidentiality, and privacy standards.
Participate in quality improvement initiatives and clinical case rounds.

Qualifications:

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree required.
Active and unrestricted medical license.
Minimum of 5 years of clinical practice experience in the respective specialty.
At least 3 years of experience in utilization management within a health plan.
Familiarity with evidence-based guidelines and UM tools (e.g., InterQual, MCG).
Strong communication and documentation skills.
Proficiency with electronic medical records and clinical review platforms.
Experience with Medicare/Medicaid and commercial insurance regulations is preferred.
Availability to work weekends (part-time or full-time) between 8:00 AM and 5:00 PM ET on Saturdays and/or Sundays is required.
One week of training is required during normal business hours.

Preferred Skills:

Experience with Medicare and/or Medicaid managed care plans.
Knowledge of medical necessity appeal processes and peer review protocols.
Knowledge of CMS, NCQA, and/or URAC standards.
Previous peer review or medical director experience.
Comfortable working in a remote, collaborative environment.

Pay: $175.00 - $200.00 per hour

Application Question(s):

Availability to work weekends (part-time or full-time) between 8:00 AM and 5:00 PM ET on Saturdays and/or Sundays is required.

Experience:

Utilization Management Review: 3 years (Required)
Medicare and/or Medicaid: 2 years (Preferred)

License/Certification:

Board-certified M.D. or D.O. medical license? (Required)

Work Location: Remote

Quick Apply

Refine Your Search

medicare appeals jobs in remote

Utilization Management Physician Reviewer (Weekends)

Physician Reviewer (Hematology / Oncology / ENT / Orthopedics / Radiology / Urology)

Remote Clinical Pharmacist – Medicare (PBM Experience)

Associate Director, Market Access & Reimbursement - Alpharetta, GA or Remote

Tribal Health Revenue Cycle Optimization Specialist

Appeals and Grievances Specialist

FULLY REMOTE - Billing Specialist (Must have hospital experience)

ISNP Utilization Management Nurse

Appeals Specialist (Part C)

Reimbursement Specialist - Appeals

RCM Billing Specialist

Appeals Professional III (Weekend Work) (Part C)

Patient Acc Rep Medicare BF (Remote)

Medicare Account Resolution Specialist - Digitech - Remote

Dispute Resolution Analyst

AR Specialist | Medicare

Revenue Cycle Associate

Clinical Analyst Appeals (Remote)

Claims - Examiner, Claims

Patient Account Rep I

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