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Sarah Jenkins
Remote Clinical Appeals Nurse jobs in the United States
Job type
Min. salary, $/year
Level
Healthcare organizations across the USA are expanding their utilization review teams, driving demand for clinical appeals nurse remote jobs. With 500+ open positions available, this growing specialty lets nurses combine nursing expertise with patient advocacy, ensuring fair coverage decisions. Remote work offers flexibility for nurses seeking a meaningful, mission-driven career nationwide.
Success in this role requires strong clinical judgment, familiarity with payer policies, and the ability to interpret medical records against criteria such as InterQual or MCG guidelines. Employers looking to hire a clinical appeals nurse value excellent written communication skills, since appeal letters must be clear, persuasive, and compliant with regulatory standards. Critical thinking and comfort navigating electronic health records round out the core competencies hiring managers seek.
Remote clinical appeals nurse positions typically involve collaborating with case managers, physicians, and insurers from a home-based office, using secure digital platforms to review denied claims. As healthcare costs rise and payer scrutiny increases, demand for experienced appeals nurses continues to grow nationwide, with organizations offering flexible schedules and competitive pay to attract qualified talent.
If you are ready to advance your nursing career while making a tangible impact on patient outcomes, now is the time to explore current clinical appeals nurse vacancies. Global Work AI connects skilled nurses with organizations eager to fill these vital remote roles, making it easier to find your next opportunity in this rewarding field.
HealthFirst
Support the clinical team by preparing case files for review, conducting appeal research, and organizing documentation. Process appeals and grievances in compliance with regulatory guidelines, ensuring timely categorization and resolution.
remote, CT, United States$49k – $66k/yrFull TimeJunior (<2 years)UBC
Provide telephonic support to healthcare providers, review payer coverage criteria, and complete clinical reviews of prior authorization and appeal submissions. Troubleshoot complex reimbursement cases, communicate effectively with providers, and prepare data for Quarterly Business Reviews.
remote, United StatesFull TimeJunior (<2 years)
Jobgether
Lead appeals operations from denial intake to submission and follow-up. Develop evidence-based appeals, manage complex denials, and establish operational procedures. Oversee AI-supported workflows and monitor performance metrics to enhance reimbursement outcomes and operational efficiency.
remote, United States$120k – $140k/yrFull TimeSenior (5+ years)
MedImpact Healthcare Systems, Inc.
Evaluate and process appeals and grievances according to established standards. Perform outreach activities to gather necessary information for processing requests. Ensure timely finalization of appeals and grievances in compliance with laws and company policies.
remote, CA, United States$34k – $44k/yrFull TimeJunior (<2 years)
UnitedHealth Group
Coordinate the Recovery Audit Contractor (RAC) audit program, ensuring compliance with regulations. Collaborate with various departments to manage audit planning, scheduling, and reporting. Analyze audit findings to identify trends and implement process improvements.
remote, United States$60k – $107k/yrFull TimeMiddle (2-4 years)
Franciscan Health
Review patient medical records using EPIC to analyze data for denied claims. Develop reports and identify root causes of denials, collaborating with departments to reduce them. Write and file appeals for Medicare, Medicaid, and Commercial payors in a timely manner.
remote, IN, United States$67k – $92k/yrFull TimeMiddle (2-4 years)
Northpoint Recovery Holdings, LLC
Manage collections and denial management for assigned accounts, ensuring timely payment from insurance companies. Perform outbound calls to resolve claims issues and follow up on denials. Prepare appeals for payer errors and document all correspondence in the billing system.
remote, United States$44k – $48k/yrFull TimeJunior (<2 years)UnitedHealth Group
Conduct clinical reviews and adjudications of appeals and grievances for various health plans. Respond to regulatory inquiries from the Department of Insurance and CMS. Collaborate with medical directors on appeals decisions and network issues.
remote, United States$249k – $373k/yrFull TimeSenior (5+ years)
Pivotal Health
Review and evaluate position statements for facility claims, ensuring clinical reasoning is robust. Define standards for strong statements and provide guidance for Product and Engineering teams. Annotate statements to train the AI model and design evaluation criteria to measure statement quality.
remote, United StatesFull TimeSenior (5+ years)
Humana
Provide clinical interpretation and judgment on service appropriateness, oversee clinical reviews of grievances and appeals, ensure compliance with medical review policies, and act as a subject matter expert on complex clinical issues.
remote, United States$246k – $344k/yrFull TimeDirector
Providence
Manage and communicate clinically-based appeals between Providence Health and Services and outside payers. Advocate for reimbursement of services provided to patients. Ensure compliance and uniformity in patient-focused activities.
remote, CA, United StatesPart TimeMiddle (2-4 years)
Gainwell Technologies LLC
Coordinate and perform appeal-related duties, including analyzing and responding to provider appeals. Review documentation to ensure all aspects of the appeal are addressed accurately. Prepare case files and summaries for hearings, and participate in virtual and on-site hearings.
remote, United States$69k – $99k/yrFull TimeSenior (5+ years)Managed Resources
Review and analyze denied MS-DRG, APR-DRG, and APC accounts from various payers. Render determinations on appealability based on client standards. Write detailed appeal letters and conduct secondary quality reviews of clinical appeal letters for accuracy and compliance.
remote, United States$65k – $91k/yrFull TimeSenior (5+ years)Managed Resources
Supervise the clinical appeals team, managing schedules and workload assignments. Ensure timely and accurate review and submission of clinical appeals, monitor quality and productivity, and conduct audits.
remote, Long Beach, CA, United States$85k – $100k/yrFull TimeLead / Manager
WellSky
Review acute and post-acute authorization requests and medical records for medical necessity. Manage medical necessity denials from notification to resolution, ensuring compliance with clinical guidelines.
remote, United StatesFull TimeMiddle (2-4 years)
Centene Corporation
Facilitate medical necessity grievances, appeals, and denials, including reviewing clinical information and generating appeal resolution communications. Prepare case reviews for the Medical Director and identify quality care concerns.
remote, CA, United States$54k – $98k/yrFull TimeJunior (<2 years)Jobgether
Manage the appeals process from receipt to resolution, ensuring compliance with regulatory requirements. Conduct detailed investigations, gather documentation, and coordinate with internal teams such as Clinical and Claims.
remote, United States$46k – $60k/yrFull TimeJunior (<2 years)
PRIORITY MANAGEMENT
Conduct comprehensive clinical reviews and produce supporting medical records for Medicare, Medicaid, and insurance audits/appeals. Develop appeal arguments using clinical evidence and participate in hearings as needed.
remote, TX, United StatesFull TimeJunior (<2 years)
Moffitt Cancer Center
Administer and coordinate denials review and appeals management processes, including denials management, claims recovery, and denial root cause analysis. Ensure compliance with Medicare and Medicaid regulations and reimbursement methodologies.
remote, United States$64k – $98k/yrFull TimeSenior (5+ years)
Baxter International Inc.
Assess cases and develop appeal strategies for insurance coverage denials. Gather clinical documentation and prepare appeal submissions for payers. Communicate with patients regarding appeal processes and responsibilities.
remote, United States$60k – $83k/yrFull TimeMiddle (2-4 years)
Amerihealth Caritas
Manage the full life cycle of member and provider appeals and grievance cases, including case intake, investigation, and documentation. Collaborate with internal departments to gather necessary information for resolution and ensure compliance with federal and state regulations.
remote, United StatesFull TimeJunior (<2 years)
ECU Health Medical Center
Coordinate daily activities of Clinical Appeals Specialists, ensuring timely follow-up on denied claims. Review and approve adjustments in accordance with policies, and evaluate staff performance and productivity.
remote, NC, United States$69k – $100k/yrFull TimeLead / Manager
Point32Health
Serve as a clinical resource for Appeals & Grievances, supporting the Analyst team with medical terminology and provider plans. Analyze and consult on physician reviews, identify complex cases for management referrals, and assess appeal trends.
remote, MA, United StatesFull TimeJunior (<2 years)Lifelancer
Review and analyze appeals related to clinical decisions, ensuring compliance with regulations. Collaborate with healthcare providers and internal teams to resolve issues and provide recommendations. Prepare detailed reports and documentation for appeals processes.
remote, CT, United StatesFull TimeJunior (<2 years)Managed Resources
Own and enhance the Clinical Appeals education and QA program. Develop standardized QA methodologies and audit frameworks, manage a centralized knowledge base, and implement process improvements. Design onboarding programs, facilitate training sessions, and evaluate training effectiveness.
remote, United States$101k – $115k/yrFull TimeSenior (5+ years)UnitedHealth Group
Conduct clinical reviews and adjudications of appeals and grievances for various health plans. Respond to regulatory inquiries from the Department of Insurance and CMS. Collaborate with medical directors on appeals decisions and benefit interpretations.
remote, United States$249k – $373k/yrFull TimeSenior (5+ years)
WellSense Health Plan
Perform administrative functions for incoming Member Appeals and Grievances, including identification, intake, and distribution. Maintain organized record-keeping processes and ensure data accuracy in the A&G system.
remote, United States$41k – $57k/yrFull TimeJunior (<2 years)
Xsolis, Inc
Investigate denied claims, document findings, and work towards reimbursement for denied services. Review supporting documentation, calculate benefits, and draft appeal letters. Analyze claims for validity and conduct research to build strong reimbursement arguments.
remote, United StatesFull TimeJunior (<2 years)Emperion
Conduct independent, evidence-based file reviews of patient records and documentation. Provide objective, high-quality reports within specified turnaround timelines. Ensure compliance with URAC, HIPAA, and internal quality standards while maintaining clinical integrity.
remote, United StatesPart TimeJunior (<2 years)UnitedHealth Group
Conduct clinical reviews and adjudications of appeals and grievances for various health plans. Respond to regulatory inquiries from the Department of Insurance and CMS. Collaborate with medical directors on appeals decisions and network quality issues.
remote, United States$249k – $373k/yrFull TimeSenior (5+ years)UnitedHealth Group
Conduct clinical reviews and adjudications of appeals and grievances for various health plans. Respond to regulatory inquiries from the Department of Insurance and CMS. Collaborate with medical directors on appeals decisions and benefit interpretations.
remote, United States$249k – $373k/yrFull TimeDirector
company
Investigate member and provider appeals, grievances, and complaints. Review medical necessity requests and clinical documentation for accuracy. Conduct clinical evaluations and manage inventory to meet regulatory timelines.
remote, Albany, NY, United States$62k – $129k/yrFull TimeMiddle (2-4 years)Xsolis, Inc
Conduct clinical reviews for managed care and payer requirements, assess medical necessity and level of care, and review clinical documentation for ICD-10 coding and DRG assignment. Support denial management and prepare appeal correspondence while providing feedback on clinical documentation.
remote, United StatesFull TimeJunior (<2 years)
Soleo Health Inc
Conduct prior authorization reviews for infusion services, evaluating patient clinicals against payer criteria. Create clinical support packets for initial authorizations and appeals, and document clinical cases for denials.
remote, United StatesFull TimeMiddle (2-4 years)
Elevance Health
Investigate and process complex grievances and appeals related to behavioral health services. Serve as a technical resource for lower-level coordinators, review medical records for denied services, and prepare recommendations for appeals.
remote, OH, United States$73k – $110k/yrFull TimeSenior (5+ years)
NTT DATA Services
Conduct clinical reviews of medical records to evaluate medical necessity for appeals. Prepare detailed case reviews and recommendations for Medical Directors. Ensure compliance with regulations and standards while maintaining accurate appeal records.
remote, FL, United States$76k/yrFull TimeMiddle (2-4 years)Gainwell Technologies LLC
Coordinate and perform all appeal-related duties, including analyzing and responding to provider appeals. Review documentation to ensure all aspects of the appeal are addressed accurately. Prepare case files and summaries for hearings, and participate in virtual and on-site hearings.
remote, United States$95k – $110k/yrFull TimeLead / Manager
Excellus BCBS
Investigate member and provider appeals, grievances, and complaints. Review medical necessity requests and clinical documentation for accuracy. Conduct clinical evaluations and manage inventory to meet regulatory timelines.
remote, Albany, New York, United States$62k – $129k/yrFull TimeMiddle (2-4 years)
Accuity
Manage daily operations of the appeals and denials process, including tracking and trending denials, writing appeal letters, and conducting audits. Supervise and mentor staff, ensuring adequate training and compliance with coding regulations.
remote, United StatesFull TimeLead / ManagerMedImpact Healthcare Systems, Inc.
Conduct clinical reviews as part of the appeals process, evaluating medical records and applying clinical criteria. Ensure compliance with regulatory standards and complete appeal reviews accurately and timely.
remote, United States$105k – $190k/yrFull TimeMiddle (2-4 years)10,000,000+ more jobs available!
