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Remote Appeals RN: Medicare Medical Necessity Review

Remote / Online - Candidates ideally in
Denver, Denver County, Colorado, 80285, USA
Listing for: WPS Health Solutions
Remote/Work from Home position
Listed on 2026-08-22
Job specializations:
  • Healthcare
    Healthcare Management, Healthcare Administration
Salary/Wage Range or Industry Benchmark: 66000 - 68000 USD Yearly USD 66000.00 68000.00 YEAR
Job Description & How to Apply Below

WPS Health Solutions seeks an Appeals Nurse to review medical records and claims for first-level appeal cases to determine medical necessity and adherence to Medicare guidelines. You will collaborate with Appeals Examiners to ensure redeterminations are medically reviewed and completed timely.

Responsibilities include preparing written rationales, maintaining CMS-compliant timelines, and staying current with healthcare regulations.

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