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Remote Kaiser Rn Jobs in Boca Raton, FL (NOW HIRING)

Seaside Home Health

Clinical Manager

Delray Beach, FL · Remote

The Part-Time QA Nurse is a remote-based RN who plays a critical role in ensuring the clinical documentation integrity, regulatory compliance, and accreditation readiness of our Florida-based home ...

ClinDCast LLC

EMR Systems Analyst

Delray Beach, FL · Remote

Preferred: * Clinical certification (e.g., RN, LPN, PT) or background in nursing or allied health. * Experience working with IT support tools (ticketing systems, remote support platforms)

Scribe-X

Remote Medical Scribe

Fort Lauderdale, FL · Remote

$14 - $17/hr

Anyone looking to begin a career in medicine (MD, DO, PA, NP, or RN) should consider becoming a medical scribe first! Scribe Pay Structure: $11/hour - No scribe experience $12/hour - 6+ months scribe ...

Tempus

Senior Data Modeler I

Boca Raton, FL · On-site +1

$90K - $130K/yr

Clinical background (MD/DO, PharmD, PA, NP, RN, etc.). * Familiarity with next-generation ... Additionally, for remote roles open to individuals in unincorporated Los Angeles - including remote ...

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Remote Kaiser Rn information

What is a Remote Kaiser RN job?

A Remote Kaiser RN job is a nursing position with Kaiser Permanente that allows registered nurses (RNs) to work from home or a remote location. These nurses typically provide virtual patient care, conduct telehealth assessments, offer patient education, and assist with case management. They use electronic health records and telecommunication tools to coordinate care and ensure patients receive necessary support. This role requires an active RN license, clinical experience, and proficiency with technology.

What are the key skills and qualifications needed to thrive in the Remote Kaiser Rn position, and why are they important?

To thrive as a Remote Kaiser RN, you need a valid registered nursing license, strong clinical assessment skills, and experience with telehealth or remote patient care. Familiarity with Kaiser's electronic health record (EHR) systems, HIPAA compliance, and telemedicine technology is usually required. Excellent communication, critical thinking, and time management abilities are vital soft skills for succeeding in a remote setting. These skills ensure you can deliver quality patient care and coordinate effectively with both patients and interdisciplinary care teams from a distance.

What are the typical daily responsibilities of a Remote Kaiser RN?

As a Remote Kaiser RN, your daily responsibilities typically include conducting virtual patient assessments, providing health education, managing care coordination, and documenting patient interactions in the EHR system. You'll triage patient needs, offer evidence-based guidance, and often collaborate with physicians, pharmacists, and other healthcare specialists via secure digital platforms. The role may also involve following up on test results, arranging referrals, and responding to patient inquiries in a timely manner. Strong organizational skills are important, as you will manage your caseload independently while ensuring adherence to Kaiser's standards and protocols.
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What are the most commonly searched types of Kaiser Rn jobs in Boca Raton, FL? The most popular types of Kaiser Rn jobs in Boca Raton, FL are:
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What cities near Boca Raton, FL are hiring for Remote Kaiser Rn jobs? Cities near Boca Raton, FL with the most Remote Kaiser Rn job openings:
Remote Kaiser Rn jobs near you
Infographic showing various Remote Kaiser Rn job openings in Boca Raton, FL as of May 2026, with employment types broken down into 87% Full Time, and 13% Part Time. Highlights an 97% Physical, and 3% Remote job distribution.
Manager, Clinical Appeals

Manager, Clinical Appeals

Health Business Solutions LLC

Cooper City, FL • Remote

Full-time

Posted 21 days ago

Job description

Job Summary:

We are seeking an experienced and highly organized Manager of Clinical Appeals to lead our clinical appeals operations across commercial and government payers. This role is responsible for overseeing day-to-day activities of clinical appeal specialists, managing appeal strategy execution, ensuring quality and compliance, and meeting client-specific performance goals.

The ideal candidate brings a strong background in clinical review, medical necessity denials, payer appeal processes, and team leadership—ideally across both U.S. and offshore teams (e.g., Philippines). This position is critical to ensuring timely and effective resolution of denied claims, supporting revenue recovery efforts, and maintaining payer and regulatory compliance.

Key Responsibilities:

  • Manage the full-cycle clinical appeals process across multiple payer types, with a focus on government (e.g., Medicare, Medicaid) and commercial payers.
  • Lead and support a team of nurses, clinical reviewers, and appeal specialists—including potential offshore (Philippines-based) staff.
  • Monitor appeal workloads, productivity, and turnaround times to ensure all appeal deadlines and client service level agreements (SLAs) are met.
  • Review and approve complex or high-value clinical appeal cases, ensuring clinical accuracy and compliance with payer guidelines.
  • Maintain up-to-date knowledge of medical necessity criteria, payer policies, NCDs/LCDs, and applicable CMS regulations.
  • Train new and existing team members on clinical guidelines, appeal writing standards, and regulatory requirements.
  • Work cross-functionally with audit, legal, compliance, and operations teams to align on strategy and escalate trends or systemic payer issues.
  • Identify and implement process improvements to increase efficiency, reduce denials, and improve overturn rates.
  • Support the creation and refinement of appeal templates, clinical arguments, and documentation standards.
  • Generate and deliver performance and quality reports to leadership, identifying risks and opportunities for improvement.

Qualifications:

  • Registered Nurse (RN) or clinical degree required; Bachelor's degree in Nursing, Health Administration, or related field preferred.
  • 5+ years of experience in clinical appeals, utilization review, or medical necessity denials.
  • 2+ years in a leadership or supervisory role, preferably within a revenue cycle or payer appeals setting.
  • In-depth understanding of payer denial processes, especially Medicare Advantage, Medicaid Managed Care, and commercial plans.
  • Experience managing remote and/or offshore teams (Philippines experience preferred).
  • Strong working knowledge of ICD-10, CPT, and HCPCS coding as they relate to clinical justifications.
  • Excellent writing skills and the ability to clearly communicate complex clinical reasoning.
  • Familiarity with appeal submission portals, EHRs, and workflow platforms.
  • Knowledge of HIPAA, CMS, and NCQA standards.

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