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Remote Tmc Rn Jobs in Miami, FL (NOW HIRING)

Sentara Health

Wellness Health Coach

Doral, FL · Remote

$10K/mo

... RD) or Registered Nurse (RN) REQUIRED within a year of hired date. Experience: * Management ... For positions that are available as remote work, Sentara Health employs associates in the following ...

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 ...

Scribe-X

Remote Medical Scribe

Miami, 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 ...

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Remote Tmc Rn information

What are the key skills and qualifications needed to thrive as a Remote TMC RN, and why are they important?

To thrive as a Remote TMC RN (Telemedicine Registered Nurse), you need a solid clinical nursing background, active RN licensure, and experience in telehealth or case management. Familiarity with telemedicine platforms, electronic health records (EHRs), and secure communication systems is typically required. Strong communication, critical thinking, and self-motivation are crucial soft skills for effectively supporting patients and collaborating with remote teams. These competencies are essential for delivering high-quality patient care, ensuring compliance, and maintaining patient engagement in a virtual healthcare environment.

What is a Remote TMC RN?

A Remote TMC RN is a Registered Nurse who works remotely for a Telemedicine Center (TMC). These professionals provide patient care, medical advice, and support through telehealth platforms rather than in-person visits. They assess patient conditions, coordinate care, educate patients, and collaborate with other healthcare providers using digital communication tools. This role allows nurses to deliver high-quality care from a remote location, increasing access for patients in underserved or rural areas.

What is the difference between Remote Tmc Rn vs Remote Tmc Lpn?

AspectRemote Tmc RnRemote Tmc Lpn
CredentialsRegistered Nurse (RN) licenseLicensed Practical Nurse (LPN) license
Work EnvironmentHospitals, clinics, telehealthLong-term care, clinics, telehealth
Industry UsageHealthcare, insurance, telehealth

Remote Tmc Rn and Remote Tmc Lpn both work in healthcare settings, often remotely, but RNs require a registered nurse license and typically handle more complex patient care. LPNs have a practical nurse license and focus on basic patient care. Both roles are in demand for telehealth and insurance industries, but RNs generally have broader responsibilities and higher qualifications.

How does a Remote TMC RN typically coordinate care with on-site medical teams and other healthcare professionals?

A Remote TMC RN (Telemedicine Center Registered Nurse) collaborates closely with on-site healthcare teams, physicians, and specialists through secure digital platforms. Daily responsibilities include reviewing patient data, participating in virtual case discussions, and providing triage or care recommendations. Effective communication is essential, as remote RNs must relay critical information promptly and clearly, ensuring continuity of care. They often work within structured schedules but must also adapt to urgent needs, making teamwork and strong organizational skills vital to their role.
What cities near Miami, FL are hiring for Remote Tmc Rn jobs? Cities near Miami, FL with the most Remote Tmc Rn job openings:
Remote Tmc Rn jobs near you
Manager, Clinical Appeals

Manager, Clinical Appeals

Health Business Solutions LLC

Cooper City, FL • Remote

Full-time

Posted 3 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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