Use your RN license to impact care on a systems level, not just at the bedside. If you know utilization management and appeals and want high-level, fully remote work with serious earning potential, this is that lane.
About BroadPath
BroadPath partners with leading health plans to manage complex utilization management, appeals, and regulatory work in a remote-first model. As a UM RN Appeals Coordinator, you sit at the center of medical necessity appeals, EMRs, and State Fair Hearings, collaborating with medical directors, physician reviewers, and network providers. Your clinical judgment, documentation, and regulatory insight help protect member rights while keeping the plan compliant with Texas and HHSC standards.
Schedule
- Fully remote within the United States
- Training: 2 weeks, Monday–Friday, 8:00 a.m. – 5:00 p.m. CST
- Production: Monday–Friday, 8:00 a.m. – 5:00 p.m. CST with some flexibility
- Occasional extended hours (evenings or weekends) may be needed for time-sensitive or pharmacy-related denials
What You’ll Do
- Collaborate with physician reviewers to determine appropriate guideline citations and responses for medical necessity denials and appeals
- Oversee the clinical evaluation and processing of appeals, External Medical Reviews (EMRs), and State Fair Hearings in line with HHSC and other regulatory requirements
- Advocate for members and families by supporting continuity of care, including out-of-network authorizations when appropriate
- Develop training materials and examples for nursing staff to improve understanding of criteria, benefits, appeals, EMR, and Fair Hearing processes
- Identify process gaps, barriers, and improvement opportunities, then help design and implement solutions
- Conduct quarterly evaluations of appeal activity and status, preparing reports for both internal leadership and the State of Texas
- Coordinate Fair Hearing requests through TIERS and work with Independent Review Organizations when specialty or external reviews are needed
- Maintain complete, accurate documentation of all case activity, communications, and determinations in electronic systems
- Generate appeal determination letters and ensure communication standards and timelines are consistently met
- Educate nurse and therapist reviewers, medical directors, and other stakeholders on appeal updates, managed care policies, and Medicaid requirements
- Support audits, NCQA file reviews, and corrective action planning based on trended findings
- Analyze and report appeal trends, types, sources, and resolutions to support state reporting and avoid financial penalties
What You Need
- Active RN license for the state of Texas or a valid compact RN license
- At least 3 years of nursing experience
- At least 1 year of Utilization Management and appeals experience
- Strong knowledge of managed care, Medicaid, and regulatory expectations (including HHSC)
- Ability to assess member and family needs and understand complex pediatrics and obstetrics within a managed care environment
- Excellent verbal and written communication skills, with comfort working across physicians, clinical teams, members, and external partners
- High-level attention to detail and comfort with documentation, electronic systems, and event tracking
- Strong customer focus and diplomacy when interacting with members, providers, and internal teams
- Self-motivated, able to work independently while also being a strong collaborator
Benefits
- Base pay up to 50 dollars per hour
- Weekly pay
- Fully remote, Monday–Friday schedule with professional-level autonomy
- Opportunity to work at the intersection of clinical practice, policy, and member advocacy
- Direct impact on appeal quality, compliance, and member experience
- Inclusive, team-focused culture that values your clinical expertise and leadership
Roles that let you use your RN and UM experience at this level, fully remote and up to 50 dollars an hour, do not linger.
If you are ready to step into a high-impact appeals role where your judgment truly matters, this is the move.
Happy Hunting,
~Two Chicks…