If you’re an RN who knows UM and appeals and you’re tired of chaos masquerading as “process,” this role is built for precision. You’ll coordinate medical necessity appeals end-to-end, protect member rights, and keep everything compliant, documented, and moving.
About BroadPath
BroadPath is a work-from-home company supporting healthcare organizations with services that keep operations running smoothly and members supported. They build remote teams focused on quality, accuracy, and efficiency. They also emphasize an inclusive culture that values different backgrounds and perspectives.
Schedule
- Fully remote (United States)
- Training: 2 weeks, Monday–Friday, 8:00 AM–5:00 PM CST
- Production: Monday–Friday, 8:00 AM–5:00 PM CST (flexible)
- Note: Some flexibility may be needed for pharmacy-related denials, including evenings/weekends
- Pay: Up to $50/hour, paid weekly
What You’ll Do
- Coordinate clinical evaluation and processing of medical necessity appeals with clinical reviewers, medical directors, physician reviewers, and network providers/facilities
- Ensure compliance with HHSC and applicable regulatory/accreditation standards, including timeliness, documentation, and member/provider notification requirements
- Partner with physician teams on denial categories, guideline citations, and appropriate responses to support consistent decision-making
- Manage EMR and Fair Hearing workflows, including coordinating requests through TIERS when requested by Members/LARs or providers
- Oversee accurate documentation and recordkeeping across electronic/event tracking systems, including appeal determination letters
- Provide education and training support for clinical reviewers (nurses/therapists), including creating training examples and updates as processes change
- Conduct audits and support corrective action planning; assist with appeal file preparation for NCQA reviews
- Analyze quarterly appeal trends and produce internal and state-required reporting, ensuring timely HHSC submissions to avoid penalties
- Advocate for continuity of care needs, including out-of-network authorization approvals when appropriate
What You Need
- Active Texas RN license or compact RN license
- 3+ years nursing experience
- 1+ year Utilization Management and Appeals experience
- Strong written, verbal, and computer skills with excellent documentation habits
- Ability to work independently and stay organized in a remote environment
- Team-first mindset with strong stakeholder communication (providers, members/LARs, internal clinical teams)
Benefits
- Work from home
- Weekly pay
- Competitive pay (up to $50/hour)
- Consistent weekday schedule with flexibility during production
These roles don’t stay open long when they’re paying top-of-range. If you’ve got UM + appeals experience and the license piece, move on it.
This is impact work: you’re protecting due process, keeping care decisions defensible, and making sure people aren’t getting lost in the system.
Happy Hunting,
~Two Chicks…