Akkodis
Utilization Review Nurse
Company Description
Akkodis is a global digital engineering company and Smart Industry leader. We enable clients to advance in their digital transformation with Talent, Academy, Consulting, and Solutions services. Our 50,000 experts combine best-in-class technologies, R&D, and deep sector know-how for purposeful innovation. We are passionate about Engineering a Smarter Future Together. With a shared passion for technology and talent, 50,000 engineers and digital experts deliver deep cross-sector expertise in 30 countries across North America, EMEA and APAC. Akkodis offers broad industry experience, and strong know-how in key technology sectors such as mobility, software & technology services, robotics, testing, simulations, data security, AI & data analytics. The combined IT and engineering expertise brings a unique end-to-end solution offering, with four service lines – Consulting, Solutions, Talents and Academy – to support clients in rethinking their product development and business processes, improve productivity, minimize time to market and shape a smarter and more sustainable tomorrow.
Job Description
Akkodis is seeking an Appeals Professional III (Weekend Only) for a 100% remote, contract‑to‑hire opportunity supporting Medicare appeals across the United States. This is for EST Shift, Schedule: Saturday & Sunday only Hours: 8–10 hours per day Start Time: Flexible (preference for 10:00 AM ET or earlier) Pay Range: $36–$44/hour, negotiable based on experience, education, geographic location, and other factors. Job Summary: This senior‑level role supports Medicare appeals and medical necessity reviews through independent clinical review of medical records and issuance of well‑supported reconsideration decisions in compliance with CMS and Medicare regulations. The workload and case complexity are equivalent to full‑time AP III roles.
Requirements
Required Qualifications: Associate’s degree or higher in Healthcare (or equivalent experience) 3+ years of experience in Medicare appeals, utilization review, medical review, or clinical review Clinical background as RN, PT, RT, or OT Experience with medical necessity decision‑making Strong written and analytical skills Preferred: Medicare Advantage or managed care experience Knowledge of CMS regulations and medical review processes Additional Details: Candidates may maintain another role, subject to no conflict of interest
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Responsibilities
Review medical records and Medicare appeal case files Prepare clear, concise, and impartial reconsideration decision letters Make independent medical necessity determinations using clinical evidence and Medicare guidelines Research CMS regulations, coverage manuals, and medical literature Participate in case discussions, quality reviews, and special projects Serve as a subject matter expert; mentor or support team members as needed
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