Remote Medical Review Nurse - CMS RAC Audits
$81k - $90kSanta Barbara Cottage Hospital
Santa Barbara Cottage Hospital is looking for a Medical Review Nurse to perform medical claims audits primarily for government clients. The role requires an active RN license and at least five years of diversified nursing experience. Responsibilities include auditing claims, documenting findings, and collaborating with the audit team. This position offers a remote work environment, with a competitive salary range of $81,000 - $90,000, alongside various benefits to support work/life balance. #J-18808-Ljbffr
- ...Medical Review Nurse - CMS RAC In October 2025, Machinify acquired Performant and we are now part of... ...Medical Review Nurse - CMS RAC (Government audits) primarily performs medical claims... ...and Commercial Payers. You will work remotely in a fast paced and dynamic...Remote workCmsMedicalFor contractorsWork at officeShift work
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- ...Position Summary Concurrent Review Nurse is responsible for performing... ...management activities to ensure medical services are delivered... ...procedures. Ensure compliance with CMS guidelines, accreditation... ...organizational skills. Work Environment Remote Equal Opportunity Employer...Remote workCmsMedicalApprenticeshipLocal area
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- ...Administrative Nurse At Reliant Management... ...Conduct regular audits of nursing documentation and medical charts for accuracy... ...regulatory compliance Review resident care records... ...regulatory updates (CDPH, CMS) to inform audit... ...and with remote teams Riverside PostAcute...Remote workCmsMedical
- ...Job Title: Medical Claim Review Nurse Location: 100% Remote Duration: 3 to 6 months ( Opportunity for ext. / based off performance/evaluation... ...HCPCS, Diagnosis and Procedure codes) Chart Audit for coding and medical necessity CMS and State specific knowledge (ability to...Remote workCmsMedicalWork at officeMonday to FridayShift work
$85k
...Job Description DRG Coding Reviewer - Auditor (Remote) Compensation and Benefits Salary... ...experience Strong knowledge of ICD-10, CMS guidelines, and coding compliance... ...opportunities for qualified candidates across medical professions. We deliver timely results...Remote workCmsMedicalFull timeShift work$85k - $90k
...parental leave, and more. The Nurse Coder DRG Auditor’s primary responsibility is to review medical records and associated claim information... ...and Medicaid Services (CMS), commercial payers, InterQual,... ...CCS, CPC, CIC Coding validation/auditing experience Well-developed...Remote workCmsMedicalWork at office$66.4k - $109.53k
...materials as needed. Performs audits on schedule or as assigned based... ..., examples of relevant medical records, resource materials, etc. Works with Manager to review findings from external audits... ...Environment and Physical Requirements: Remote work from home. Supervisory...Remote workCmsMedicalFor contractorsWork from homeShift work- ...Utilization Review Nurse The utilization review (UR) nurse serves to... ...regular utilization reviews and audits, the UR nurse ensures that... ...extensive knowledge of patient care, medical treatments and hospital... ...ensuring compliance with CMS Conditions of Participation for...CmsMedicalFull timeWork at officeMonday to FridayShift work
$50.68 per hour
...Overview The Utilization Review RN participates as a... ...multidisciplinary team to support medical necessity reviews,... ...will be primarily remote but may require onsite... ...requirements, including CMS and Joint Commission Standards... ...Bachelor of Science in Nursing (BSN). Three years of...Remote workCmsMedicalHourly payLive inRelocationFlexible hoursShift workWeekend workDay shiftAfternoon shift- ...Director of HIM in preparing claim audits, reviewing and recommending coding,... ...assigned. Location & Status Remote USA; work from home office. Full... ...information and access to medical documentation. Audit all aspects... ...and apply guidelines, CMS/Payer specific guidelines, coding...Remote workCmsMedicalFull timeWork at officeWork from homeHome office
$93.8k - $106k
...Billing Compliance Reviewer Reporting to the Director... ...and executes risk-based audits, analyzes documentation and coding for medical necessity and regulatory... ...selection in alignment with CMS, OIG, and other... ...revenue integrity, pharmacy, nursing, research billing, and practice...Remote workCmsMedical- ...Operations Job Title: Quality Review and Audit Analyst Duties: The Risk... ...Review Analyst in IFP brings medical coding and Hierarchical... ...internal program processes ensuring CMS/HHS compliant programs,... ...Hours 9am - 5:30pm EST 100% Remote Financials: Currency USD...Remote workCmsMedicalMonday to FridayShift work
$93.4k - $116.8k
...including quality of care reviews, incident investigation... ...and your loved ones, Medical, Dental, Vision, Life... ...programs are aligned with CMS Triple Aim framework:... ...and studies. Conducts audits of patient/member case... ...professional nurse preferably in New York...Remote workCmsMedicalWork experience placementFlexible hours$16.9 - $23.42 per hour
...Bill Review Analyst I - Temp The Bill Review Analyst is responsible for reviewing, auditing and data-entry of medical bills for multiple states and lines of business. This is a remote, temporary position. Essential functions... ...4/DWC-9/DWC-10 and CMS 1500 form types...Remote workCmsMedicalHourly payFull timeTemporary workWork at officeFlexible hours$68k - $88k
...Medical Review Auditor (Fraud Waste and Abuse) Join to apply... ...Reviewer, you will be auditing medical records to... ...licenses: Licensed Practical Nurse (LPN) Registered Nurse... ...guidelines (including CMS NCCI). Healthcare... ...Premium Insurance Auditor - Remote Remote: Full Time...Remote workCmsMedicalHourly payFull timeContract workPart timeWork experience placementImmediate startWork from home$68.57k - $104.84k
...Clinical Review QC Auditor CERIS in Fort Worth, TX... ...clinical/coding) reviews of medical records and/or other... ...rules. This is a remote position. Essential... ...DRGs assigned Conduct audits to ensure accurate reimbursement... ...of Medicare, CMS guidelines and ICD-10 coding...Remote workCmsMedicalMinimum wageFull timeWork at officeLocal areaFlexible hours$30 - $34 per hour
...Complex Medicare Claims Review Complex Medicare claims/prior authorization... ...requests require the review of medical record documentation to determine... ...are required to use Registered Nurses ("RNs"). Clinical decisions will be based on CMS policies/procedures defined in the...Remote workCmsMedicalHourly payContract work$58.4k - $97.4k
Job Summary The Quality Review & Audit Senior Analyst ("Analyst") exhibits expertise in evaluating complex medical documentation for diagnosis code accuracy and compliance in support... ...medical diagnosis coding. Familiarity with CMS regulations for Risk Adjustment programs...Remote jobCmsMedicalWork experience placementLocal areaWork from home- ...Opportunity As a Clinical Bill Review Analyst, you’ll review... ...You’ll Do Here Review medical bills to identify... ...the Team 3+ years of auditing, claims, review and/or... ...written. Knowledge of CMS guidelines. A plus if... ...ll Work This is a fully remote position, and we’ll provide...Remote workCmsMedicalImmediate startFlexible hours
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$100k - $166.6k
...Position Summary Quality Review & Senior Audit Advisor provides... ...ensure alignment with CMS, NCQA, and state regulatory... ...integrity, including medication therapy management,... ...clinical, pharmacy, nursing, or healthcare‑... ...cost drivers preferred. Remote Work Requirements Internet...Remote workCmsMedicalWork at officeLocal area- ...completing quality assurance reviews on internal and/or... ...include onboarding audits and training of newly hired... ...client electronic medical record systems, following... ...AMA CPT Guidelines, and CMS directives. The Outpatient... ...: This is a remote role; work is performed...Remote workCmsMedicalFull timeTemporary workHome office
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$35 - $40 per hour
...- $40.00/hr Location Fully Remote Position Summary The Utilization Review Nurse serves as a key liaison in coordinating... ...with company policy. Assess medical documentation to determine the... ...for compliance with CMS Chapter 7 and Milliman Care Guidelines...Remote workCmsMedicalContract workFlexible hoursWeekend work$34 - $40 per hour
...range $34.00/hr - $40.00/hr Remote (Compact Licensure Required)... ...seeking an experienced Utilization Review Nurse to support our mission of... ...compliance with Medicare and CMS guidelines, and collaborate with... ...documentation to determine medical necessity for continued care...Remote workCmsMedicalFull time- ...healthcare services clinical auditing activities. Performs... ...and Medicaid Services (CMS), and state/federal... ...clinical gaps in care from a medical and/or behavioral... ...experience. • Registered Nurse (RN). License must be... ...experience in clinical review/auditing of care...Remote workCmsMedicalContract workWork at office
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