Remote RN Medical Reviewer III - Clinical Claims & Denials
Southcarolinablues
Southcarolinablues is seeking a RN Medical Reviewer III (Remote in SC) to perform medical reviews using clinical information and established guidelines. This role involves reviewing complex medical claims and educating teammates on healthcare processes. The ideal candidate should possess an active RN license, have at least two years of clinical experience, and demonstrate strong communication and analytical skills. The position offers the flexibility to work from home while ensuring compliance with healthcare standards and quality control. #J-18808-Ljbffr
- ...Overview Work remotely with a... ...collaborative enterprise denials team focused on... ....0 FTE) The Clinical Denial... ...care, utilization review, and patient access... ...denied claims from a clinical... ...standards • Perform medical record reviews,... ...Registered Nurse (RN) or Licensed...Remote workClaimsFull timeWork at office
$36 - $48 per hour
...Santa Barbara Cottage Hospital is seeking a Medical Claims Clinical Review Nurse for a remote position. This role involves conducting clinical reviews of medical... ...with regulations. The ideal candidate will have an RN license in California and a minimum of three years of...Remote workClaimsHourly pay$45.29 - $84.11 per hour
...better. Hybrid/Remote Summary:... ...purpose of the Denial Prevention Nurse... ...timely and accurate clinical information to... ...to support the medical necessity of... ...obstacles and deny claims and escalating... ...: # Review all inpatient admission... ...: Current RN License in Connecticut...Remote workClaimsHourly payDaily paidPart timeShift workNight shiftRotating shift- ...Stryker Corporation is seeking a Clinical Claim Review Nurse to perform detailed reviews of claims against medical records. The position offers the flexibility to telecommute... ...should possess an Associate's degree and an active RN license. Responsibilities include ensuring...Remote workClaims
- ...Remote Rn – Medical Claims Reviewer At Broadway Ventures, we transform challenges into opportunities with... ...ensure compliance with established clinical criteria and guidelines. The ideal candidate... ...rationales for service approvals or denials. Educate internal and external...Remote workClaimsFull timeFor contractorsWork at officeHome officeMonday to Friday
- The University of Minnesota School of Nursing is seeking a Clinical Claim Review Nurse who will perform claim reviews to verify coding and charges... ....S. Candidates must hold an associate's degree and an active RN license, with a minimum of 2 years of clinical experience....Remote jobClaims
- Texas Health Institute is hiring a Clinical Claim Review Nurse to perform claim reviews, ensuring correct... ...an Associate's degree, an active RN license, and at least 2 years of clinical... .... Bountiful benefits, including PTO, medical plans, and 401(k), are offered to support...Remote jobClaims
- Optum is seeking a Clinical Claim Review Nurse to perform claim reviews and ensure compliance in a telecommute role. You will verify coding accuracy... ...resources. This role requires an Associate's degree, active RN license, and clinical experience. You’ll enjoy comprehensive...Remote jobClaimsFlexible hours
- Optum is looking for a Clinical Claim Review Nurse to perform claim reviews and... ...policies. This fully remote position allows you to contribute... ...benefits including paid time off, medical plans, and a 401(k) savings... ...'s degree, an active RN license, and at least 2 years...Remote jobClaims
- ...skilled Appeals Processor III (APP III) to join... ...dedicated team in a remote capacity. The... ...is responsible for reviewing, analyzing, and processing... ...Healthcare appeals Medical claims / utilization review... ...medical documentation (clinical roles may require RN) Responsibilities...Remote workClaimsContract work
$28.72 - $36.92 per hour
...administrative and clinical support staff... ...position is primarily remote, candidates must... ...-Up Specialist III, Coding and Complex Denials is responsible... ...appeal denied claims and ensure... ...advanced coding review to appropriate CPCs... ...including Letters of Medical Necessity and...Remote jobClaimsHourly payFull timeWork at officeLocal area- ...seeking a dedicated Registered Nurse (RN) to join the Medical Review team. This role involves conducting... ...medical reviews to ensure compliance with clinical guidelines. The successful candidate... ...essential. This position offers a remote work environment with all necessary equipment...Remote workClaims
- ...accounts receivable related to denied claims, the full-time Clinical Denials Specialist will investigate denials... ...non-clinical appeals while working remotely to ensure compliance with billing... ...One year of training in medical billing, coding, insurance processing...Remote workClaimsFull time
- ...Healthcare is looking for a Clinical Denial Specialist to manage claim denials related to... ...and authorizations from a remote location. The role includes... ...an Associate's Degree and RN certification, experience... ...skills. Benefits include medical, vision, dental, and 401K....Remote jobClaims
- ...Clinical Denials Specialist Role: Clinical Denial Specialist... ...successfully manage claim denials related to referral... ..., non-coverage, medical necessity, and other clinically... .... The specialist will review claims and make... .... Registered Nurse (RN) Certification with experience...Remote workClaimsContract workLocal area
$69.38k - $92.28k
Overview As a Clinical Appeals RN, you will review denied service authorizations and claims, evaluate medical necessity, and work closely with Medical... ...and recommend whether the denial should be overturned... ...combination of office and remote settings. EEO Statement MVP...Remote workClaimsWork at office$96k - $132k
...empathy, insight, and clinical intelligence, we... ...Specialist is responsible for reviewing inpatient medical records to ensure... .... • Assist with denial prevention by supporting... ...Work location: Remote-United States Travel... ...schemes that falsely claim to represent Solventum...Remote workClaimsH1bWork at officeRelocation packageFlexible hours- ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To:... ...revenue cycle operations by reviewing denied claims for clinical accuracy and medical necessity, developing... ...critical part in overturning denials, improving...Remote workClaims
$50 - $53 per hour
...Job Title: Clinical Review RN (IDR/Appeals) Experience: Open to... ...license*** Location: Remote (can sit anywhere in the US... ...benefits review, supporting Medical Review Analysts, and Physician... ...project expands. 4. Claims assessment and adjudication....Remote workClaimsLocal areaImmediate startFlexible hours- Stryker Corporation is looking for a Clinical Claims Review RN to perform reviews of inpatient hospital claims. This role supports a high-volume environment and allows for telecommuting from anywhere in the U.S. The ideal candidate must have an RN license, a minimum of...Remote jobClaims
$28.37 - $36 per hour
...Summary Acentra Health is looking for a Clinical Reviewer - RN - PRN (Remote U.S.) to join our growing team. Responsibilities Review medical records against criteria, contract... ...consultant decisions, ensuring the reason for denial is described in sufficient detail in...Remote workContract workWork experience placementReliefWork at officeLocal areaMonday to FridayFlexible hours- Optum is seeking a Clinical DRG RN auditor to join their team remotely from anywhere in the United States. This role requires expertise in MS-DRG and APR-DRG... ...to ensuring accurate coding for inpatient claims. The ideal candidate will have an Associate's degree...Remote jobClaims
$28.94 - $51.83 per hour
Crains Cleveland is seeking a Clinical Claims Review RN to perform administrative reviews of short-stay inpatient hospital claims. This role supports a production-driven environment and allows telecommuting from anywhere in the U.S. The ideal candidate must have an associate...Remote jobClaimsHourly pay- Optum, part of the UnitedHealth Group, is looking for a Clinical Claims Review RN to conduct administrative reviews of short stay inpatient hospital claims. This position is open to telecommuting from anywhere in the U.S. and is situated in a high-volume, production-driven...Remote jobClaims
$29 - $52 per hour
UnitedHealth Group is seeking a qualified Registered Nurse in Massachusetts to perform clinical coverage review services. As part of this role, you will communicate benefit determinations and work closely with healthcare providers to explain coverage. We offer telecommuting...Remote jobClaimsHourly pay$82.23k - $155.81k
Elevance Health is seeking a Diagnosis Related Group Clinical Validation Auditor-RN to ensure clinical documentation accuracy for inpatient records... ...flexibility through virtual work. The ideal candidate will analyze claims, maintain auditing standards, and possess an RN license...Remote jobClaims- UnitedHealth Group is seeking a Clinical DRG RN auditor to leverage expert coding knowledge in auditing inpatient claims. This remote role allows for flexibility within the U.S., focusing... ...overpayments. Responsibilities include reviewing code assignments, providing rationale...Remote jobClaims
- ...Minnesota School of Nursing is seeking a Clinical DRG RN auditor. In this role, you will use your... ...DRG and APR-DRG coding to audit inpatient claims, ensuring accuracy and compliance with coding guidelines. You will enjoy remote work flexibility and be part of a culture...Remote jobClaims
$82.23k - $155.81k
Elevance Health is looking for a Diagnosis Related Group Clinical Validation Auditor‑RN, responsible for auditing claims while working virtually. The position entails analyzing claims to ensure compliance with medical coding standards and identifying documentation errors....Remote jobClaims$62.5k - $79.8k
...based on experience The Denials RN Coordinator prepares appeals for clinical and technical claim denials across all... ...insurance contract terms, reviewing claim denials and... ...expected, analyzing medical records and determining... ...of AI. This is a remote position; however, candidates...Remote workClaimsFull timeContract workTemporary workWork at officeLocal area
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