Remote RN: Clinical Review & Claims Specialist
First Coast Service Options
- Remote job
First Coast Service Options is seeking a Clinical Review Nurse to evaluate medical necessity and payment levels for health claims in line with national and local policies and care standards. The role requires RN licensure, clinical experience, and strong communication skills. The position involves reviewing claims, medical records, and provider practices, with opportunities to educate providers and participate in CMS-related initiatives. #J-18808-Ljbffr First Coast Service Options
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims, documenting determinations and maintaining screening criteria. The role supports telecommuting from anywhere in the U.S. and requires...Remote jobWork at office
$45 - $50 per hour
...Healthcare Staffing is looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting... .... Candidates must be graduates of accredited nursing programs with an active New York RN license. #J-18808-LjbffrRemote workHourly pay- ...established industry player is seeking a Medical Review Nurse to join their dynamic team in... ...reviewing and adjudicating medical claims, ensuring compliance with industry standards... ...enjoying the flexibility of a primarily remote work environment. If you are passionate about...Remote work
Clinical Review Nurse - Concurrent Review for a remote, 9-month assignment. The role involves handling Denial Letters for FL Medicaid Physical Health Codes and requires you to work remote with a Friday-Tuesday schedule, 2 pm-10... Remote job- UnitedHealth Group's Optum is seeking a Clinical Review Clinician to serve as a subject matter expert for itemized bill reviews and hospital... ...limited supervision and requires an associate degree, active RN or LPN license, and 2+ years of clinical experience plus 1+ year...Remote job
- Medix is seeking a Clinical Review RN for Prior Authorization, with 2 years of acute care experience and 1 year in prior authorization. The role... ...physicians and analysts to ensure accurate authorizations. Onsite in Jericho or remote in RI is possible. #J-18808-Ljbffr Medix™Remote job
$29 - $52 per hour
...Program Integrity Clinical Compliance AuditorOptum Insight... ...performing compliance reviews of medical and... ...care providers who submit claims for payment. This position... ...schedule.This position is Remote in Massachusetts. You... ...experienceNurse licensure (RN or LPN) with a current,...Remote workHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work- Comagine Health is seeking an RN to perform Clinical Review work and QIDP reviews. The role is remote, with half-time focus on QIDP reviews and half-time on nurse clinical review. The position requires licensure in Alabama, a BA/BS in Nursing, and at least 3 years of direct...Remote job
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims and document determinations. This role offers telecommuting from anywhere in the U.S. while maintaining rigorous screening criteria and...Remote job
- ...among the first 25 applicants Job Title:Clinical Review Nurse (RN) – Utilization Management Location:... ...) Clinical Program Coordinator RN *Remote* Clinical Program Coordinator RN *Remote... ...) RN Clinical Document Integrity Specialist Oregon, United States $150,000.00-$30...Remote workContract work
- Optum, a UnitedHealth Group company, seeks a Clinical Review Clinician to serve as a subject matter expert for itemized bill reviews and hospital... ...within policy frameworks, leveraging your clinical claim review and medical record review knowledge, while maintaining...Remote job
- ...experienced Pediatric Registered Nurses for a part-time, remote consulting role focused on reviewing and evaluating pediatric clinical outputs and structured nursing data. You will... ...projects. Ideal candidates have active US RN licensure (outside California), recent...Remote jobPart time
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims and to document all determinations. The role emphasizes adherence to Federal, State and client requirements in a telecommuting setting...Remote jobHome office
- Optum is seeking a Clinical Review Clinician to act as a subject matter expert for itemized bill reviews and hospital facility bills. This role involves documenting, researching, and identifying adjustments for payment as part of a team preparing Forensic Reviews for specific...Remote job
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting... ...applications This is a 100% remote role, and requires robust internet... ...authorization data with post-service claims validation, we're creating a transparent...Remote workFull timeFlexible hoursShift work- ...improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our... ...professionally. Position Overview We are seeking an RN to perform Clinical Review work and QIDP reviews work. Team member will serve as the...Remote workContract work
- Comagine Health is seeking an RN to perform Clinical Review work and QIDP reviews. The role will split time as a QIDP (.5 FTE) and a nurse clinical reviewer (.5 FTE); you will operate remotely from Alabama and hold an active RN license in the state with a minimum of 3...Remote job
- UnitedHealth Group is seeking a Clinical Review Clinician to serve as a subject matter expert for itemized bill reviews and hospital facility... ...Forensic Reviews for clients. Role involves understanding claim review processes, medical record review, and applicable billing...Remote job
$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization that delivers care, aided by technology... ...a comprehensive understanding of the claim review process including clinical claim... ...Associate's degree ~ Active and unrestricted RN license OR LPN in the state of residence...Remote workHourly payMinimum wageFull timeTemporary workWork experience placementLocal area- Optum Insight is recruiting for a Clinical Claim Review RN to perform compliance reviews of medical and administrative documentation in Massachusetts... ...with clients to ensure policy adherence. This remote Massachusetts position requires a MA license (RN/LPN), 2+ years...Remote jobFull time
- UnitedHealth Group seeks a Clinical Review Clinician to serve as a subject matter expert for itemized bill reviews and analysis of hospital... ...is supported from anywhere in the U.S. The position requires RN or LPN licensure, 2+ years clinical experience, and 1+ year bill...Remote job
- A leading organization in healthcare quality is seeking a Clinical Quality Reviewer to review clinical cases and identify potential quality or safety concerns. This remote position is ideal for licensed clinical professionals with a strong analytical mindset and a minimum...Remote job
- UnitedHealth Group seeks an experienced SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims. The role requires documenting determinations and maintaining screening criteria, contributing to efficient, compliant health...Remote job
$71.1k - $97.8k
...Utilization Management Nurse 2 uses clinical nursing skills to support the... ...Licensed Registered Nurse (RN) in an Enhanced Nurse... ...experience in prior authorization, claims review, utilization management, or... ...: US Nationwide Work Style: Remote Travel Requirements: None Work...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday- UnitedHealth Group seeks a Clinical Review Clinician to analyze itemized hospital bills and document adjustments... ...U.S. The role requires clinical experience, RN or LPN license, and bill review knowledge. You will support claims through research and QA until client-ready....Remote job
- Comagine Health in Alabama is seeking Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent... ...retrospective utilization reviews. This is a full-time remote role supporting Alabama contracts. You will apply...Remote jobFull time
- Optum is hiring a Clinical Review Clinician to act as a subject matter expert for itemized bill reviews and hospital facility bills. The role includes documenting, researching, and identifying adjustments needed for payment as part of a team preparing Forensic Reviews for...Remote job
- The Fountain Group is seeking an experienced Registered Nurse (RN) to support clinical trial safety surveillance and medical review activities for a global pharmaceutical organization. This is a fully remote, long-term contract opportunity ideal for an RN with clinical...Remote jobLong term contract
- NTT DATA, Inc. in Tampa, Florida seeks a BPO Clinical Review Specialist to perform clinical and medical necessity reviews supporting member and provider... ...compliance with NCQA standards and Medicaid guidance. This remote Florida role offers benefits including medical, dental and...Remote job
- Comagine Health seeks Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This full-time, remote position requires Alabama licensure and focuses on compliant, cost-effective...Remote jobFull timeContract work
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