Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Remote RN Medical Claims Reviewer & Utilization Expert

$67.7k

Broadway Ventures LLC

New York, NY
  • Remote job

A specialized consulting firm is seeking a Medical Claims Reviewer to conduct medical reviews and provide guidance on claims. This remote role requires an active RN license, a bachelor's degree in nursing, and at least five years of clinical experience. Ideal candidates will work full-time Monday to Friday, with a salary of $67,700 per year. Join a team that values integrity and operational success. #J-18808-Ljbffr Broadway Ventures LLC

Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote RN Medical Claims Reviewer & Utilization Expert in New York, NY vacancy
  • The role offers innovative consulting solutions and a chance to work remotely. Candidates who are detail-oriented and passionate about medical review are encouraged to apply. #J-18808-Ljbffr Broadway Ventures LLC
    Remote job
    Claims

    Broadway Ventures LLC

    New York, NY
    1 day ago
  •  ...traditional bedside setting to review and audit claims, support program...  ...judgment to analyze medical records,...  ...unrestricted Registered Nurse (RN) license   Strong...  ...records   Experience in utilization review, case...  ...vulnerable populations   Remote work – enjoy the... 
    Remote job
    Claims
    Full time
    Temporary work
    Work at office
    Work from home

    HealthSkil

    Harrisburg, PA
    25 days ago
  •  ...RN / Medical Reviewer / Remote Job Details Professional Discipline : Registered Nurse Specialty : Utilization Review Employment Type : Full Time City :...  ...your clinical proficiency and claims knowledge. This is a REMOTE... 
    Remote work
    Claims
    Full time
    Contract work
    Local area
    Shift work

    InGenesis

    United States
    3 days ago
  •  ...traditional bedside setting to review and audit claims, supportprogram...  ...judgment to analyze medical records,...  ...unrestricted Registered Nurse (RN) license Strong...  ...records Experience in utilization review, case...  ...vulnerable populations Remote work - enjoy the convenience... 
    Remote work
    Claims
    Full time
    Temporary work
    Work at office

    The CKHobbie Group

    Harrisburg, PA
    1 day ago
  •  ...opportunities with expert program management,...  ...5:00 PM Location : Remote (U.S. - Work from home...  ...dedicated Registered Nurse (RN) to join our Medical Review team . This role...  ...medically complex claims, pre‑authorization...  ...following: Home Health Utilization/Medical Review... 
    Remote job
    Claims
    Full time
    For contractors
    Work at office
    Home office
    Monday to Friday

    Broadway-Ventures

    Nashville, TN
    4 days ago
  • L.A. Care Health Plan in Los Angeles is hiring a Utilization Management Claims Review Nurse RN II responsible for conducting clinical reviews of medical claims. The position requires a minimum of 5 years in clinical nursing, with experience in Medi-Cal and Medicare managed... 
    Claims

    L.A. Care Health Plan

    Los Angeles, CA
    2 days ago
  •  ...Utilization Management Position Provide health care services regarding...  ...planning and utilization review. Review admissions and...  ...concurrent and retrospective medical necessity and/or compliance with...  ..., reimbursement and claim denials/appeals. Assess and... 
    Remote work
    Claims

    St. Vincent's Health System

    United States
    2 days ago
  • $84.06k - $118.67k

     ...a Licensed Registered Nurse for a remote position in Utilization Management. The role involves providing...  ...discharge planning, conducting reviews for medical necessity, and assisting with coding and claims issues. Candidates must hold an RN license from the Texas Board of... 
    Remote job
    Claims

    Ascension

    Austin, TX
    1 day ago
  •  ...hiring a full-time Licensed Medical Review Nurse to conduct reviews...  ...while working remotely. This role involves managing...  ...managing appeals and validating claims to ensure medical...  ...nursing experience, including utilization review, and a valid RN license in Florida or Kentucky... 
    Remote job
    Claims
    Full time

    Molina Healthcare, Inc.

    New York, NY
    3 days ago
  • $47.06k - $70.24k

     ...solutions provider is seeking a Utilization Review Nurse in Fort Worth, TX. This remote role involves analyzing medical bill appropriateness, documenting...  ..., and communicating with claims examiners. Candidates must have a current RN license and at least four years... 
    Remote job
    Claims

    Care Options for Kids

    Fort Worth, TX
    3 days ago
  • Appworkshub is seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this role, you will conduct inpatient and outpatient utilization reviews, support transitions of care, and ensure compliance with... 
    Remote job

    Appworkshub

    New York, NY
    2 days ago
  • $49.34 - $76.59 per hour

    A leading healthcare organization is seeking a Utilization Review RN for a fully remote role in Oregon. Candidates must hold an Oregon Registered Nurse...  ...in collaboration with physicians. This position manages medical management programs to optimize patient care.... 
    Remote job

    Providence Health & Services

    Portland, OR
    2 days ago
  • Concierge Home Care is seeking a Utilization Review Specialist (RN) for a remote opportunity. This position requires a Florida RN License, OASIS Certification...  ..., along with a full benefits package, including medical and dental insurance. #J-18808-Ljbffr Santa Barbara Cottage... 
    Remote job
    Flexible hours
    Weekend work
    Weekday work

    Santa Barbara Cottage Hospital

    New York, NY
    2 days ago
  • $116.3k - $264.6k

     ...Angeles, CA, USA Onsite or Remote Flexible Hybrid...  ...for Medicare Advantage Utilization Management, you'll...  ...Letters Concurrent Review Continuity of Care Retro Claims Retrospective Review...  ...Current unrestricted RN licensure in CA required... 
    Remote work
    Claims
    Monday to Friday
    Flexible hours

    UCLA Health

    Los Angeles, CA
    2 days ago
  • $45.9 - $71.4 per hour

    Description Utilization Review RN - Remote. The RN Care Coord‑Qual Med Mgmt will provide administration of medical management programs that include prior authorization, concurrent hospital...  ...medical policy development and medical claims audits. These programs are developed to... 
    Remote job
    Claims
    Hourly pay
    Local area

    Providence Health & Services

    Renton, WA
    1 day ago
  • $85.7k - $128.54k

    The Supervisor, Utilization Management (UM), reports to the Manager of...  ...department, including pre‑service and claims reviews. Supervise licensed and...  ...UM processes, including medical claims review and program policies...  ..., valid, and unrestricted RN or LVN license in California... 
    Remote job
    Claims
    Local area

    E2E Alignment Healthcare USA, LLC

    California, MO
    2 days ago
  • UnitedHealth Group is seeking a Clinical Review Clinician in Plymouth,...  ...reviews of hospital bills and claims while ensuring compliance with...  ...Associate's degree, an active RN or LPN license, and at least 2...  ...include paid time off, medical plans, and a comprehensive benefits... 
    Remote job
    Claims

    UnitedHealth Group

    Minneapolis, MN
    4 days ago
  •  ...Description Description: The Medical Nurse Reviewer applies clinical...  ...expertise to review claims, medical records, and...  ...necessity reviews, utilization audits, and...  ...unrestricted Registered Nurse (RN) license in state of...  ...Environment 100% Remote PHI/PII Requirement... 
    Remote work
    Claims
    Full time
    Work at office
    Flexible hours

    Verve LLC

    Baltimore, MD
    21 days ago
  •  ...Appeals Nurse to oversee the review and appeal of claims related to clinical...  ...candidate will have a valid RN license, experience in...  ..., and familiarity with utilization review. This remote position offers a...  ...of benefits, including medical, dental, vision, and a competitive... 
    Remote job
    Claims

    Knowtion Health

    New York, NY
    2 days ago
  • $82.23k - $155.81k

     ...Related Group Clinical Validation Auditor-RN to conduct audits on inpatient medical records, ensuring documentation accuracy and compliance. This remote role requires a current Registered...  ...Nurse license and extensive experience in claims auditing. Responsibilities include... 
    Remote job
    Claims

    Elevance Health

    Mason, OH
    1 day ago
  • $70k - $80k

     ...seeking a Clinical Validation Auditor to ensure accuracy in medical claims coding. This fully remote position requires a Registered Nurse with over 5 years of acute care experience. Responsibilities include reviewing medical records, documenting findings, and using... 
    Remote job
    Claims

    EXL

    New York, NY
    2 days ago
  •  ..., Inc. is seeking a full-time Remote Content Analyst II responsible...  ...quality assurance related to medical policies. This role involves providing...  ...active professional license (RN or Pharmacist) or a Bachelor's...  ...coding and familiarity with claims payment methodologies. #J-188... 
    Remote job
    Claims
    Full time

    Cotiviti, Inc.

    New York, NY
    3 days ago
  • $65k - $90k

    Dane Street is seeking a Clinical (RN) QA Specialist in Washington, D.C. to ensure accuracy and compliance in long-term disability claims. This role involves assessing physician reports and providing excellent customer service by managing complex cases. Ideal candidates... 
    Remote job
    Claims

    Dane Street

    Washington DC
    3 days ago
  • $65k - $90k

    Dane Street is looking for a Clinical (RN) QA Specialist specializing in Disability to join our team. The role involves assessing long-term disability claims, ensuring quality of physician reports, and providing outstanding customer service. The ideal candidate will have... 
    Remote job
    Claims

    Dane Street

    New York, NY
    4 days ago
  •  ...looking for a Clinical Auditor to perform clinical reviews and audits on medical records, ensuring compliance with company...  ...assurance guidelines. This role requires an active RN license and the ability to analyze claims data and regulations effectively. The candidate... 
    Remote job
    Claims

    Performant Corp

    Florida, NY
    1 day ago
  • $1,150 - $1,450 per month

     ...Position: Health Insurance Expert Type: Contract...  ...task Location: Remote Role Responsibilities Review and evaluate AI-...  ...coverage determination, claims adjudication, and medical necessity criteria....  ...medical underwriting, utilization management, benefits administration... 
    Remote work
    Claims
    Hourly pay
    Contract work
    Summer work

    Mercor

    New York, NY
    16 days ago
  • Rising Medical Solutions, LLC is seeking a Legal Nurse to evaluate medical...  ...necessity within various claims such as auto, general...  ...Degree in nursing and an active RN license, with a minimum of 5 years...  ...include analyzing demand packages, utilizing evidence-based guidelines, and... 
    Claims

    Rising Medical Solutions, LLC

    Chicago, IL
    3 days ago
  •  ...a full-time Michigan Licensed Medical Review Nurse to manage the review of documentation in a remote capacity. This role involves ensuring...  ...records, and overseeing claims for accurate reimbursement. The...  ...experience and possess an active RN license in Michigan. Knowledge... 
    Remote job
    Claims
    Full time

    Molina Healthcare, Inc.

    New York, NY
    3 days ago
  • A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and... 
    Remote job
    Claims
    Full time

    Innovative Systems Group

    Richardson, TX
    2 days ago
  •  ...seeking a Professional Fee Coder to work from home and ensure the accuracy and compliance of billing claims. The coder will handle various work queues including Charge Review and Follow Up while maintaining industry standards in CPT and ICD-10 coding. Candidates must have... 
    Remote job
    Claims
    Full time
    Work from home

    Dayton Children's Hospital

    Brooklyn, NY
    2 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote RN Medical Claims Reviewer & Utilization Expert. Be the first to apply!