Remote RN Medical Claims Reviewer & Utilization Expert
$67.7kBroadway Ventures LLC
- 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
- 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 LLCRemote jobClaims
- ...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 jobClaimsFull timeTemporary workWork at officeWork from home
- ...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 workClaimsFull timeContract workLocal areaShift work
- ...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 workClaimsFull timeTemporary workWork at office
- ...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 jobClaimsFull timeFor contractorsWork at officeHome officeMonday to Friday
- 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
- ...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 workClaims
$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 jobClaims- ...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 jobClaimsFull time
$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 jobClaims- 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
$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- 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 jobFlexible hoursWeekend workWeekday work
$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 workClaimsMonday to FridayFlexible hours$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 jobClaimsHourly payLocal area$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 jobClaimsLocal area- 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 jobClaims
- ...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 workClaimsFull timeWork at officeFlexible hours
- ...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 jobClaims
$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 jobClaims$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 jobClaims- ..., 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 jobClaimsFull time
$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 jobClaims$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 jobClaims- ...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 jobClaims
$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 workClaimsHourly payContract workSummer work- 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
- ...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 jobClaimsFull time
- 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 jobClaimsFull time
- ...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 jobClaimsFull timeWork from home
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