Remote RN: Clinical Claims Review and Resolution
CVS Health Corporation
CVS Health is seeking a Clinical Claims Review Nurse to interpret clinical documentation and apply decision-making for post-service claims. This role supports claims processing teams and collaborates with clinicians to resolve complex cases.
The ideal candidate has RN licensure with 2–3 years of RN experience and may hold a bachelor’s degree. This full-time, remote position is based in North Dakota.
#J-18808-Ljbffr$29 - $52 per hour
...Connecting. Growing together. The Clinical Claim Review RN will be responsible for performing... ...contract compliance. The Sr. Recovery Resolution Analyst will present and discuss audit... ...your schedule. This position is Remote in Massachusetts. You will have the flexibility...Remote workClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization that delivers... ...comprehensive understanding of the claim review process including... ...as applicable Assists with resolution of claims as needed to... ...~ Active and unrestricted RN license OR LPN in the state of...Remote jobClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal area- ...Optum Waste and Error Claims Investigator Optum is a global organization... ...of the claim for further review in a production environment.... ...Primary Responsibilities: Clinical Case Reviews - 75% Perform... ...as well as recovery and resolution for health plans, commercial...Remote jobClaimsContract workWork at officeLocal areaMonday to Friday
- ...The IRR Clinical Claim Review Nurse at UnitedHealth Group performs claim reviews to verify coding and charges, researching guidelines to determine... ..., MA with a full-time day shift, the position supports remote work anywhere in the U.S. while complying with HIPAA, state...Remote workClaimsFull timeDay shift
- UnitedHealth Group seeks a Clinical Review Clinician to act as a subject matter expert in itemized bill reviews... ...team preparing Forensic Reviews for clients. Remote work is available nationwide, with responsibilities spanning claim review, medical record evaluation, and...Remote jobClaims
- UnitedHealthcare, part of the UnitedHealth Group family, invites you to join as a SSBV Clinical Claims Review RN. This role is a multifaceted position with autonomy and responsibility, focusing on administrative reviews of inpatient hospital claims and documenting determinations...Remote jobClaimsWork at office
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims, document determinations, and maintain screening criteria. This multifaceted role offers telecommuting from anywhere in the U.S. and...Remote jobClaims
$26.01 - $68.55 per hour
...About This Role The Clinical Claims Review Nurse at CVS Health is responsible... ..., and coordinating clinical resolutions. This role is ideal for... ...- $68.55/hour Location: Remote, ND Schedule: Full-time... ...Education Nursing degree (RN) required Bachelor’s degree...Remote workClaimsFull time$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 workClaimsFull timeFlexible hoursShift work$28.94 - $51.83 per hour
...Ssbv Clinical Claims Review Rn Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits...Remote jobClaimsHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal areaHome office$93.35k - $132.43k
...City/State Norfolk, VA Work Shift First (Days) Overview: Sentara Health Plans is hiring a Clinical Claims Reviewer/ RN - Remote! Status: Full-time, permanent position (40 hours) Standard working hours: 8am to 5pm EST, M-F. Remote opportunities available...Remote workClaimsPermanent employmentFull timeTemporary workWork at officeShift work$69.3k - $78k
...integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and... ...The position requires an active RN license and a minimum of five years... ...documenting findings, all in a remote work environment. This role...Remote jobClaims- ...Clinical Review Nurse - RemoteARC Group has multiple positions open for Clinical... ...! These positions are 100% remote. These are direct hire FTE... ...as to the validity of health claims and levels of payment in... ...unrestricted Registered Nurse (RN) licensePreferred Qualifications...Remote workClaimsPermanent employmentWork at officeLocal area
- ...The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review... ...communication skills. Advanced Remote EMR access is essential as... ...Licenses/Certifications RN - Registered Nurse - State...Remote workClaimsFull timeWork at office
$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the... ...case development and resolution, ensuring compliance with... ...also handle clinical claim appeals from providers... ...and prepare cases for review and appeals. Minimum...Remote jobClaimsFull timeMonday to FridayShift work- ...seeking a licensed Registered Nurse to review clinical documentation, apply decision-making to post-service claims, and coordinate clinical resolutions with clinician support. The role... ...candidates hold a BSN, have 2-3 years of RN experience, and demonstrate strong analytical...Claims
- ...seeking a full-time Registered Nurse to review clinical documentation, apply policy-based criteria for post-service claims, and coordinate resolutions with clinician support. The role... ...environment. Ideal candidates hold an active RN license in their state, possess a Bachelor...ClaimsFull time
$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant, we’re focused... ...primarily performs medical claims audit reviews. As a MR Nurse... ...Commercial Payers. You will work remotely in a fast paced and dynamic... ...Active unrestricted RN license in good standing, is...Remote workClaimsFor contractorsWork at officeWork from homeHome officeShift work- ...and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical... ...Key responsibilities Perform clinical assessments and evaluate patient... ...Collaborate with physicians, claims examiners, and other stakeholders...Remote workClaimsFull timeWork experience placement
$46 per hour
...immediately hiring for a RN Clinical Appeals Specialist Position... ...: Philadelphia PA 19103 (Remote) As a RN Clinical... ...appeals from intake through resolution including case review outreach documentation gathering... ...authorization history claims information medical policy...Remote workClaimsHourly payFull timeContract workTemporary workFor contractorsWork experience placementWork at officeImmediate startWorldwideFlexible hours- Health Business Solutions LLC is seeking a Clinical Appeals Nurse (RN) for a remote role. The position focuses on reviewing denied claims for clinical accuracy and medical necessity, developing appeal strategies, and drafting payer-ready documentation to overturn denials...Remote jobClaims
$65k - $75k
Gainwell Technologies LLC is seeking a Nurse Reviewer (RN) to perform clinical reviews remotely in the United States. Responsibilities include reviewing medical... ...experience, and 2+ years in utilization review or claims auditing. This full-time position offers health benefits...Remote workClaimsFull time- ...Description The utilization review and management (UM) component... ...facilities are medically necessary, clinically appropriate, evidence-based,... ...logging and documentation of claims along the process chain. #... ...This is an in-office, no remote work capability position...Remote workClaimsWork at office
- TalentLNX LLC seeks a remote Clinical Claims Review RN to audit hospital claims line by line against medical records, ensuring charges are ordered, documented, and supported. The role blends acute care nursing judgment with chart auditing, coding, and revenue integrity...Remote jobClaims
$63k - $65k
...Services & Insurance Utilization Review RN As a nurse at Sedgwick, you... ...patients in a nontraditional clinical setting. Apply your RN... ...and well-being of others in a remote work environment. Enjoy flexibility... ...effectively with physicians, claims examiners, clients, vendors,...Remote workClaimsWork experience placementFlexible hours$25 - $35 per hour
...Companies is seeking a Clinical Appeals Nurse to... ...for a contract remote opportunity... ...the appeals team, reviewing complex cases, ensuring... ...facilitate timely appeal resolutions across multiple... ...necessary claim adjustments. • Identify... ...Registered Nurse (RN) license in the...Remote workClaimsHourly payContract work$70k - $80k
...Companies is seeking a Clinical Appeals Nurse for a fully remote healthcare-based opportunity... ...focused on clinical review, appeal resolution, regulatory compliance,... ...facilitating necessary claim corrections and adjustments... ...Registered Nurse (RN) license in the State of...Remote workClaimsLong term contract$63.1k - $94.65k
...partner is looking for a Utilization Review RN based in the United States. Join... ...operations. In this part-time, remote role, you will apply your clinical expertise to evaluate medical necessity... ...utilization concerns and minimize claim denials. You will also contribute...Remote workClaimsTemporary workPart timeWork at officeWork from homeFlexible hoursShift workAfternoon shift- ...Position Summary: The RN Integrated Care... ...to the operation of our Clinical Team and the overall experience... ...to address utilization review cases. Roles and... ...certification, reimbursement, and claim denials/appeals.... ...This is a remote position. Our whole company...Remote workClaimsLive inFlexible hoursWeekday work
- ...to the LTSS department. RN will be responsible for... ...and concurrent review. Provides monthly telephonic... ...community resources. Applies clinical knowledge to work with... ...of care and accurate claims payment. May also... ...Additional Info: *possible remote opportunity after training...Remote workClaimsContract workMonday to FridayFlexible hours
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