Remote Nurse Reviewer Utilization & QR
HCSC
Health Care Service Corporation in the United States seeks a Registered Nurse for Utilization Management and Quality Review oversight. The role requires 5+ years of nursing experience with UR/QR exposure and travel as needed. This is a remote, nationwide position with potential for professional development.
The successful candidate will support clinical review activities, ensure compliance, and contribute to decisions affecting benefits and patient care across the health plan.
#J-18808-Ljbffr- ...Gainwell Technologies LLC is seeking a Senior Nurse Reviewer to perform reviews of medical records, healthcare claims, itemized medical... ...expertise and itemized bill review experience, with potential utilization review responsibilities. Home-based position within the...Remote workWork from homeFlexible hours
- ..., listing on behalf of a partner, seeks a Senior Nurse Reviewer based in the United States. You will evaluate medical... ...of care using established criteria. This remote role combines clinical analysis with utilization review and claims auditing. You will mentor other...Remote work
$28 per hour
LPN Utilization Management Nurse Reviewer Miami, FL (Work from Home position for FL residents only) Currently seeking an LPN FL licensed Utilization Management... ...LPN clear and active for the state of FL (Required) Work Location: Remote #J-18808-Ljbffr Coastal Care Services, Inc.Remote workHourly payFull timeWork at officeLocal areaWork from homeRelocationHome officeWeekday work- Gainwell Technologies LLC is seeking a Nurse Reviewer (RN) to perform clinical reviews ensuring medical necessity based on criteria, policies... ...and support review determinations. The role is full-time with remote options for US-based employees. Expect to review records,...Remote jobFull time
- Gainwell Technologies is seeking a Nurse Reviewer to perform clinical reviews to determine if documentation supports the need for the service according to criteria and policies. This role emphasizes accuracy, compliance, and timely decisions within contract-specific review...Remote jobContract workWork from homeFlexible hours
$78k - $99.2k
...Review medical records and itemized bills to ensure billing accuracy and appropriate care... ...benefits, 401(k), education assistance, remote work. Partner Company Our partner is a... ...company that conducts medical claims and utilization reviews to ensure accurate billing and...Remote workFlexible hours$78k - $88k
...development. Summary We are seeking a talented individual for a Nurse Reviewer who will be responsible for performing clinical reviews to... ...service based on clinical criteria, coverage policies, and utilization and practice guidelines as defined by review methodologies...Remote workFull timeContract workWork from homeFlexible hoursWeekend work$78k - $99.2k
...Summary We are seeking a talented individual for a Senior Nurse Reviewer to perform reviews of medical records, healthcare claims, itemized... ...our mission Perform an in-depth review of medical claims utilizing the UB-04 and detailed itemized statement to ensure the...Remote workFull timeWork from homeFlexible hours$40 per hour
...PT (20-30 hours week) – Remote Work Environment Non-Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical... ...medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and...Remote workContract workWork at officeLocal areaImmediate start- ...transform healthcare delivery and make a meaningful difference in the lives of our members. SUMMARY: The Utilization Management Authorization Review Nurse is responsible for managing inpatient & outpatient utilization by conducting thorough reviews of clinical...
- ...Cost Projections. This includes reviewing records, preparing the... ...Associate Degree or Diploma in Nursing required ~3-5 years' experience... ..., medical bill reviews and utilization reviews in injury cases preferred... ...utilization #LI-ZP1 #LI-Remote For over 50 years, Verisk...Remote workFull time
- Astiva Health, Inc. in Orange, CA seeks an experienced Utilization Management Authorization Review Nurse to manage inpatient and outpatient utilization. You will review clinical documentation, apply CMS and health plan guidelines, and issue denials, deferrals, or authorizations...
- ...clients and the people they serve. Location: Remote with on‑site visits across Illinois Position Overview The Nurse Reviewer conducts provider compliance reviews to... ...documentation supporting compliance findings. Utilize technology and web‑based systems to convert paper...Remote workH1bWork at officeFlexible hours
$50 per hour
...Registered Nurse Clinical Reviewer / AIMS - RemoteLocation: Remote (Jericho, NY) Employment Type: Full-time Hourly Rate: $50/hrGreenlife Healthcare Staffing... ...an experienced RN with a background in acute care utilization review who is detail-oriented, flexible, and capable...Remote workHourly payFull timePrivate practiceFlexible hours- ...Description The Clinical Nurse Reviewer plays a crucial role in the healthcare industry by evaluating... ..., ideally in case management, utilization review, or quality assurance. Familiarity... ...the essential functions. This is a remote position. While performing the duties of...Remote workWork at office
- ...Staffing Solutions Organization LLC (SSO) is seeking a Nurse Reviewer to conduct provider compliance reviews, onsite visits, and evaluate... ...judgment to guide provider improvement and statewide oversight. Remote work with 2–3 on‑site provider visits per week across Illinois...Remote work
$78k - $88k
...development. Summary We are seeking a Nurse Reviewer (RN) who will be responsible for performing... ...criteria, coverage policies, and utilization and practice guidelines. This role involves... .... Monday through Friday work schedule.Remote role available to employees residing...Remote jobFull timeMonday to FridayFlexible hours- ...Commence is seeking a Nurse Reviewer to perform expert medical record reviews of Medicare Part A/B and DMEPOS claims. You will apply clinical... ...policies, documenting clear rationales for actions. This remote role emphasizes HIPAA compliance and precise medical notation....Remote workLocal area
$88.85k
...Select how often (in days) to receive an alert: Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Location: ID, US Position Type: Full Time Requisition ID: 13392 Salary Range: $88,854.00(Min.) -$115,509.00(Mid.) -$142...Full time- ...Arkansas Blue Cross and Blue Shield is seeking an RN Utilization Management Nurse to perform clinical reviews for medical necessity across various services. The role involves weekend coverage and work from home within Arkansas and several western states. The ideal...Remote workWork from homeWeekend work
- ...Supporting the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database (CHSD) Audit Program, the part-time remote Registered Nurse CHSD Reviewer will conduct independent reviews of medical records, ensuring data accuracy and completeness while adhering to...Remote workPart timeWork at office
$43 - $47 per hour
...Roles, MA, Phlebotomist, CNA|| Passionate ||… Home Health RN – Remote (CA License Required) Facility: Compassus Providence Home... ...Torrance, CA (5315 Torrance Blvd, Ste 169-B) Role Type: Remote Reviewer RN – Back Office Chart Review Start Date: 11/03/2025...Remote workContract work$65k - $75k
...measurable impact. Job Description Performs utilization review of cases to determine if the request... ...requirements in collaboration with Nursing Management. Keeps current with regulation... ...Training: 10:30am CST - 7:00pm CST Location: Remote Job Type - Full-time Compensation...Remote workFull timeWork at officeLocal areaMonday to Friday- ...Cambia Health Solutions is seeking an Utilization Management Nurse to support care decisions for members across Oregon, Washington, Idaho, and Utah. You’ll review medical necessity, apply evidence-based criteria, and work with physicians and care teams to optimize outcomes...Remote workWork from homeFlexible hours
- ...Cambia Health Solutions seeks an UM IP Clinical Specialist to review inpatient utilization requests, research information, and coordinate with clinicians to support efficient reviews. The role emphasizes accuracy, timeliness, and adherence to regulatory standards. Work...Remote workWork from home
- ...SafeGuard Services (SGS), a subsidiary of Peraton, seeks a Nurse Reviewer to conduct medical record reviews and apply clinical judgment to payment decisions. You will research claims data, identify issues, and help develop fraud investigations. Travel for meetings and...Remote work
- ...CVS Health Corporation seeks an experienced Registered Nurse (RN) to support 24/7 Utilization Management operations. You will review cases, assess medical necessity, coordinate care, and ensure members receive appropriate, high-quality healthcare services. Join a dynamic...Remote workWork from home
$66k - $106k
...data analysis, investigation, and medical review to detect, prevent, deter, reduce, and... ...review sophisticated data model output, and utilize a variety of tools to detect situations... ...Experience in the medical field as a Registered Nurse or other clinician, and/or experience in...Remote workContract workTemporary workShift workNight shift$69.8k - $125.9k
...responsible for ensuring compliance with Utilization Management (UM) and Quality Review (QR) functions performed by the health... ...5+ years of experience as a Nurse Reviewer or Clinical Reviewer.... ...Sponsorship is not available This is a remote role Pay Transparency Statement...Remote workNight shift- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board certification and unrestricted medical license in relevant states. The role involves performing detailed...Remote workFull timeWork from home
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