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

Remote Nurse Reviewer - Medical Necessity & Medicaid

Healthcare Quality Strategies, Inc. (HQSI)

Florida, NY
  • Remote job

Healthcare Quality Strategies, Inc. (HQSI) is seeking a Nurse Reviewer for a remote position supporting Medical Review Services. The role requires conducting comprehensive medical necessity reviews and ensuring compliance with established guidelines. The ideal candidate will have a BSN with active RN licensure and 3-5 years of experience in medical record review. Proficiency in medical terminology and excellent communication skills are essential. Benefits include medical/dental/vision insurance and 401k. #J-18808-Ljbffr Healthcare Quality Strategies, Inc. (HQSI)

Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote Nurse Reviewer - Medical Necessity & Medicaid in Florida, NY vacancy
  •  ...least 3 years of experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity. Current/Active Nursing or...  ...developing fraud cases Knowledge of Medicaid requirements, laws, rules and... 
    Remote work
    Medical
    Night shift

    Peraton

    New York, NY
    2 days ago
  • A healthcare organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The role involves examining claims, maintaining...  .... This position offers a chance to work in a remote setup with competitive hours. Benefits include... 
    Remote job
    Medical

    Healthcare Quality Strategies, Inc. (HQSI)

    Florida, NY
    4 days ago
  •  ...healthcare quality organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The ideal candidate will have a BSN and...  ...participating in ongoing training. This is a part-time remote position, offering a flexible work environment... 
    Remote job
    Medical
    Hourly pay
    Part time
    Flexible hours

    Healthcare Quality Strategies, Inc. (HQSI)

    Florida, NY
    2 days ago
  • Peraton is seeking a Medical Reviewer for SafeGuard Services to conduct medical record reviews,...  .... Responsibilities include researching Medicaid regulations, identifying improper payments...  ...with external agencies. Must have nursing or related clinical background; U.S. #J... 
    Remote work
    Medical

    Peraton

    Brooklyn, NY
    2 days ago
  • $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...  ...comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous... 
    Remote work
    Medical
    Contract work
    Work at office
    Local area
    Immediate start

    HQSI

    Tampa, FL
    4 days ago
  • $35.54 - $55.73 per hour

     ...Nurse Reviewer I Nurse Reviewer I Seeking RNs that have a current, unrestricted RN license...  ...routine having limited or no previous medical review experience requiring guidance by...  ...mentoring learns to conduct medical necessity clinical screenings of preauthorization... 
    Remote work
    Medical
    Full time
    Work experience placement
    Work at office
    Local area
    Monday to Friday
    Shift work
    Weekend work
    Afternoon shift

    Elevance Health

    United States
    3 days ago
  •  ...to better care.? Requirements The Nurse Reviewer performs complex medical record reviews of Medicare Part A/B...  ...apply clinical judgment to medical necessity, coverage, and appropriateness-of-care...  ...the essential functions. This is a remote position. While performing the... 
    Remote work
    Medical
    Contract work
    For contractors
    Local area

    Commence, LLC

    Virginia, IL
    3 days ago
  • $95k - $110k

     ...DRG Nurse Reviewer Appeals and Hearings- Remote It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career... 
    Remote work
    Medical
    Full time
    Work from home
    Relocation package
    Flexible hours

    Gainwell Technologies

    United States
    4 days ago
  •  ...Nurse Reviewer Contract Duration: Initial 6-months Pay: $27.50/hr on W2 Start Date: 9/8/2026 Location: Fully Remote (US Only) LPN State License must be active and in good standing...  ...Overview Review applications and medical documentation received from... 
    Remote work
    Medical
    Contract work

    Tailored Management

    United States
    4 days ago
  • Commence is seeking a Nurse Reviewer to perform complex medical record reviews of Medicare Part A/B and DMEPOS claims. The role requires clinical judgment...  ...validity according to CMS guidelines. The position is remote, offering flexibility while demanding high accuracy and... 
    Remote job
    Medical

    Commence, LLC

    Brooklyn, NY
    3 days ago
  • $174.07k - $374.92k

     ...This is a full-time, fully remote role. You can work from anywhere...  ...health and well-being of Medicaid members across the country....  ...Virginia. We are seeking a Medical Director to join our centralized...  ...Management and medical necessity reviews Prior authorization and precertification... 
    Remote work
    Medical
    Hourly pay
    Full time
    Temporary work
    Local area
    Work from home

    CVS Health

    Virginia, IL
    22 hours ago
  •  ...more personalized. PWN Remote Care Services, P.A. (PWN) is...  ...state physician, registered nurse, and genetic counselor...  ...physicians to support asynchronous medical necessity review following a completed...  ...Enrollment in Kansas or Arkansas Medicaid preferred, or willingness... 
    Remote work
    Medical
    Contract work
    Flexible hours

    EverlyWell

    United States
    4 days ago
  •  ...Job Description Provide timely review and determination of medical claims, including prior authorization...  ...unrestricted State license as a Registered Nurse (RN),as required by contract(s).  ~...  ...essential for this position Remote but need to be local to 18702 RN... 
    Remote work
    Medical
    Contract work
    For contractors
    Work experience placement
    Work at office
    Local area

    Federal Hearings And Appeals

    Wilkes Barre, PA
    3 days ago
  • Hawaii Medical Service Association is seeking a Concurrent Nurse Reviewer for the Facility Utilization Review Unit. The role requires applying clinical and policy criteria to determine the appropriateness of inpatient stays and suspended claims for HMSA members. Under... 
    Medical

    Hawaii Medical Service Association

    Brooklyn, NY
    22 hours ago
  • Peraton’s SafeGuard Services seeks a Nurse Reviewer to conduct medical record reviews, applying clinical judgment to claim payments and supporting fraud investigations. Telework is available from any state. The ideal candidate will hold a US nursing license, have 5+ years... 
    Remote job
    Medical

    Peraton

    New York, NY
    2 days ago
  •  ...Utilization Management Authorization Review Nurse Astiva Health, Inc., located in Orange...  ...Review authorization requests for medical necessity, ensuring adherence to regulatory and...  ...Guidelines (MCG), InterQual, Medicare, Medicaid, and CMS regulations. Utilization management... 
    Medical

    Astiva Health, Inc

    Orange, CA
    3 days ago
  •  ...support the coding department, the full-time Registered Nurse Clinical Reviewer will perform clinical validation by ensuring diagnosis codes billed by providers are supported within medical records, while working remotely from anywhere in the United States. Key... 
    Remote work
    Medical
    Full time

    Virtual Vocations Inc

    United States
    4 days ago
  •  ...Incorporated seeks a CQE Rehabilitation Services Manager I to lead medical necessity reviews for rehabilitation services. The role supports...  ...with PT practitioners and internal teams. The position allows remote work with a WFH setup and requires strong knowledge of PT guidelines... 
    Remote job
    Medical
    Work from home

    American-Specialty-Healt

    New York, NY
    1 day ago
  • $60 per hour

     ...contractor position. We are seeking a Nurse Practitioner who can provide...  ...discretion and completely remote. We require at least 5...  ...you will be responsible for reviewing pertinent patient data, developing...  ...context of each patients' medical history, care plan goals, and... 
    Remote work
    Medical
    Hourly pay
    For contractors

    Tapestry

    United States
    4 days ago
  • $30 - $45 per hour

     ...Operations Specialist III - Medicaid / Medi-Cal (Epic + Utilization Review. This is a 06+months...  ...located in Long Beach, CA(Remote). Please review the job...  ...to, health insurance (medical, dental, vision), 401(k)...  ...Shield, etc.) Review medical necessity documentation... 
    Remote work
    Medical
    Contract work
    Local area
    Immediate start

    Pyramid Consulting

    Long Beach, CA
    3 days ago
  •  ...Medicaid Content Writer (Quality - Medical Management - Behavioral Health)Medicaid proposal writing with subject matter expertise in at least one of the following topics: Quality - Medical Management - Behavioral HealthWriting experience, preferably in a Medicaid environmentProblem... 
    Remote work
    Medical

    Samprasoft

    United States
    4 days ago
  • Palmetto GBA is seeking an Appeals Nurse Reviewer to research complex appeal or retrospective review requests and determine medical necessity according to guidelines and regulations. This full-time remote role (40 hours/week) operates Monday-Friday, 8:00 a.m. to 4:30 p.... 
    Remote job
    Medical
    Full time
    Monday to Friday

    Southcarolinablues

    Brooklyn, NY
    2 days ago
  •  ...UnitedHealthcare is seeking a Chief Medical Officer for the New Mexico Community Plan. You...  ...population health programs for New Mexico’s Medicaid beneficiaries, reporting to top...  ...innovative care delivery while enabling remote work from anywhere in the United States.... 
    Remote job
    Medical

    Jobleads-US

    Albuquerque, NM
    3 days ago
  •  ...Alliance in the United States is seeking a Medical Necessity specialist for ABA services to ensure contract compliance and review treatment plans. This role supports adherence...  ...certification, and DoD background clearance; remote work options are available for qualified... 
    Remote job
    Medical
    Contract work

    TriWest Healthcare Alliance

    Phoenix, AZ
    2 days ago
  • Rad Cube Llc seeks a detail-oriented Certified Medical Coder / Medical Record Audit Specialist to support coding accuracy, medical record review, and billing compliance for Indiana Medicaid programs. You will review records and claims documentation, identify discrepancies... 
    Remote job
    Medical

    Rad Cube Llc

    Carmel, IN
    4 days ago
  • Revive BHS in Maryland seeks a Medical Billing Manager to oversee the Medicaid billing team, coordinating with Medical Billing Specialists and clients to ensure accurate submissions, documentation, and timely authorizations. This role drives effective billing workflows... 
    Remote job
    Medical

    Revive BHS

    Glen Burnie, MD
    4 days ago
  •  ...Compliance support specialist for a fully remote role. You will assist the Compliance...  ...guidelines across 50 states related to Medicaid autism ABA regulations, perform audits,...  ...professional outputs. The role entails reviewing Medicaid regulations, state mandates, payer... 
    Remote job
    Medical

    BruntWork

    New York, NY
    22 hours ago
  •  ...seasoned Revenue Cycle Specialist to manage Medicaid payer accounts and ensure timely...  ...reimbursement for healthcare services. This fully remote role involves critical tasks such as...  ...must have at least 2 years of experience in medical billing or revenue cycle management. #J-1... 
    Remote job
    Medical

    Medical Guardian

    New York, NY
    3 days ago
  • Med-Care Providers is seeking a Medical Billing / Credentialing Specialist in Las Vegas, NV...  ...billing with a focus on Medicare and Medicaid claims. Responsibilities include preparing...  ...relevant certifications. Flexibility for remote or hybrid work may be available. #J-18808... 
    Remote work
    Medical
    Part time

    Med-Care Providers

    Las Vegas, NV
    2 days ago
  • Humana is seeking a Behavioral Health Medical Director to lead clinical decision-making on...  ...authorization for services, aligned with Medicaid rules and Humana policies. Role requires...  ...experience in a health plan environment. Remote work from cluster states with occasional... 
    Remote job
    Medical

    Humana

    Raleigh, NC
    1 day ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Nurse Reviewer - Medical Necessity & Medicaid. Be the first to apply!