Remote Nurse Reviewer - Medical Necessity & Medicaid
Healthcare Quality Strategies, Inc. (HQSI)
- 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)
- ...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 workMedicalNight shift
- 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 jobMedical
- ...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 jobMedicalHourly payPart timeFlexible hours
- 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 workMedical
$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 workMedicalContract workWork at officeLocal areaImmediate start$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 workMedicalFull timeWork experience placementWork at officeLocal areaMonday to FridayShift workWeekend workAfternoon shift- ...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 workMedicalContract workFor contractorsLocal area
$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 workMedicalFull timeWork from homeRelocation packageFlexible hours- ...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 workMedicalContract work
- 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 jobMedical
$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 workMedicalHourly payFull timeTemporary workLocal areaWork from home- ...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 workMedicalContract workFlexible hours
- ...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 workMedicalContract workFor contractorsWork experience placementWork at officeLocal area
- 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
- 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 jobMedical
- ...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
- ...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 workMedicalFull time
- ...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 jobMedicalWork from home
$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 workMedicalHourly payFor contractors$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 workMedicalContract workLocal areaImmediate start- ...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 workMedical
- 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 jobMedicalFull timeMonday to Friday
- ...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 jobMedical
- ...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 jobMedicalContract work
- 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 jobMedical
- 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 jobMedical
- ...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 jobMedical
- ...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 jobMedical
- 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 workMedicalPart time
- 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 jobMedical
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