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)
$33.12 - $56.77 per hour
...Elevance Health is seeking a Nurse Reviewer I who will perform medical necessity reviews for diagnostic imaging services from a virtual setting. Candidates are encouraged to apply remotely, ensuring a flexible work-life arrangement. The role requires a nursing degree and...Remote workMedicalHourly payFlexible hours$36.27 - $56.77 per hour
...Elevance Health is looking for a Nurse Reviewer I in Walnut Creek, CA, allowing for virtual work full-time with in-person training. Responsibilities include conducting reviews for diagnostic imaging services and collaborating with healthcare providers to ensure quality...Remote workMedicalFull time$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$5,833.33 - $6,666.67 per month
...webpage. Functional Title: Nurse Reviewer Job Title: Nurse III... ...the requirements of Texas Medicaid as well as state and federal... ...hospital records to validate medical necessity, accurate diagnoses and... ...Microsoft software in a telework/remote environment....Remote workMedicalFull timeTemporary workPart timeWork at officeShift workNight shiftDay 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
- ...Commission (HHSC) is hiring a Nurse Reviewer (Nurse III) to work under... .... The role supports Texas Medicaid compliance through clinical... ...assessment of resident needs, medical necessity of care, and Medicaid... ...and Microsoft software in a remote/telework environment. Additional...Remote workMedicalFull timeWork at officeNight shift
$45k - $70k
A healthcare management firm is seeking a Utilization Management Nurse Reviewer to ensure efficient use of medical services. The role involves reviewing medical records, assessing treatment necessity, and collaborating with healthcare providers. Candidates should possess...Remote jobMedical- A leading medical review company in Washington is seeking a Utilization Management Nurse Reviewer. The role involves assessing medical necessity, reviewing patient records, and collaborating with healthcare... ...a competitive salary range, remote work options, and a...Remote jobMedical
- Yourtexasbenefits is hiring a Nurse Reviewer (Nurse III) in Austin, Texas. This position involves conducting clinical reviews of hospital and nursing facility records to support Texas Medicaid compliance and identify potential fraud. A Texas RN license and RAC‑CT certification...Remote job
- Rising Medical Solutions in Chicago seeks a Legal Nurse to evaluate medical necessity and appropriateness in various claims. Candidates should have an Associate or Bachelor's Degree in nursing and an active RN license. Responsibilities include assessing demand packages...Medical
- ...DOMA Technologies is seeking a Nurse Reviewer to support independent dispute resolutions at Federal... ...levels. This role involves analyzing medical records, providing quality assurance... ...direct patient care experience. This is a remote position that offers the flexibility of...Remote workMedicalWork from home
$45k - $70k
...A leading healthcare company in the United States is looking for a Utilization Management Nurse Reviewer to ensure the efficient use of medical services and provide clinical expertise. Applicants must have an active LVN/RN license, with a preference for candidates having...Remote workMedical- ...PWN Remote Care Services, P.A. (PWN) is a telehealth practice... ...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
$27.5 per hour
...Title: Nurse Reviewer Pay: $27.50/hr Start Date: 9/8/2026 Location: Remote LPN State License must be active and in good standing for the entirety of the assignment... .... Description Review applications and medical documentation received from applicants/medical...Remote workMedical$90k - $99k
...DRG Nurse Reviewer Appeals and Hearings- Remote Date: Jan 9, 2026 Location: Any city, FL, US, 99999 Work Mode: Virtual (Exception only) It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and...Remote workMedicalFull timeWork from homeFlexible hours- ...Description Description: The Medical Nurse Reviewer applies clinical nursing... ...compliance with Medicare, Medicaid, and hospice-specific regulatory... ...This role performs medical necessity reviews, utilization audits... ...and Environment 100% Remote PHI/PII Requirement: Yes...Remote workMedicalFull timeWork at officeFlexible hours
- ...Job Description We are seeking Medical Analysts with experience in... ...Cost Projections. This includes reviewing records, preparing the... ...Associate Degree or Diploma in Nursing required • 3-5 years' experience... ...utilization #LI-ZP1 #LI-Remote About Us For over 50 years, Verisk...Remote workMedicalFull time
- ...services organization is seeking a Medical Director to ensure compliance with healthcare... ...standards and evaluate medical necessity for Medicare and Medicaid services. Required qualifications... ...clinical experience. The role supports remote work and requires participation in...Remote jobMedical
$79.56k - $115.72k
...professionals, including doctors, nurses, business people, tech... ...performing teams drive groundbreaking medical discoveries and invite all... ...The Senior Nurse Reviewer is responsible for the coordination... ...Working schedule: ~ Remote, M-F eastern standard business...Remote workMedicalShift work$125k - $201k
...Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization... ...of an accredited registered nursing (RN) degree program required... ...Review experience preferred Medicaid/Medicare/Commercial experience...Remote jobMedicalHourly payWork at office$45k - $70k
A healthcare services company is seeking a Utilization Management Nurse Reviewer to ensure medical services are used appropriately. The role involves reviewing medical records and coordinating care while adhering to guidelines. Candidates should possess an unrestricted...Remote jobMedical$45k - $70k
A leading healthcare company is looking for a Utilization Management Nurse Reviewer to ensure medical services are appropriately utilized. Responsibilities include conducting assessments, reviewing patient records, and collaborating with healthcare providers. A valid nursing...Remote jobMedical- ...Elevance Health seeks a Nurse Appeals - Licensed Nurse to investigate medical necessity appeals from members and providers. This role allows associates to work virtually... ...in managed care. Key responsibilities include reviewing medical records, preparing recommendations, and...Remote workMedicalFull time
- ...Elevance Health is seeking a Nurse Appeals - Licensed Nurse to work virtually from Indianapolis, IN, conducting investigations for medical necessity appeals. The role requires a current RN license and a minimum of two years in managed care healthcare. Candidates must have...Remote workMedicalShift work
$45 - $55 per hour
Commence is looking for a Nurse Reviewer to analyze medical records and support independent dispute resolutions at federal and state levels. The role... ...position offers a flexible work environment, including remote options. The salary ranges from $45 to $55 per hour, depending...Remote jobMedicalHourly payPart timeFlexible hours- ...Elevance Health is seeking a Nurse Appeals - Licensed Nurse to investigate medical necessity appeals from members and providers. This role allows for flexibility... ...a managed care setting. Responsibilities include reviewing denied services, documenting appeals, and providing...Remote workMedicalFull time
- ...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
- ...contractor position. We need a Nurse Practitioner who can provide... ...discretion and completely remote. We require at least 5 state... ...you will be responsible for reviewing pertinent patient data, developing... ...context of each patients’ medical history, care plan goals, and...Remote workMedicalFor contractors
- ...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 Health Writing experience, preferably in a Medicaid...Remote workMedical
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