Remote RN Auditor - Clinical Validation & Utilization
Cotiviti
- Remote job
Cotiviti is seeking a senior auditing RN to perform retrospective chart reviews on Readmission and Place of Service Claims, applying clinical guidelines and considering claims-specific contracts. The role requires strong documentation, decision-making, and proficiency with Cotiviti auditing systems. The ideal candidate has 5–7+ years in Utilization/Case Management with an ICU/CCU background, and holds an RN license with active state credentials. #J-18808-Ljbffr Cotiviti
$60.2k - $107.4k
...Utilization Management & Clinical Validation 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...Remote jobMinimum wageFull timeWork experience placementLocal area$45.67 per hour
Auditor Clinical Validation Outpatient Specialty Clinical Job Locations US-Remote ID 2026-18743 Category Audit - Healthcare Position Type Full-Time Overview This... ...Responsibilities Audits Outpatient and Specialty Claims: Utilizes medical chart coding principles and client...Remote workHourly payFull timeContract workWork at officeImmediate start$45 - $50 per hour
...Clinical Documentation Consultant (CDI) DRG Validation / Auditor Immediate need for a talented Clinical Documentation... ...and is located in US(Remote). Pay Range: $45 -... ...Experience: RN, BSN, MSN, MD or... ...Hospitalist, Case Management, Utilization Review, or CDI...Remote workContract workLocal areaImmediate start$85k - $90k
...role partners closely with Clinical Auditors, Quality Analysts, and Subject... ...coding guidelines, clinical validation requirements, and audit... ...training and performance support. Utilize industry standards and EXL... ...partners in a cross-functional, remote environment. Strong...Remote work$71.1k - $97.8k
...our caring community The Utilization Management Nurse 2 uses clinical nursing skills to support... ...Licensed Registered Nurse (RN) in an Enhanced Nurse Licensure... ...US Nationwide Work Style: Remote Travel Requirements: None... ...decisions only on valid job requirements. This policy...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday$70.8k - $123.8k
Clinical Nurse Auditor Position Description CGI is one of the... ...medical necessity, validate clinical services, and... .... This position is remote within the United States... ...Registered Nurse (RN) license in your state... ...medical necessity and utilization review determinations...Remote workWork at officeLocal area$45 - $50 per hour
...looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical... ...of accredited nursing programs with an active New York RN license. #J-18808-LjbffrRemote workHourly pay- UnitedHealth Group seeks a Clinical Review Clinician to analyze itemized hospital bills and document adjustments for forensic reviews. Telecommute... ...anywhere in the U.S. The role requires clinical experience, RN or LPN license, and bill review knowledge. You will support...Remote job
$80k - $90k
...Job Title: RN Medical Bill Auditor Location: Remote Compensation: $80,000 - $90,000... ...opportunity to leverage clinical nursing expertise in a data... ...and billing data to validate charges and identify discrepancies... ...medical charges Utilize knowledge of surgical...Remote workFull timeWork experience placementLocal area- Optum Insight is seeking a Clinical Claim Review RN to perform compliance reviews of medical and administrative... ..., and collaboration with a team of auditors to document findings and input data... ...is full-time (40 hours/week) with remote work options in Massachusetts and potential...Remote jobFull timeLocal area
$63.74k - $95.26k
...Diagnostic Related Groups (DRG) Clinical Auditor will be responsible for performing DRG validation (clinical/coding)... .... This role will utilize their experience with ICD... ...EXPERIENCE: LVN or RN license in the state of... ...complies with ADA regulations as applicable. #LI-Remote...Remote workMinimum wageFull timeWork at officeLocal areaFlexible hours$68.57k - $104.84k
...a DRG Quality Control/Clinical Auditor. The Diagnostic Related... ...for performing DRG validation (clinical/coding) reviews... .... This role will utilize their experience with... ...necessity rules. This is a remote position. ESSENTIAL... ...EXPERIENCE: LVN or RN license in the state...Remote workMinimum wageFull timeWork at officeLocal areaFlexible hours$90k - $105k
...talented individual for a Clinical DRG Auditor who is responsible for performing DRG validation (clinical/coding)... ...conclusions. Utilizes HMS proprietary auditing... ...required CEUs to maintain RN license and coding certification... ...in this role Remote within the U.S. May...Remote workFull timeContract workFlexible hours- Comagine Health in Alabama is seeking Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent... ...retrospective utilization reviews. This is a full-time remote role supporting Alabama contracts. You will apply...Remote jobFull time
$35.29 - $54.71 per hour
...Aurora - CO Department: Clinical Care Annex Work... ...not offer a hybrid or remote option Minimum Requirements... ...as a Registered Nurse (RN). ~6 months of... ...in direct patient care utilizing the nursing process... ...training for competency validation throughout clinical orientation...Remote workFull timeTemporary workLocal areaFlexible hoursShift workNight shift- Comagine Health is seeking a Clinical Manager, Care Management to lead a team in utilization management from a fully remote position in the U.S. The ideal candidate will have extensive experience in clinical settings and will be responsible for clinical quality, operational...Remote job
- Comagine Health seeks Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This full-time, remote position requires Alabama licensure and focuses on compliant, cost-effective...Remote jobFull timeContract work
$86.56k - $129.84k
...Patient Safety DRG Clinical Validation Auditor Location: This role enables associates to work virtually full-time, except for required in-person... ..., and industry knowledge to substantiate conclusions. Utilizes audit tools, auditing workflow systems and reference...Full timeWork at officeLocal area$69.3k - $78k
...Medical Review Nurse II - Clinical Validation At Performant, we’re... ...experienced medical auditors and coders performing... .... You will work remotely in a fast paced and dynamic... ...Experience with utilization management systems or... ...Active unrestricted RN license in good standing...Remote workFor contractorsWork at officeWork from homeHome officeShift work$35.29 - $54.71 per hour
...Aurora - CO Department: Clinical Care Annex Work... ...not offer a hybrid or remote option Minimum Requirements... ...as a Registered Nurse (RN). ~6 months of... ...in direct patient care utilizing the nursing process... ...training for competency validation throughout clinical orientation...Remote workFull timeTemporary workLocal areaFlexible hoursShift work- ...Clinical Validation Nurse At MedReview, our mission is to bring accuracy, accountability... ...Registered Nurse with active RN licensure required CCS (... ...Windows PC with the ability to utilize multiple applications at the same time Remote Work Requirements: High...Remote workFull timeMonday to Friday
$55.1k - $99k
...Clinical Coding Auditor & Trainer Location: Remote, NY, US (The Clinical Coding Auditor & Trainer position is primarily remote with a... ...Willingness to travel to New York twice a year RN, PA, MD, APRN, DO, or MBBS license Valid/Current CPC or CIC Certification, through...Remote workPermanent employmentFull time- ...Nurse Auditor Remote We are seeking a detail-oriented Registered Nurse (RN) Auditor to support revenue integrity... ...audit and billing validation. In this role, you... ...Validate charges based on clinical documentation,... ...auditing, denials or utilization review. Familiarity...Remote workTemporary work
$2,210 per week
...Holidays Work-life balance. Remote/hybrid setting (once trained)... ...DESCRIPTION: This individual will utilize clinical knowledge and communication... ...and claim concerns, and validation of criteria. Communicates knowledge... ...but is not limited to RN, LMSW, LMHC. Successful completion...Remote workFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours- ...TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews,...Remote work
- ...Utilization Management RNThere's no place like Liberty HealthCome... ...for members and within clinical guidelinesMonitor... ...License, (Compact, RN preferred)1–5 years managed... ....Must have a valid driver's license.Proven... ...communicates instructions to remote users.Visit for more information...Remote workWork at office
- ...Job Title Validates Acute Inpatient coded charts to ensure the diagnostic information... ...documentation in the Medical Record. Seeking RN candidates with a HCS-D - Home Care... ...COS-C Certificate for OASIS Specialist-Clinical. Remote position in New York. Job Responsibility...Remote workHourly payFull time
- ...is seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this role, you will conduct... .... The ideal candidate will have strong clinical judgment, a valid RN license, and 3+ years of experience in utilization...Remote job
$60k - $90k
...Description Join the PPD™ clinical research business of Thermo... ...the Role As a GCP Clinical Auditor II , you will lead and perform... ...for the role (up to 50%). Valid driver's license and ability to... ...travel (25-50%). Location: Remote United States. Relocation...Remote workFull timeWork at officeWork from homeRelocation package- ...healthcare staffing firm is seeking a skilled Utilization Review RN to join their team. This fully remote position requires a valid PA RN license and prior experience in... ...review. Responsibilities include conducting clinical reviews, applying evidence-based criteria for...Remote job
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