Remote RN: Medical Claims Review Specialist
Axius Technologies Inc.
- Remote job
An established industry player is seeking a Medical Review Nurse to join their dynamic team in Phoenix. This role involves reviewing and adjudicating medical claims, ensuring compliance with industry standards, and working collaboratively with healthcare providers. The ideal candidate will possess a strong nursing background, excellent organizational skills, and the ability to analyze complex medical documentation. In this position, you will contribute to the efficiency of healthcare delivery while enjoying the flexibility of a primarily remote work environment. If you are passionate about making a difference in healthcare, this opportunity is perfect for you. #J-18808-Ljbffr Axius Technologies Inc.
$60 - $90 per hour
...experienced in insurance claims handling, claims operations, coverage review, claims documentation,... ...supports current and upcoming remote consulting opportunities... ..., claims operations specialist, claims examiner, claims... ..., workers compensation, medical, specialty lines, or...Remote jobMedicalHourly payWeekly payJob sharingContract workPart timeFor contractorsFlexible hours- ...Description Job Description Fully remote- Must have state of MI unrestricted RN license. You will perform... ...prospective, concurrent and retrospective review of inpatient, outpatient,... ...and ancillary services to ensure medical necessity, appropriate length of stay...Remote workMedicalWork at officeFlexible hours
$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX Agency: Mindlance Health... ...contact and will include 80% travel. Remote role. Will require a driver’s license.... ...partner with top-tier hospitals and medical institutions nationwide, helping you...Remote workMedicalHourly payFull timeContract workImmediate startShift work3 days per week- ...Description Job Description We are seeking a Registered Nurse (RN) – Medical Necessity Review (Prior Authorization / Program Exception) to support the... ...in Harrisburg, PA, with a hybrid schedule (three days remote, two days onsite). This position focuses on reviewing...Remote workMedicalLong term contractFull timeContract work
- ...seeking a registered nurse for Clinical Review and QIDP responsibilities, working remotely from any U.S. location. The role requires an active RN license in Alabama, a BA/BS in Nursing,... ...Medicaid criteria to determine medical necessity and managing reviews according...Remote jobMedicalWork from home
- ...management, discharge planning and utilization review. Review admissions and service... ..., concurrent and retrospective medical necessity and/or compliance with reimbursement... ...documentation, precertification, reimbursement and claim denials/appeals. Assess and coordinate...Remote workMedical
$84.06k - $118.67k
...seeks a Licensed Registered Nurse for a remote position in Utilization Management. The... ...admissions and discharge planning, conducting reviews for medical necessity, and assisting with coding and claims issues. Candidates must hold an RN license from the Texas Board of Nursing...Remote jobMedical- COMAGINE HEALTH is seeking Clinical Utilization Review Nurses (RN) for a full-time remote position focused on assessing the medical necessity of healthcare services in Alabama. Candidates must hold an active RN license and possess a BA/BS in nursing, alongside a minimum...Remote jobMedicalFull time
- P3 Health Partners in Henderson, NV is seeking an RN Concurrent Review to ensure compliance with the Medical Management Program. The role may be hybrid or fully remote, with competitive hourly rates based on experience. The successful candidate will have at least two years...Remote jobMedicalHourly pay
- Providence is seeking an RN for a remote Utilization Review role. This per diem position involves conducting prospective, retrospective, and concurrent... .... Responsibilities include daily clinical reviews and assessments of medical records. #J-18808-Ljbffr ProvidenceRemote jobMedicalDaily paid
- ...is hiring a full-time Licensed Medical Review Nurse to conduct reviews of... ...medical documentation while working remotely. This role involves managing appeals and validating claims to ensure medical necessity... ...review, and a valid RN license in Florida or Kentucky...Remote jobMedicalFull time
- Providence Health & Services is hiring a Utilization Review RN for a remote position focused on administering medical management programs, including prior authorization and review processes. Candidates must have a strong clinical nursing background with 5 years of experience...Remote jobMedical
$28.37 - $36 per hour
Acentra Health, LLC is seeking a Clinical Reviewer - RN - PRN (Remote U.S.) to interpret patient records, ensuring medical necessity and appropriateness of care. Ideal candidates will possess an RN license and relevant clinical experience. This position offers flexible...Remote jobMedicalReliefFlexible hours- UnitedHealth Group is seeking a Clinical Review Clinician in Plymouth,... ...reviews of hospital bills and claims while ensuring compliance with... ...Associate's degree, an active RN or LPN license, and at least 2... ...include paid time off, medical plans, and a comprehensive benefits...Remote jobMedical
- A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and...Remote jobMedicalFull time
- ...Services is seeking a Clinical Review Nurse I for Medicare Part A, primarily... ...be responsible for reviewing claims and ensuring they meet members' benefits based on medical policy. Qualifications include... ...'s degree in nursing, an active RN license, and at least one year of...Remote jobMedical
- ...a full-time Michigan Licensed Medical Review Nurse to manage the review of documentation in a remote capacity. This role involves ensuring... ...records, and overseeing claims for accurate reimbursement. The... ...experience and possess an active RN license in Michigan. Knowledge...Remote jobMedicalFull time
- ...nonprofit organization is seeking a Registered Nurse (RN) to perform Clinical Review work and QIDP reviews. This remote position requires an active RN license in Alabama... ...include applying Medicaid criteria to determine medical necessity, completing reviews within established...Remote jobMedical
- A regional healthcare provider in Houston is seeking a Utilization Management Review Nurse. This role involves evaluating the appropriateness of medical services based on necessity and promoting quality care outcomes. The candidate must have a Bachelor's in Nursing and...Remote jobMedicalFlexible hours
$49.34 - $76.59 per hour
...leading healthcare organization is seeking a Utilization Review RN for a fully remote role in Oregon. Candidates must hold an Oregon Registered... ...particularly in collaboration with physicians. This position manages medical management programs to optimize patient care. Competitive...Remote jobMedical$75k
...looking for a Registered Nurse (RN) to perform concurrent inpatient utilization reviews. The role requires a BSN and current... ...vision benefits. The position is remote with a standard Monday-Friday... ...emphasizes teamwork and compliance with medical standards. #J-18808-Ljbffr...Remote jobMedicalMonday to Friday- Inland Empire Health Plans seeks a Provider Quality Review Nurse, RN to ensure high-quality care delivery through case review and quality assurance... ...include investigating PQI cases and working closely with the Medical Director on resolutions. Join IEHP for an impactful career in...Remote jobMedical
$91.25k - $120.91k
...professional for a short-term assignment focused on quality assurance and management. The role includes reviewing cases, providing recommendations, and working closely with Medical Directors. The ideal candidate will have at least three years of relevant experience in...Remote jobMedicalTemporary work$28.94 - $51.63 per hour
...Association Inc is seeking a Clinical Appeals RN to manage appeals and grievances... ...proficiency with Microsoft Office. You will review medical records, assess clinical eligibility for... ...with all regulations while working remotely from anywhere in the U.S. Attractive benefits...Remote jobMedicalHourly payWork at office- ...Territorial Epidemiologists is seeking a Clinical Review Supervisor to provide operational... ...utilization review activities. This fully remote position requires an RN license and relevant experience in patient care and medical management. The role focuses on quality oversight...Remote jobMedical
- ...active licensure and minimum 3 years of clinical experience for a remote position. Candidates must have strong clinical documentation... ...be eligible for DoD background clearance. This role involves reviewing medical records, identifying quality issues, and supporting quality...Remote jobMedical
- ...Abstractor The Suicide Mortality Review (SMR) Program, within the... ...Program integrates data from medical, behavioral health, and social... ...communication within a multidisciplinary remote team. Qualifications... ...Nurse Clinical Licensure (RN, LPC, APRN) Bachelor's Degree...Remote workMedicalWork at office
- A health organization is seeking a Registered Nurse (RN) to perform clinical review and QIDP work remotely. The ideal candidate will assess medical necessity according to Alabama Medicaid guidelines and possess a current RN license in Alabama, along with a BA/BS in Nursing...Remote jobMedical
$50.68 per hour
Children's Hospital Colorado is seeking a Utilization Review RN to support medical necessity reviews and compliance in a hybrid role based in Colorado. This position requires strong pediatric nursing experience and knowledge of utilization review. Responsibilities include...Remote jobMedicalHourly payFlexible hours- ...staffing agency seeks a Wound Care Registered Nurse for a remote role focusing on conducting medical reviews for the Veterans Administration. Candidates must have extensive experience in wound care, hold a valid RN license, and be board-certified. This position offers...Remote jobMedicalFlexible hours
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