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.
- ...established industry player is seeking a Medical Review Nurse to join their dynamic team in... ...involves reviewing and adjudicating medical claims, ensuring compliance with industry standards... ...enjoying the flexibility of a primarily remote work environment. If you are passionate...Remote workMedical
- AHCCCS, Arizona Health Care Cost Containment System, seeks a Claims Medical Review Nursing Consultant to monitor, evaluate, and approve or deny... ..., coding, and utilization review, with the state offering remote work options and a comprehensive benefits package in a mission...Remote jobMedical
$27.52 per hour
...Position Summary The Claims Technical Review Specialist provides advanced technical review of all types of claims in accordance with Company... ...loss claims and communicates with local union offices, medical service providers, employers, and members. Reviews and...Remote workMedicalLocal area- Claims Review Specialist / Medical Coding ** Largely Remote ** Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of the largest health delivery systems in California, seeks an accomplished Claims Review Specialist / Medical...Remote jobMedicalContract workTemporary work
$17.71 - $25.28 per hour
...performing teams drive groundbreaking medical discoveries and invite all applicants... ...opportunities, and much more. The D‑SNP Claims Review Specialist reviews and processes Senior Care... ...applicable) Working Condition This is a remote role that can be done from most US states...Remote workMedicalHourly payFull timeWork at officeFlexible hoursShift work- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims, documenting determinations and maintaining screening criteria. The role supports telecommuting from anywhere in the U.S. and requires...Remote jobWork at office
- ...RN Utilization Review Review patient medical records to assess the appropriateness and medical necessity of hospital admissions, continued stays, and... ...experience (hospital-based) ~ Skilled experience with remote work Length of assignment: 13 weeks Shift /...Remote workMedicalShift workWeekend work
$1,949.74 per month
...Specialty Utilization Review Job ID 17979666... ...Title Utilization Review RN Weekly Pay $1949.74... ...) Job Description Remote Utilization Review RN responsible for concurrent reviews, medical necessity determinations, prior...Remote workMedicalWeekly payShift work- A leading medical service provider in Washington, DC is seeking a DME Medical Reviewer to ensure compliance with nursing standards and provide... ...candidate must hold an active RN license and have at least two... ...audits. The role emphasizes remote work capabilities and...Remote workMedical
- ...Sacred Heart Hospital is seeking a nurse to join our Utilization Management team in a remote role. You will perform prospective, concurrent, and retrospective reviews to ensure medical necessity and alignment with reimbursement policies. Join a multidisciplinary team,...Remote workMedical
- ...WNS, part of Capgemini, is seeking a remote RN/LPN for utilization review in the United States. The role involves assessing medical necessity, resolving escalations, and maintaining HIPAA-compliant documentation with HealthHelp policies. Requires active nursing license...Remote workMedicalWork at office
- Optum is seeking a Utilization Review Nurse, RN to perform inpatient utilization management, applying evidence-based guidelines and medical necessity criteria. The role involves day-to-day clinical reviews, documentation, and collaboration with Medical Leadership across...Remote jobMedical
- Vaya Health seeks a Physical Health Registered Nurse to perform clinical reviews for authorization requests and medical necessity. You will reference standardized criteria and coordinate with physician peers when needed. This role is part of a multidisciplinary team focused...Remote jobMedical
- ...Job Title Registered Nurse (RN) for Critical Incident... ..., you will be responsible for reviewing and evaluating critical incidents... ...aligned with each participant's medical and functional needs. You will... ...utilizing technology to support remote and hybrid work functions. Your...Remote workMedicalFull timeWork from home
- ...In this role, you will manage utilization review processes, ensuring quality patient care... ...contributing to a collaborative and supportive remote work environment. Benefits... ...~ Weekly Pay ~ Referral Bonus ~ Medical benefits ~ Dental benefits ~ Vision...Remote workMedicalWeekly payMonday to FridayWeekend work
- ...HealthHelp is seeking a remote Utilization Review clinician (RN/LPN/LVN) to support medical necessity determinations across client programs. You will review cases, coordinate with providers, and ensure timely decisions in line with policy and regulatory requirements. Ideal...Remote workMedicalWork at office
- Medix is seeking a Clinical Review RN for Prior Authorization, with 2 years of acute care... ...reviewing inpatient cases, documenting medical necessity, and coordinating with physicians... ...authorizations. Onsite in Jericho or remote in RI is possible. #J-18808-Ljbffr Medix...Remote jobMedical
- ...Abstractor The Suicide Mortality Review (SMR) Program, within the... ...including but not limited to medical, behavioral health, law enforcement... ...within a multidisciplinary remote team. Qualifications... ...Registered Nurse Clinical Licensure (RN, LPC, APRN) Bachelor's Degree...Remote workMedicalWork at office
- ...Fully Remote Utilization Review Position Setting: Fully Remote – Utilization Review Schedule: Full... ...N/A Job Requirements: Active RN license with Multi-State/Compact... ...preferred) Strong understanding of medical necessity, utilization management, healthcare...Remote workMedicalFull timeMonday to Friday
- Walker Healthforce, LLC seeks a Medical Claim Review Nurse for a fully remote contract based in Washington. The role focuses on retrospective medical necessity... ...of Washington. The ideal candidate holds an active RN license (LPN/LVN accepted) and 3-5 years of appeals review...Remote jobMedicalContract work
- ...Fully Remote Utilization Review Position Setting: Fully Remote – Utilization Review Schedule: Full... ...Job Requirements: Active RN license with Multi-State/Compact License... ...experience Strong understanding of medical necessity, utilization management, healthcare...Remote workMedicalFull timeMonday to Friday
- Palmetto GBA is seeking an experienced RN for remote utilization review to evaluate medical claims using established criteria and guidelines. The role emphasizes timely decisions, documentation, and collaboration with internal teams. You will work from a home office and...Remote jobMedicalWork from homeHome office
- ...UnitedHealth Group, is seeking a Clinical Review Clinician to analyze hospital facility bills... ...telecommute flexibility within the U.S. and requires RN or LPN licensure and clinical experience. You will perform bill review, review medical records, and ensure HIPAA compliance while...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
- ...Description JOB DESCRIPTION This RN will act as a Care Review Clinician supporting our Medicaid... ...notes. This is a telephonic remote position and productivity is... ...Responsible for verifying that services are medically necessary and align with established...Remote workMedicalWork at officeMonday to FridayWeekend work
- University of Maryland Medical System seeks a Utilization Review Nurse for weekend shifts in Towson, MD. The role bridges care teams and insurers, ensuring... ..., and nursing credentials. Training is partly remote with onsite start as needed. #J-18808-Ljbffr University...Remote jobMedicalShift workWeekend work
$30 - $38 per hour
A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Remote jobMedicalHourly payPart time- An established industry player is seeking a dedicated Registered Nurse for a remote contract position focused on reviewing medical claims within the insurance sector. This role involves validating treatment plans using accepted criteria and requires strong communication...Remote jobMedicalContract work
- HonorHealth in Arizona seeks an Utilization Review RN Specialist to review and monitor utilization for... ..., high-quality care. This role ensures medical necessity across Medicare, AHCCCS, and... ...with physicians and care teams. Remote work is available after training. #J-1...Remote jobMedical
- ...Care Review Clinician This RN will act as a Care Review Clinician supporting our Medicaid members... ...contact notes. This is a telephonic remote position and productivity is important... ...for verifying that services are medically necessary and align with established...Remote workMedicalWork at officeMonday to FridayWeekend work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN: Medical Claims Review Specialist. Be the first to apply!

