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.
$27.52 per hour
...looking for aClaims Technical Review Specialist based in United States. This... ...to apply advanced claims expertise while ensuring accurate... ...limitations. Familiarity with medical and dental claims terminology... ...approximately $27.52 per hour . Remote work opportunity with...Remote workMedicalHourly payWork at office- 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 workMedicalFull time
$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- ...seeking experienced nursing professionals to review medical records and ensure appropriate admission... ...Candidates must have a valid California RN license and at least two years of... ...in a related field. The position offers remote work with emphasis on critical thinking...Remote workMedical
- ...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
$26.41 - $51.49 per hour
...Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical... ...education and experience. Registered Nurse (RN). License must be active and unrestricted in state...Remote workMedicalHourly payWork experience placementWork at office- ...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
$26.41 - $51.49 per hour
...Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical... ...education and experience. Registered Nurse (RN). License must be active and unrestricted in state...Remote workMedicalHourly payWork experience placementWork at office- ...Comagine Health is looking for a Clinical Utilization Review Nurse (RN) to perform remote assessments on the medical necessity of healthcare services. This full‑time position involves managing utilization reviews and ensuring compliance with clinical policies for quality...Remote workMedicalFull time
- ...Dignity Health – St. Bernardine Medical Center is a 342-bed, acute... ...Responsibilities Responsible for the review of medical records for... ...market. Job Requirements Remote. Must reside within driving... ...year experience. California RN license. AHA BLS Ability...Remote workMedical
$30 - $34 per hour
...healthcare services company is seeking an experienced Utilization Review Nurse to work remotely. The ideal candidate must hold an active LVN license in... ...management. Responsibilities include approving or denying medical services based on established criteria. Competitive hourly...Remote workMedicalHourly pay- ...telephonic and e-referral case review and authorization of services... ...mental health and substance abuse medical necessity criteria to provide... ...position is full-time, fully remote (work from home) and requires... ...of Michigan clinical license (RN, LMSW, LP, LPC, or LLP)...Remote workMedicalFull timeWork from homeShift workWeekend workAfternoon shift
$85k - $92k
...to identify a Clinical Quality Reviewer. This role focuses on... ...What you will be doing Review medical records to identify potential... ...license as a Registered Nurse (RN) or Licensed Clinical Social Worker... ...environment Other Information Remote or onsite depending on business...Remote workMedicalHourly payWork at officeHome office- ...Job Title Utilization Review/Case Management – Nurse Department Case Management (Quality... ...position. Hybrid (combination of in person and remote considered) General Summary The... ...planning is provided. Working closely with the Medical Staff and Nursing units in this effort,...Remote workMedicalFull timeShift work
- Comagine Health is seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This full-time remote role supports compliant, cost-effective care under Alabama...Remote jobMedicalFull timeContract work
$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$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$45 per hour
SPECTRAFORCE is seeking a Clinical Appeals Specialist to handle member-generated appeal processes remotely from California. The role involves reviewing medical records and ensuring compliance with... ...communication skills. A California RN license and ADN are required. The...Remote jobMedicalHourly pay- NeighborHealth’s SCO RN UM Reviewer role is based in East Boston within the Senior Care Options team. You will review clinical appeals and service authorization needs to ensure medical necessity aligns with CMS standards and organizational determinations. The role requires...Remote jobMedical
$85k - $92k
...is seeking a Clinical Quality Reviewer to support a federal healthcare... ...This role involves reviewing medical records, conducting case analyses... ...Candidates must have a valid RN or LCSW license with at least... .... The position may be remote or onsite based on business requirements...Remote jobMedicalWork at officeHome office- ...intelligence company is seeking a Nurse Itemized Bill Reviewer to analyze medical claims and ensure compliance with industry standards. This remote position allows candidates to work from... ...candidates should possess an active RN, LPN, or LVN license, along with at least 1...Remote jobMedical
- 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 jobMedical
$63k - $65k
...Financial Services & Insurance RN Utilization Review As a nurse at Sedgwick,... ...the management of complex medical conditions, treatment... ...and well-being of others in a remote work environment. Enjoy flexibility... ...with physicians, claims examiners, clients, vendors,...Remote workMedicalWork experience placementLocal areaFlexible hours$51.43 - $79.84 per hour
...Overview Description – This is a remote role. You MUST live in the state... ...to be considered. Care Manager RN, Per diem / On call, Day shift. The Utilization Review (UR) Nurse has a strong clinical... ...in Utilization Management (UM), medical necessity and patient status...Remote workMedicalDaily paidLive inShift workDay shift- ...RN / Medical Reviewer / Remote Job Details Professional Discipline : Registered Nurse Specialty : Utilization Review... ...monitor medical necessity using your clinical proficiency and claims knowledge. This is a REMOTE opportunity for candidates...Remote workMedicalFull timeContract workLocal areaShift work
- ...Clinical Utilization Review Nurses (RN) Based In Alabama Comagine Health is a national, mission... ...and patient outcomes. Our talented remote workforce spans the country and plays a... ...Nurses (RN) based in Alabama to assess the medical necessity and quality of healthcare...Remote workMedicalFull timeContract work
$30 - $38 per hour
...Summary We are seeking Utilization Review Nurse RN to join our team on a part‑... ...and review for the medical necessity of treatment requests... ...medical necessity; and post claim or post service reviews. Staff... ...to successfully perform in a remote healthcare environment. Ability...Remote workMedicalHourly payFull timePart timeWork at officeMonday to FridayWeekend work- ...completion of appropriate clinical review of all applicable patients as... .... Oversees Clinical Review Specialist as indicated. Maintains... ...first week. This role will be remote BUT regular meetings/trainings... ...information regarding patient's medical condition, intensity of...Remote workMedicalReliefShift workWeekend work3 days per week
$32 - $48 per hour
...RN-Utilization Review/Case Manage Nurse - RFT Hot Job Gibson City, IL 60936 Overview... ...Hybrid (combination of in person and remote considered) GENERAL SUMMARY The... ...is provided. Working closely with the Medical Staff and Nursing units in this effort...Remote workMedicalHourly payFull timeWork at officeRelocation packageShift work$50 per hour
...RN Clinical Reviewer / IDR - Remote Location: Remote Employment Type: Full-time Hourly Rate: $50/hr About Greenlife Healthcare Staffing... ...Responsibilities, focusing on conducting comprehensive medical-legal reviews and appeals for a respected non-profit organization...Remote workMedicalHourly payFull timePrivate practice
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