Remote RN - Clinical Claims Review Specialist
University of Minnesota School of Nursing
- Remote job
UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims, document determinations, and maintain screening criteria. This multifaceted role offers telecommuting from anywhere in the U.S. and a chance to impact member care. The position expects an Associate's degree, an unrestricted RN license in the resident state, 5+ years of clinical documentation, plus 3+ years as an RN in inpatient settings. #J-18808-Ljbffr University of Minnesota School of Nursing
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- ...CVS Health is seeking a Clinical Claims Review Nurse to interpret clinical documentation and apply decision... ...cases. The ideal candidate has RN licensure with 2–3 years of RN... ...hold a bachelor’s degree. This full-time, remote position is based in North Dakota. #J...Remote workFull time
- ...Medix is seeking a fully remote Registered Nurse to perform clinical review and telehealth–style assessments from anywhere in the United States. You will review... ...processes. The role requires 3+ years of RN experience, an active license, and strong clinical judgment...Remote workLong term contractMonday to Friday
- ...TEEMA is seeking a Registered Nurse for a remote role with Arizona hours (1st shift). You will review medical records for quality, safety, and utilization... ...Medical Directors. Must hold an active RN license, have 3+ years of clinical experience in med/surg or behavioral health...Remote workDay shift
- ...established industry player is seeking a Medical Review Nurse to join their dynamic team in... ...reviewing and adjudicating medical claims, ensuring compliance with industry standards... ...enjoying the flexibility of a primarily remote work environment. If you are passionate about...Remote work
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- ...Utilization Management Registered Nurse (RN) for a fully remote, full-time position. The role involves... ...medical necessity criteria to reviews, documenting findings, and interfacing... ...Illinois license active and 3+ years clinical experience preferred. Responsibilities...Remote workFull time
$29 - $52 per hour
...us to start Caring. Connecting. Growing together. The Clinical Claim Review RN will be responsible for performing compliance reviews of medical... ...will be aligned with your schedule. This position is Remote in Massachusetts. You will have the flexibility to work...Remote workHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work- UnitedHealth Group is seeking a Remote Appeals Clinician in Texas. You will conduct comprehensive reviews of Medicaid-related... ...records, and provide independent clinical judgments on medical necessity... ...Requirements include a Texas RN license and 2+ years in Medicaid...Remote jobFlexible hours
$48 - $65 per hour
...Remote Registered Nurse – Clinical Review Fully Remote | $48–$65/hr | Monday–Friday, 9:00 AM–6:00 PM ET Medix is supporting a healthcare technology... ...familiar with the work What we’re looking for ~ Active RN license ~ BSN preferred ~3+ years of RN experience...Remote workLong term contractMonday to Friday- Comagine Health is seeking a Clinical Utilization Review Nurse (RN) for a 100% remote, full-time role supporting Alaska contracts. The nurse will assess medical necessity and care quality through prospective, concurrent, and retrospective reviews, applying InterQual criteria...Remote jobFull time
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$85k - $92k
...Equivalent: ~$41–$44/hr Location: Remote Schedule: Must work AZ hours (typically... ...) Active, unrestricted license: RN Minimum 3+ years clinical experience (med/surg and/or... ...DESIRED) Clinical Quality / Utilization Review / Case Review experience...Remote workHourly payDay shift- UnitedHealthcare, part of the UnitedHealth Group family, invites you to join as a SSBV Clinical Claims Review RN. This role is a multifaceted position with autonomy and responsibility, focusing on administrative reviews of inpatient hospital claims and documenting determinations...Remote jobWork at office
- Comagine Health is seeking an RN to perform Clinical Review work and QIDP reviews as part of a remote team. The role is a (.5 FTE) QIDP and (.5 FTE) nurse clinical reviewer, primarily serving Alabama Medicaid program needs. The position requires Alabama RN licensure and...Remote job
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting... ...applications This is a 100% remote role, and requires robust internet... ...authorization data with post-service claims validation, we're creating a transparent...Remote workFull timeFlexible hoursShift work- ...Acentra Health is seeking a Clinical Reviewer to join our growing team. You will apply clinical judgment to review medical records against... ...requirements, ensuring accuracy and compliance. The position is remote national scope, with on‑call weekends, holidays and evenings....Remote workContract workWeekend workAfternoon shift
- ...improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our... ...professionally. Position Overview We are seeking an RN to perform Clinical Review work and QIDP reviews work. Team member will serve as the...Remote workContract work
- Lynn Rodens is seeking a skilled Clinical Reviewer/Nurse for a remote role aligned with AZ hours. The position requires active RN license, U.S. citizenship, 3+ years in med/surg and/or behavioral health, and eligibility for DoD background clearance. Ideal candidates have...Remote job
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- ...or Illinois. We are searching for a new RN to join our team. Our Nurses enjoy the flexibility to work remotely and do not have face-to-face Patient contact... ...and documentation skills in addition to clinical experience. Please review the roles and responsibilities of this...Remote jobHome office
- ...outcomes through technology, services, and clinical expertise. Our mission is to innovate... ...Acentra Health is looking for a Clinical Reviewer to join our growing team. Job Summary... ...contract requirements. ~*Position is remote* ~*Required Work Hours: On‑call weekends...Remote workContract workReliefWeekend workAfternoon shift
$45 - $50 per hour
...Healthcare Staffing is looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting... ...of accredited nursing programs with an active New York RN license. #J-18808-Ljbffr kozmetickesluzby.vecnakraska.sk...Remote jobHourly pay- Hippocratic AI is seeking Registered Nurses with 5+ years of clinical experience for a remote data annotation contract role. You will review AI agent conversations across primary care and related areas and provide safety-focused feedback. The position is 1099 contract with...Remote jobContract workFlexible hours
- Acentra Health is seeking a Clinical Review Advisor to join our remote US team. You will review medical records, prepare cases for physician review, and ensure... ...per MCC policies. Requirements include an active RN license, a related Bachelor's degree, and 2+ years of nursing...Remote jobHome office
- TEEMA Group is seeking a Clinical Quality Reviewer (RN or LCSW) for remote work in approved states. This role focuses on reviewing clinical cases, identifying quality or safety concerns, and supporting quality improvement initiatives across a healthcare network. The candidate...Remote job
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