Remote Medical Review Nurse II - Clinical Validation
Machinify
- Remote job
Machinify is seeking a Medical Review Nurse II to perform medical claims audit reviews for Government and Commercial Payers. This role requires an active RN license and at least 2 years of relevant experience. The position is remote, and you will be part of a dynamic, multi-location team. Key responsibilities include auditing claims, documenting findings, and collaborating with teams to ensure compliance and quality. Preferred qualifications include expertise in ICD-10 coding and utilization management systems. #J-18808-Ljbffr Machinify
$69.3k - $78k
A healthcare payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and Commercial... ...auditing claims and documenting findings, all in a remote work environment. This role offers a competitive...Remote jobMedical$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled... ...for Government and Commercial Payers. You will work remotely in a fast paced and dynamic environment and be part...Remote workMedicalFor contractorsWork at officeWork from homeHome officeShift work$27.61 - $41.41 per hour
...Location: UCHealth UCHth Parkview Medical Center, US:CO:Pueblo... ...and does not offer a hybrid or remote option Summary:... ...and cost of living. Market reviews: All UCHealth positions are reviewed... ...employment decisions based on valid requirements. No applicant shall...Remote workMedicalFull timeTemporary workLocal areaFlexible hoursShift work$143.1k - $165.05k
...Nurse Case Manager II P Burlingame, CA 94010 Overview... ...to the clinical team, service lines... ...not provide direct medical care to patients;... ...CC/CM program. Reviews and updates case... ...Qualifications: Valid California Registered... ...in understaffed/remote areas, in the...Remote workMedicalFull timeWork at office$61.05k - $98.33k
...Itemization Review Nurse II The Itemization Review Nurse provides a summary and analysis of items by... ...reviewing all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. This is a remote position. Essential functions and...Remote workMedicalFull timeWork at officeFlexible hours- ...community. Description The Clinical Research Nurse II will support human... ...recruitment and screening, reviewing laboratory results, and maintaining... ...evaluations, administers medications and research instruments... ...Emory University location. Remote work from home day options...Remote workMedicalWork from home
- ...Overview Clinical Review Nurse - Concurrent Review TX Location: 100% Remote - TX: RN only with TX license SHIFT: Tuesday... ...clinical faxed in by facilities for medical necessity. The nurse gains... ...inpatient services to validate the necessity and setting of care...Remote workMedicalContract workShift work
$31.05 - $48.13 per hour
...Clinical Registered Nurse (RN) II The Clinical Registered Nurse (RN) II is responsible... ...health in accordance with medical and nursing plans of care... ...educational workshops; reviews nursing professional publications... ...be (are) waived for 100% remote employees** Cath Lab/...Remote workMedicalWork experience placementImmediate startFlexible hours$85.98 - $103.68 per hour
...NorthBay Health, a Registered Nurse in the Emergency Department... .... License and Certifications Valid, current, and unencumbered RN... ...comprehensive benefits package including medical, dental, vision, life,... ...market‑based compensation review. Remote Work Disclosure NorthBay...Remote workMedicalHourly payDaily paidShift workNight shift- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote... ...Nurse is responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting...Remote workMedicalPermanent employmentWork at officeLocal area
$85k - $95k
...Clinical Validation Nurse At MedReview, our mission is to bring accuracy, accountability... ...Outlier and Readmission reviews. We are seeking a... ...provider are supported within the medical record Must be able to... ...at the same time Remote Work Requirements: High...Remote workMedicalFull timeMonday to Friday$28.76 - $62.3 per hour
...Provides lead level support for medical claim and internal appeals review activities - ensuring... ...medically appropriate clinical guidelines. Contributes to... ...least 4 years clinical nursing experience, including broad... ...in a DRG/clinical validation setting, and 3 years utilization...Remote workMedicalHourly payWork experience placementWork at office$27.02 - $48.55 per hour
...The standard fully remote work schedule is... ...Perform concurrent reviews, including determining... ..., evaluating medical necessity, and contributing... ...services to validate the necessity and... ...based on clinical policies and guidelines... ...accredited school of nursing or a Bachelor’s degree...Remote workMedicalHourly payWork at officeMonday to FridayFlexible hours$26.5 - $47.59 per hour
...Clinical Review Nurse - Concurrent Review Be among the first 25 applicants... ...clinical professional on our Medical Management/Health Services team... ...workplace flexibility. Remote-US position. Must work... ...evaluating inpatient services to validate the necessity and setting of...Remote workMedicalHourly payWork at officeFlexible hours$62.7k - $100.4k
Job Summary Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting... ...(A.S.) Completion of an accredited registered nursing (RN) degree program required Three (3) years...Remote jobMedicalWork at office$96.35 - $111.14 per hour
...Category: Nursing Job Type: Full time Shift... ...Benefits Eligible: Yes Remote Eligible: No... ...purpose of the job. The Clinical Nurse II is an RN that practices... ...in the design, review, and evaluation of QI... ...beliefs, marital status, medical condition, genetic information...Remote workMedicalHourly payFull timeRotating shift$65k - $75k
...Nurse - Clinical Review Performs utilization review of cases to determine if the request meets medical necessity criteria in accordance with medical policies agreed upon with the Client... ...: 10:30amCST - 7:00pm CST Location: Remote Benefits - Medical, Dental, & Vision...Remote workMedicalWork at officeLocal areaMonday to Friday$115k - $125k
...the highest level of innovative medical care for post-acute communities.... ...you will provide assistance to a clinical manager. You will be responsible for chart reviews, onboarding process, support... .../LTAC, chronic care management. Remote work experience beneficial. PCC,...Remote workMedicalWork experience placementWork at officeMonday to FridayWeekend workWeekday work- ...contractor position. We need a Nurse Practitioner who can... ...and completely remote. We require at least 5... ...will be responsible for reviewing pertinent patient data,... ...received for accuracy of clinical and demographic information... ...of each patients’ medical history, care plan goals...Remote workMedicalFor contractors
- ...Clinical Nurse Reviewer Quality Management Saint Peter's is among the few hospitals... ...requirement protocol, validate and submit the data through... ...Surgery, Medicine, Nursing, Medical Records, Infection Control,... ...on‑site with limited remote work hours as allowed based...Remote workMedicalFull timeWork experience placementShift work
$79.1k - $105.95k
...duties for the Primary Nurse population using established... ...Do Assesses member's clinical need against... ...services provided are medically appropriate to member's... ...conducted by external review organizations. Performs... ...Compact License. Requires a valid Driver's License and Insurance...Remote workMedicalLive inLocal area$61 - $65.21 per hour
Clinical Project Lead II for Life Cycle Management (LCM) in Vision care 4 days... ...) in Vision care Location: Remote Duration: 06 months Pay Range... ...clinical functional review and expertise on the assigned... ...clinical related documents for Medical Device Regulation (MDR) remediation...Remote workMedicalContract work$96.35 - $111.14 per hour
Category: Nursing Job Type: Part time Shift: Day - 0... ...Benefits Eligible: Yes Remote Eligible: No Scheduled... ...: 32 Job Summary The Clinical Nurse II is an RN who practices... ...; design, review, and evaluate QI initiatives... ...beliefs, marital status, medical condition, genetic information...Remote workMedicalHourly payPart timeShift work- ...and completeness of the medical record documentation. The clinical documentation RN will provide... ...assessment and review of inpatient medical records... ...through written methodology to validate observations and suggest... ...with physicians, nursing and all other disciplines...MedicalFull time
$70.3k - $85.47k
...The Professional Review Nurse provides analysis of medical services to determine... ...care. This is a remote position in CA.... ...treatment plans Utilize clinical and/or technical... ...of care, DRG validation, service/treatment... ...leveled roles (I, II, III, Senior, Lead,...Remote workMedicalMinimum wageFull timeWork at officeLocal areaFlexible hours$50 per hour
Overview Registered Nurse Clinical Reviewer / IDR - Remote to Office-Based, Jericho, NY (ID #25302) Location: Remote to Office-Based, Jericho, NY Employment... ...-based position involves conducting comprehensive medical-legal reviews, research, and appeals while ensuring...Remote workMedicalHourly payFull timePrivate practiceWork at officeFlexible hours- ...TriHealth as a Coding Specialist II! At TriHealth , our Medical Coding Specialists play a... ...In this position, you'll review provider documentation,... ..., and collaborate with clinical teams to ensure clarity and... ...and clinical systems. Validate and/or abstract codes specific...Remote workMedicalFull timeWork from homeDay shift
- ...A healthcare organization is seeking a Clinical Review Nurse – Concurrent Review to perform utilization management functions remotely. The role requires conducting concurrent reviews, collaborating with medical teams, and ensuring quality healthcare outcomes. Candidates...Remote workMedicalWork at office
- As a Registered Nurse on the Labor & Delivery... ...including a Level II Trauma Center and... ...and specialty care clinics. We provide advanced... ...may include medical, dental, and vision... ...based compensation review and increases subject... ...role requirements. Remote Work Disclosure NorthBay...Remote workMedicalFull timeShift workNight shift
$125k - $201k
...Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services,... ...Science (A.S) Completion of an accredited registered nursing (RN) degree program required Three (3) years...Remote jobMedicalHourly payWork at office
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