Medical Review Nurse Analyst

Medical Review Nurse Analyst – Registered Nurse (RN) U.S. Citizenship is required for this position due to Department of Defense restrictions. Our Medical Review Nurse Analyst is responsible for reviewing medical records to determine whether services are payable based on TRICARE policy, reference materials, and evidence‑based research. This analyst evaluates clinical documentation across a variety of workloads, including authorizations, appeals, and medical review claims. The analyst collaborates closely with internal teams, providers, and external partners to ensure accurate, timely, and compliant review outcomes. Salary Range $70,000 ~ $85,000 Work Location Remote work available in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin. Responsibilities Review authorization requests by evaluating submitted medical records to determine service eligibility and compliance with TRICARE policy and evidence‑based guidelines. Analyze clinical documentation for disputed appeals, ensuring accurate interpretation of medical information and appropriate application of policy and criteria. Review supporting medical documentation for medical review claims, verifying clinical necessity, completeness, and adherence to regulatory requirements. Gather, assess, and summarize clinical information needed to support second‑level appeal reviews, collaborating with internal stakeholders as required. Handle escalated or high‑risk cases requiring specialized clinical knowledge or interpretation. Minimum Qualifications U.S. Citizenship is required for this position due to Department of Defense restrictions. Bachelor’s Degree in Nursing (BSN) or equivalent combination of education and experience. Active Registered Nurse (RN) license in state of practice or a compact nursing license. 3 or more years of experience in healthcare, health policy, clinical research, or a related field. Proven experience conducting research, analyzing information, and summarizing findings. Strong critical thinking, ability to work independently applying sound nursing judgement, creative problem solving, and clinical decision‑making skills. This includes: Strong organizational skills with the ability to meet deadlines, manage competing priorities, and maintain quality standards. Strong written and verbal communication skills with the ability to communicate complex medical information clearly and concisely. Proficiency in Microsoft Office tools (Outlook, Word, Excel, One‑Note) and shared document environments. Preferred Qualifications Working knowledge of medical coding (e.g., ICD‑10, CPT, HCPCS); certification in medical coding. Experience navigating in a multilingual setting. Remote Work Requirements Wired (ethernet cable) internet connection from router to computer. High speed cable or fiber. Minimum 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at Please review Remote Worker FAQs for additional information. Benefits Remote work options available. Performance bonus and/or merit increase opportunities. 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately). Competitive paid time off. Health insurance, dental insurance, and telehealth services start DAY 1. Professional and Leadership Development Programs. Review additional benefits: This position supports services under U.S. Department of Defense (DoD) Defense Health Agency contract(s). As such, the role is subject to all applicable federal regulations, DoD contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. DoD contractors and their personnel are subject to screening and background investigation prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services. #J-18808-Ljbffr