Remote Nurse Reviewer - Medical Claims & Policy Reviews
Healthcare Quality Strategies, Inc. (HQSI)
- Remote job
A healthcare organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The role involves examining claims, maintaining knowledge of Medicaid policies, and managing the screening process effectively. Candidates must possess a BSN with an active RN license and have 3-5 years of review experience. This position offers a chance to work in a remote setup with competitive hours. Benefits include medical, dental, and 401k options. #J-18808-Ljbffr Healthcare Quality Strategies, Inc. (HQSI)
$78k - $99.2k
...Senior Nurse Reviewer Make a meaningful impact on healthcare quality and claims accuracy by applying your clinical... ...expertise to complex medical reviews. As a Senior... ...compliance with applicable policies and industry... ..., and feedback. This remote opportunity combines...Remote workPolicyMedicalClaimsFull timeWork from homeFlexible hours- ...Provide timely review and determination of medical claims, including prior authorization,... ...Coverage Determination (NCD) policies, and other federal regulations... ...license as a Registered Nurse (RN),as required by... ...for this position Remote but need to be local to 1...Remote workPolicyMedicalClaimsContract workFor contractorsWork experience placementWork at officeLocal area
- Commence is seeking a Nurse Reviewer to perform expert medical record reviews of Medicare Part A/B and DMEPOS claims. You will apply clinical judgment... ...with national and local policies, documenting clear rationales for actions. This remote role emphasizes HIPAA compliance...Remote jobPolicyMedicalClaimsLocal area
$95k - $110k
...It takes great medical minds to create powerful solutions... ...individual for a DRG Nurse Reviewer Appeals and Hearings... ...knowledge of clinical policies, procedures, rules,... ...perform reviews of multiple claim types to provide a... ...in this role Remote (Work from Home) Up...Remote workPolicyMedicalClaimsFull timeWork from homeRelocation packageFlexible hours$40 per hour
PT (20-30 hours week) - Remote Work Environment Non-Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the... ...medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination...Remote workPolicyMedicalClaimsContract workWork at officeLocal areaImmediate start$78k - $88k
...It takes great medical minds to create powerful solutions that solve... ...a talented individual for a Nurse Reviewer who will be responsible for... ...clinical criteria, coverage policies, and utilization and practice... ...perform reviews of multiple claim types to provide a flexible workforce...Remote workPolicyMedicalClaimsFull timeContract workWork from homeFlexible hoursWeekend work- ...: We are seeking Medical Analysts with experience... .... This includes reviewing records, preparing... ...knowledge of CMS policies related to... ...Degree or Diploma in Nursing required ~3-5 years... ...information, claims payment histories... ...#LI-ZP1 #LI-Remote For over 50 years...Remote workPolicyMedicalClaimsFull time
$78k - $99.2k
It takes great medical minds to create powerful solutions that solve... ...talented individual for a Senior Nurse Reviewer to perform reviews of medical records, healthcare claims, itemized medical bill, and UB... ...in accordance with client policy and industry standards. Perform...Remote jobPolicyMedicalClaimsFull timeWork from homeFlexible hours$78k - $88k
...It takes great medical minds to create powerful solutions... ...We are seeking a Nurse Reviewer (RN) who will be responsible... ...criteria, coverage policies, and utilization and... ...-trains on multiple claim types to support business... ...Friday work schedule.Remote role available to...Remote workPolicyMedicalClaimsFull timeMonday to FridayFlexible hours$51k - $82k
...performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and... ...and abuse. We are looking to add a Nurse Reviewer to our SGS team of talented professionals... ...and to apply sound clinical judgment to claim payment decisions. Responsibilities may...Remote workMedicalClaimsContract workShift workNight shift- Join our team: Gainwell Technologies is looking for a Nurse Reviewer to join their Remote team. This Full-Time role comes with a competitive package... ...the continental US. The position focuses on reviewing medical claims, UB-04 forms, and itemized bills to ensure accuracy...Remote workMedicalClaimsFull timeWork from home
- Gainwell Technologies LLC is seeking a Senior Nurse Reviewer to perform reviews of medical records, healthcare claims, itemized medical bills, and UB-04 forms to ensure accuracy, compliance, and proper billing practices. This role requires clinical review expertise and...Remote jobMedicalClaimsWork from homeFlexible hours
- Peraton is seeking a Nurse Reviewer Team Lead for SafeGuard Services to oversee medical reviews, ensure quality, mentor staff, and coordinate with investigations for... ...skills, and the flexibility to work remotely from anywhere in the United States. #J-18808-Ljbffr...Remote jobMedicalClaims
- ...Management Department (Fully Remote)Job Summary:• Provides... ...and utilization review.Responsibilities:• Reviews... ...and retrospective medical necessity and/or compliance... ...compliance with reimbursement policy criteria. Provides... ..., reimbursement and claim denials/appeals.• Assesses...Remote workPolicyMedicalClaims
- Optum is seeking a remote IRR Clinical Claim Review Nurse to perform clinical review of claims against medical records and guidelines. The role requires an active RN license, 2... ...areas. You will adhere to HIPAA and internal policies while supporting efficient billings and...Remote jobPolicyMedicalClaimsWork from home
- Gainwell Technologies is seeking a Medical Reviewer (Physician) to support Medical Review Services for California healthcare programs.... ...provides physician-level clinical expertise supporting medical policy, claim adjudication, TARs, appeals, provider-related medical...Remote jobPolicyMedicalClaims
- ...Medicine physicians to conduct Independent Medical Exams (IME) and Peer Reviews. This opportunity allows you to... ...expertise, and reviews disability claims by providing an interpretation of the... ...based guidelines, client-specifics, policies, procedures, performance standards,...Remote workPolicyMedicalClaimsFor contractorsMonday to Friday
$1,766.5 per month
...Offering Nursing Profession... ...Specialty Utilization Review Job ID 3... ...operating fully remote - Provide exceptional... ...compliance with medical necessity and reimbursement policy criteria - Deliver... ...Reimbursement and claim denials/appeals -...Remote workPolicyMedicalClaimsWeekly payWork experience placementShift work- ...Physician Peer Reviewer - Multiple Specialties in Texas... ...accredited Independent Medical Review Organization (IRO... ...independent review claims and appeals in any of the... ...regulations, and applicable policy guides Completes and... ...Contract Work Location RemoteRemote workPolicyMedicalClaimsContract workWork experience placementWork at office
- Concentra, Inc. is seeking a licensed medical reviewer to perform telecommute health claim reviews from New Jersey. The role is a 1099 independent contractor... ...communicates findings to providers under Concentra policies and URAAC guidelines. #J-18808-Ljbffr Concentra, IncRemote jobPolicyMedicalClaimsFor contractorsFlexible hours
- ...Description: Nurses - are you looking for... ..., including medical, dental, vision, long... ...life balance. * Remote setting ROLE DESCRIPTION... ...to a second level reviewer. This individual... ...guidelines, Hines policies and procedures,... ..., benefit and claim concerns, and validation...Remote workPolicyMedicalClaimsTemporary workMonday to FridayFlexible hours
- Elevance Health is seeking a Clinical Review Nurse I to review and determine whether a claim meets the benefits the member carries. This... ...commuting distance. The role focuses on medical necessity assessment and adherence to policy, with a current unrestricted RN license...Remote jobPolicyMedicalClaimsFull time
- Elevance Health is seeking a Clinical Review Nurse I to review and make medical determinations on claims to ensure members receive the benefits described in their plans... ...reasonableness of items in claims using medical policy, with a current RN license and nursing education...Remote jobPolicyMedicalClaimsFlexible hours
- Description The Clinical Nurse Reviewer plays a crucial role in the healthcare... ...industry by evaluating medical records, treatment plans,... ...on healthcare regulations, policies, and guidelines, and ensure... ...essential functions. This is a remote position. While performing the...Remote workPolicyMedicalWork at office
- Elevance Health seeks a Clinical Review Nurse I to review claims and determine benefit eligibility per policy. The role supports virtual work with required in-person training... ..., ASN with clinical experience, and strong medical policy understanding. This is a hybrid/virtual...Remote jobPolicyMedicalClaimsWork at office
- ...Medicine & Rehabilitation physician for our medical review stream. This telecommute, independent... .... Job duties include reviewing health claims, providing medical interpretation, and... ...compliance with Concentra Physician Review policies and #J-18808-Ljbffr ConcentraRemote jobPolicyMedicalClaimsFor contractorsMonday to FridayFlexible hours
- ...Certified Orthopedic Surgeon for a telecommute medical review role. This is a 1099 independent contractor position reviewing health claims, providing medical interpretation, and... ...in line with Concentra Physician Review policies and URAAC guidelines. The ideal candidate...Remote jobPolicyMedicalClaimsContract workFor contractorsMonday to Friday
- ...Clinical Validation Reviewer Focused review of professional claims related to Fraud Waste and... ...billed charges. Assesses medical records for clinical accuracy... ...guidelines, payer policy, and regulatory requirements... ...: Registered Nurse (RN). License must be active...Remote workPolicyMedicalClaimsWork at office
- Elevance Health is seeking a Clinical Review Nurse I to work virtually full-time with required in-person training sessions. You will review claims to determine if benefits apply, using medical policy and criteria. The role requires an active RN license and at least 1 year...Remote jobPolicyMedicalClaimsFull timeFlexible hours
$36.49 - $41.49 per hour
...Overview: The Clinical Medical Review Nurse handles day to day review of... ...and institutional claims and provider appeals that require... ...for enrollment in specific policies. This role will also understand... ...communication skills. Remote EMR access experience is essential...Remote workPolicyMedicalClaimsWork at office
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