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Remote Nurse Specialist II, Medical Claims & Compliance

$57.51k - $85.84k

Qlarant

New York, NY
  • Remote job

Qlarant is seeking a Nurse Specialist II to perform medical record and claims review for Medicare, Medicaid, and other claims data, ensuring guidelines are followed and identifying potential overpayment, fraud, waste, and abuse. The role requires a minimum Bachelor's Degree and 2–4 years of experience (5–7 years preferred); RN licensure is required and coding certification preferred. Remote work options are available; salary ranges from $57,512 to $85,839 annually. #J-18808-Ljbffr Qlarant

Vacancy posted 2 days ago
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