Remote RN - Clinical Claim Review & Compliance Auditor
Texas Health Institute
- Remote job
Optum Insight is seeking a Clinical Claim Review RN to perform compliance reviews of medical and administrative documentation to identify fraud or wasteful practices. The role involves site visits, desk audits, and collaboration with a team of auditors to document findings and input data into audit systems. The position is full-time (40 hours/week) with remote work options in Massachusetts and potential overtime. Training is provided and hours align with 8:00 am–5:00 pm local time. #J-18808-Ljbffr Texas Health Institute
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims and document... ...U.S. while maintaining rigorous screening criteria and compliance with state/federal requirements. Qualified candidates will...Remote jobClaims
- Optum Insight is recruiting for a Clinical Claim Review RN to perform compliance reviews of medical and administrative documentation in Massachusetts. The... ...collaboration with clients to ensure policy adherence. This remote Massachusetts position requires a MA license (RN/LPN),...Remote jobClaimsFull time
- ...leading healthcare intelligence company. The Medical Review Nurse II audits home health claims, working remotely with a multi-location team to ensure compliance and high-quality documentation. The role emphasizes strong clinical judgment, coding accuracy, and regulatory...Remote jobClaimsWork from home
$29 - $52 per hour
...Program Integrity Clinical Compliance Auditor Optum Insight is improving... ...compliance reviews of medical and administrative... ...providers who submit claims for payment. This... ...This position is Remote in Massachusetts. You... ...~ Nurse licensure (RN or LPN) with a current...Remote workClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work- UnitedHealth Group in Massachusetts is seeking a Clinical Claim Review RN to perform compliance reviews of medical and administrative documentation, identifying... ...using our auditing tools. The position is full-time, remote within Massachusetts, with standard 8-hour shifts and...Remote jobClaimsFull timeShift work
$35 - $62.5 per hour
...In this position as a Clinical DRG RN auditor , you will apply your... ...of inpatient claims. Employing both industry... ...DRG and APR-DRG coding reviews to verify the accuracy... ...Demonstrate knowledge of and compliance with changes and... ...independently in a remote environment and deliver...Remote workClaimsHourly payDaily paidMinimum wageFull timeTemporary workPart timeWork experience placementWork at officeLocal areaRelocation package- UnitedHealth Group seeks an experienced SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims. The role requires documenting determinations and maintaining screening criteria, contributing to efficient, compliant health...Remote jobClaims
- Trillium Health Resources is seeking a Compliance Nurse to join our NC-based team. This exempt, full-time role focuses on clinical compliance reviews and claims evaluation to ensure regulatory... ...cases end-to-end. Candidates must be an RN with NC licensure and a valid driver...Remote jobClaimsFull time
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims and to document all determinations. The role emphasizes adherence to Federal, State and client requirements in a telecommuting setting...Remote jobClaimsHome office
- UnitedHealth Group seeks a Clinical Review Clinician to serve as the subject matter expert for itemized bill reviews and analysis of hospital... ...within a broad policy framework and must understand the claim review process, clinical review, medical record review, and billing...Remote jobClaims
- First Coast Service Options is seeking a Clinical Review Nurse to evaluate medical necessity, coverage, and payment levels for Medicare-related claims. The role applies clinical knowledge to determine the appropriateness of care in line with CMS policies and standards....Remote jobClaims
- ...Registered Nurse to perform medical review of complex claims, pre-authorization requests,... ...referrals. You will apply clinical expertise and established guidelines... ...determinations. The role is remote and full-time, requiring an active RN license and at least two years...Remote jobClaimsFull time
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims, documenting determinations and maintaining screening criteria. The role supports telecommuting from anywhere in the U.S. and requires...Remote jobClaimsWork at office
$64.48k - $72.8k
...Opportunity Overview: The Clinical Review & Correspondence RN plays a critical role in... ...-quality care, regulatory compliance, and improved member... ...role: This is a 100% remote role, and requires robust... ...authorization data with post-service claims validation, we’re creating...Remote workClaimsFull timeFlexible hoursShift work- ...provide strategic direction for teams performing advanced medical claim reviews. You will drive accuracy, regulatory compliance, and payment integrity by leveraging ICD-10, CPT/HCPCS coding, and clinical guidelines. The role leads standardization of processes, development...Remote jobClaims
$62.7k - $100.4k
...Clinical Care Reviewer II (Remote)(Must Have - Unrestricted Massachusetts RN License) remote type Remote locations Massachusetts WFH time type Full time... ...expertise to make every opportunity count. Each claim, each phone call, each consumer-centric...Remote workClaimsHourly payFull timeWork at office- ...Medical Review Nurse - Home Health Auditor Machinify is a leading healthcare... ...performs medical claims audit reviews with a... .... You will work remotely in a fast-paced and... ...Cross train in all clinical departments/areas.... ...active/unrestricted RN license) is required...Remote workClaimsWork at office
$137k - $150k
...Itasca, IL 60143, USA Remote, 1100 N Arlington... ...information. Description The Clinical Risk Specialist RN is responsible for... ...case management and claims management... ...COMPETENCIES REQUIREMENTS: Reviewing stop-loss cases,... ...visits. This includes compliance with all of the...Remote workClaimsFull timeTemporary workShift work- ...Description The utilization review and management (UM)... ...medically necessary, clinically appropriate, evidence-... ...supporting regulatory compliance and organizational... ...and documentation of claims along the process chain... ...This is an in-office, no remote work capability...Remote workClaimsWork at office
$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization that delivers... ...comprehensive understanding of the claim review process including... ...~ Active and unrestricted RN license OR LPN in the state of... ...with billing, charge master and compliance Experience working with...Remote workClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal area$86.8k - $124k
...Summary The Clinical Policy Specialist – Itemized Bill Review is responsible for... ...facility billing, UB-04 claim processing,... ...methodologies to ensure compliance and program alignment... ..., Unrestricted RN license from the United... ...Location: Remote (U.S.-based) Travel...Remote workClaimsFull timeFlexible hours- ...training curricula for clinical audit nurses and audit... ...IPF and IRF claim review, documentation requirements... ...effective delivery in a remote environment.... ...including: the 60%/75% compliance rule and qualifying conditions... ...vs. SNF — and train auditors to apply those distinctions...Remote workClaimsFull timeWork at office
- ...Utilizing clinical expertise, the full-time Licensed Medical Review Nurse (LVN/LPN) will conduct medical reviews of claims and documentation to ensure medical necessity and compliance with regulations while working remotely on a MST/PST schedule. Key responsibilities...Remote workClaimsFull time
$70.8k - $123.8k
Clinical Nurse Auditor Position Description CGI is one... ...skills to review inpatient and outpatient claims, evaluate medical... ...This position is remote within the United... ...corporate policies and compliance requirements Required... ...Registered Nurse (RN) license in your...Remote workClaimsWork at officeLocal area$69.3k - $78k
...integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and... ...The position requires an active RN license and a minimum of five years... ...documenting findings, all in a remote work environment. This role...Remote jobClaims$29 - $52 per hour
...on some tough challenges. Primary Responsibilities Perform clinical coverage review services, which require interpretation of state and federal... ...Required Qualifications Associate's degree Current unrestricted RN license in the state of Massachusetts 3+ years of experience...Remote workClaimsHourly payMinimum wageFull timeWork experience placementLocal area$40 per hour
...-30 hours week) – Remote Work Environment... ...Supports Medical Review Services. The Nurse... ...reviews for Medicaid claims. This involves... ...records to ensure compliance with established guidelines... ...regulations. The RN will work closely... ...CPT and HCPCS Clinical criteria (...Remote workClaimsContract workWork at officeLocal areaImmediate start- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These... ...determinations as to the validity of health claims and levels of payment in meeting... ...Valid unrestricted Registered Nurse (RN) license PREFERRED QUALIFICATIONS...Remote workClaimsPermanent employmentWork at officeLocal area
- ExlService Holdings, Inc. is seeking a Clinical Validation Auditor to review inpatient records and validate billed DRG codes. You will... ...clinical judgment to ensure accuracy and fairness in claims coding while working remotely. Ideal candidates are licensed nurses with...Remote jobClaims
- ...passion for getting the details right? Join EXL as a Clinical Validation Auditor and help ensure medical claims are coded accurately and fairly. This is a fully remote position where you’ll use your clinical judgement to review medical records, validate billed DRG codes, and...Remote workClaims
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