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)
$90k - $99k
...DRG Nurse Reviewer Appeals and Hearings- Remote Date: Jan 9, 2026 Location: Any city, FL... ...Exception only) It takes great medical minds to create powerful... ...knowledge of clinical policies, procedures, rules, and... ...reviews of multiple claim types to provide a flexible...Remote workPolicyMedicalClaimsFull timeWork from homeFlexible 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... ...comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous...Remote workPolicyMedicalClaimsContract workWork at officeLocal areaImmediate start- ...healthcare quality organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The ideal candidate will have a BSN and an... ...participating in ongoing training. This is a part-time remote position, offering a flexible work...Remote jobPolicyMedicalClaimsHourly payPart timeFlexible hours
- ...Description Provide timely review and determination of medical claims, including prior... ...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
- ...Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually... .... Please note that per our policy on virtual work, candidates not within a... ...are routine having limited or no previous medical review experience requiring guidance by...Remote workPolicyMedicalFull timeWork experience placementWork at officeLocal areaMonday to FridayWeekend work
$59k - $75.05k
...Nurse Reviewer The Nurse Reviewer is primarily responsible for conducting post-service... ..., pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments...PolicyMedicalClaimsFull timeWork at officeLocal areaVisa sponsorshipFlexible hours- Location: Remote (U.S.) - Must reside in or be eligible... ...experienced Registered Nurses (RNs) to support the... ...Candidate Assessment and Review for Eligibility Support... ...This position provides medical record review and... ...compliance with HIPAA, TSA policies, and federal regulations...Remote workPolicyMedicalFull timeWork at officeMonday to FridayDay shift
- ...-quality at-home care, the full-time remote Medical Review Nurse will ensure compliance with CMS regulations... ...Interpret and operationalize LCD policies for surgical dressings and establish... ...process for surgical dressing claims, ensuring clinical completeness and billing...Remote workPolicyMedicalClaimsFull time
- ...Working remotely, the Clinical Denials Specialist will review denied claims, analyze denial reasons, and collaborate with... ...discrepancies Analyze medical records and payer policies to prepare effective appeal... ...healthcare administration, nursing, health information management...Remote workPolicyMedicalClaims
$41 per hour
...Medical Review Nurse (RN) Remote position, however, candidates must reside in the State of TX or State of... ...accurate and timely medical review of claims suspended for medical necessity,... ...experience. Needs to be able to navigate MCG and medical policies with the reviews....Remote workPolicyMedicalClaimsContract work- ...experience, Associates and 7 years of experience At least 3 years of experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity. Current/Active Nursing or Physical Therapy...Remote workMedicalClaimsNight shift
$248.5k - $373k
...00 - $373,000/yearJob Area: Medical & Clinical OperationsCompany... ...clinical coverage and medical claims reviews. Our role is to empower... ...enjoy the flexibility to work remotely * from anywhere within the U... ...proprietary coverage review policies, render coverage determinationsDocument...Remote workPolicyMedicalClaimsMinimum wageFull timeWork experience placementLocal area- ...Quality Assurance Reviewer: Remote Position Grapefruit Health is... ...: Complete monthly claim review using clinical judgment and established policies and procedures by deadlines... ...a healthcare background: nursing, pharmacy, social work, medical assisting, dietitians,...Remote workPolicyMedicalClaimsImmediate start10 hours per week
- ...Medlogix, LLC delivers innovative medical claims solutions through a seamless... ...comprehensive Medical Review Services, Medical Case Management... ...per week) Non-Exempt Remote- EST time zone POSITION SUMMARY... ...to guidelines and RW policies and procedures. Determines...Remote workPolicyMedicalClaimsFull timeWork at office
- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical... ...responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical...Remote workPolicyMedicalClaimsPermanent employmentWork at officeLocal area
$30 - $38 per hour
...are seeking Utilization Review Nurse RN to join our team on... ...and review for the medical necessity of treatment... ...medical necessity; and post claim or post service... ...guidelines, internal medical policies, group specific... ...successfully perform in a remote healthcare environment...Remote workPolicyMedicalClaimsHourly payFull timePart timeWork at officeMonday to FridayWeekend work$50 - $52 per hour
...Claims Clinical Documentation Reviewer Schedule: 5-10 hours per week. Resource can work... ...weekends if they prefer. Remote position. Equipment is... ...providers for Medicaid services (medical, behavioral health, NEMT,... ...Statute, Rules, and Policies applicable to AHCCCS...Remote workPolicyMedicalClaimsPart timeWork at officeLong distance10 hours per week- ...Working at HHS webpage. Functional Title: Nurse Reviewer Job Title: Nurse II Agency: Health &... ...statewide UR program and to ensure UR policies and procedures are applied consistently... ...laws, rules, standards, and regulations, medical diagnoses and procedures, community...Remote workPolicyMedicalFull timeTemporary workPart timeWork at officeLocal areaWork from homeShift work
- Itemized Bill and Medical Record Reviewer job at Alaffia Health. New York, NY. About... ...have experience reviewing claim forms and auditing provider... ...Flexible, paid vacation policy Work in a flat organizational... ...direct access to Leadership LI-REMOTE #J-18808-Ljbffr Alaffia...Remote workPolicyMedicalClaimsFlexible hours
$35 per hour
...range $35.00/hr - $35.00/hr Medical Review Nurse Location: Phoenix, AZ 85034 (Remote) 3+ Months Day Shift... ...Federal Emergency Services (FES) 1500 claim forms. Some coordination will be... ...Interpretation of rules, laws and agency policy pertaining to the AHCCCS program...Remote workPolicyMedicalClaimsHourly payContract workTemporary workPart timeFor contractorsWork at officeShift workDay shift$112.7k - $193.2k
...Payment Integrity's Professional Claim Review products. These are... ...fairly, reducing unnecessary medical spend across the full claim lifecycle... ...the flexibility to work remotely * from anywhere within the U.... ...coding validation, reimbursement policy, provider billing, or...Remote workPolicyMedicalClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaShift work$7.25 per hour
...drive down healthcare costs. The Medical Review Nurse II primarily performs medical claims audit reviews with a focus on... ...Payers. You will work remotely in a fast-paced and dynamic environment... ...appropriate medical review guidelines, policies and rules. Document all...Remote workPolicyMedicalClaimsHourly payFull timeWork at officeShift work- ...Description Physician Peer Reviewer – Multiple Specialties... ...accredited Independent Medical Review Organization (... ...independent review claims and appeals in any of the... ...regulations, and applicable policy guides Completes and... ...Job Type Contract Work Location Remote...Remote workPolicyMedicalClaimsContract workWork experience placementWork at office
- ...Ophthalmologist Telecommute Medical Review Stream Physician Location... ...clinical background, reviews health claims providing medical... ...with Concentra Physician Review policies, procedures, and performance... ...agencies, carriers, employers, nurses and health care professionals...Remote workPolicyMedicalClaimsContract workTemporary workFor contractorsLocal areaMonday to FridayFlexible hours
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical... ...by conducting medical necessity reviews,... ...assigned Registered Nurse with active,... ...This is a 100% remote role, and requires... ...continuum–including policy, prior authorization... ...with post-service claims validation, we're creating...Remote workPolicyMedicalClaimsFull timeFlexible hoursShift work$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization that delivers... ...within a broad framework of policies and procedures. Employees in this... ...comprehensive understanding of the claim review process including clinical claim review, medical record review, and a broad...Remote workPolicyMedicalClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal area- ...The utilization review and management (UM... ...contracted facilities are medically necessary,... ...documentation of claims along the process... ...with organizational policies and regulatory requirements... ...~ Registered nurse with active,... ...an in-office, no remote work capability position...Remote workPolicyMedicalClaimsWork at office
$29 - $52 per hour
...performing compliance reviews of medical and administrative documentation... ...providers who submit claims for payment. This... ...federal compliance policies, reimbursement... .... This position is Remote in Massachusetts. You... ...equivalent work experience ~ Nurse licensure (RN or LPN)...Remote workPolicyMedicalClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work$2,210 per week
...exclusive features. Nurses - are you looking... ..., including medical, dental, vision, long... ...Work-life balance. Remote/hybrid setting (once... ...to a second level reviewer. This individual... ...guidelines, Hines policies and procedures, and... ...status, benefit and claim concerns, and...Remote workPolicyMedicalClaimsFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours$80k - $90k
...Range: $80-90k The Medical Review Clinical Appeals... ...with department quality policies and procedures, scoring... ...conducts research, analyzes claims data, applies... ...work independently in remote setting with minimum supervision... ...and diversified nursing experience providing direct...Remote workPolicyMedicalClaimsFor contractorsImmediate startWork from homeHome officeFlexible hoursShift work
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