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)
- 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
...DRG Nurse Reviewer Appeals and Hearings- Remote It takes great medical minds to create powerful solutions that solve some of healthcare... ...working knowledge of clinical policies, procedures, rules, and... ...perform reviews of multiple claim types to provide a flexible workforce...Remote workPolicyMedicalClaimsFull timeWork from homeRelocation packageFlexible hours- ...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
- ...better care.? Requirements The Nurse Reviewer performs complex medical record reviews of Medicare Part A/B and DMEPOS claims that require clinical... ...meeting national and local policies as well as accepted... ...essential functions. This is a remote position. While performing...Remote workPolicyMedicalClaimsContract workFor contractorsLocal area
- ...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
$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- Hawaii Medical Service Association is seeking a Concurrent Nurse Reviewer for the Facility Utilization Review Unit. The role requires applying clinical and policy criteria to determine the appropriateness of... ...inpatient stays and suspended claims for HMSA members. Under...PolicyMedicalClaims
- ...Nurse Reviewer Applies appropriate medical necessity criteria from established medical policies and clinical practice guidelines to apply concurrent review determinations as described... ...and interventions. Evaluates suspended claims against medical records to determine the...PolicyMedicalClaimsWork at office
$35.54 - $55.73 per hour
...Nurse Reviewer I Nurse Reviewer I Seeking RNs that have a current, unrestricted RN license... ...an office. Please note that per our policy on hybrid/virtual work, candidates not within... ...routine having limited or no previous medical review experience requiring guidance by...Remote workPolicyMedicalFull timeWork experience placementWork at officeLocal areaMonday to FridayShift workWeekend workAfternoon shift- ...Nurse Reviewer Utilize medical necessity criteria from established medical policies and clinical practice guidelines to render precertification determinations as described... ...depending on the concern. Evaluate suspended claims against medical records to determine the...PolicyMedicalClaimsWork at office
$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 areaFlexible hours$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- ...As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews... ...and prospective and retrospective claims. The Physician Reviewer will... ...in compliance with client-specific policies, nationally recognized evidence-based...Remote workPolicyMedicalClaimsExtra income
- ...industry player is seeking a dedicated Registered Nurse for a remote contract position focused on reviewing medical claims within the insurance sector. This role involves... ..., along with the ability to navigate medical policies effectively. Join a dynamic team where your...Remote jobPolicyMedicalClaimsContract work
- ...a UnitedHealth Group company, seeks a Clinical Review Clinician to serve as a subject matter expert for... .... You will work with limited supervision within policy frameworks, leveraging your clinical claim review and medical record review knowledge, while maintaining HIPAA...Remote jobPolicyMedicalClaims
- J29, Inc. is seeking experienced RVC Reviewers to perform automated and complex reviews of Medicare FFS claims, including Part A/B and DMEPOS, to ensure... .... Qualifications include 5+ years in medical coding or billing, 3+ years remote work, Medicare FFS exposure, and AHIMA...Remote jobPolicyMedicalClaims
- Optum is seeking a Medical Director to lead claims review, provide clinical oversight, and ensure quality across medical services... ...liaising with physicians and payers, and shaping policies for medical programs and services. Remote work offered across the U.S. with focus on...Remote jobPolicyMedicalClaims
- UnitedHealth Group seeks a Clinical Review Clinician to serve as the subject matter expert for... ...enjoy limited supervision within a broad policy framework and must understand the claim review process, clinical review, medical record review, and billing guidelines. #J-...Remote jobPolicyMedicalClaims
- ...seeking an Optometrist to review optometry-related medical records, claims, TARs, and supporting documentation from a remote home office. You will... ...services against medical policies, provide clinical rationale... ...collaborate with physicians, nurses, and operations teams to...Remote jobPolicyMedicalClaimsHome office
- Gainwell Technologies is seeking a Medical Reviewer (Physical Therapist) to provide... ...review therapy-related records, claims, TARs, treatment plans, and... ...ensure services meet clinical and policy requirements. The role is full-time and remote, with a Monday-Friday schedule....Remote jobPolicyMedicalClaimsFull timeMonday to Friday
- ...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
- ...and Grievance Coordinator Reviewer Location- Phoenix, AZ or Remote Duration- 03 Month+... ...Job Summary: Support medical and pharmacy appeals and... ...reviewing medical records, claims, coverage guidelines, and... ...to interpret healthcare policies, procedures, and guidelines...Remote workPolicyMedicalClaimsWork at office
- ...Clinical Validation Reviewer Performs focused clinical... ...and outpatient claims to verify that coded diagnoses... ...charges. Assesses medical records for clinical accuracy... ...guidelines, payer policy, and regulatory requirements... ...: Registered Nurse (RN). License must be active...Remote workPolicyMedicalClaimsWork at office
$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$248.5k - $373k
...00 - $373,000/yearJob Area: Medical & Clinical OperationsCompany... ...clinical coverage and medical claims reviews. Our role is to empower... ...proprietary coverage review policies, render coverage determinationsDocument... ...*All employees working remotely will be required to adhere...Remote workPolicyMedicalClaimsMinimum wageFull timeWork experience placementLocal area- Peraton is seeking a Medical Reviewer for SafeGuard Services to conduct medical record reviews, apply clinical judgment to claim payment decisions, and support fraud investigations. Telework... ...with external agencies. Must have nursing or related clinical background; U.S....Remote workMedicalClaims
- ...Remedial Pro is a specialized medical billing company serving... ..., billing and claims submission, and utilization review, we help treatment centers... ...accordance with HIPAA and company policy requirements.Required... ...and working on a computer.Remote PositionBenefits:• Competitive...Remote workPolicyMedicalClaimsHourly payWork at office
- ...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
- ...Medical Review Nurse - Home Health Auditor Machinify is a leading healthcare... ...primarily performs medical claims audit reviews with a focus... ...Commercial Payers. You will work remotely in a fast-paced and dynamic... ...medical review guidelines, policies and rules. Document all...Remote workPolicyMedicalClaimsWork 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
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