Remote RN: Clinical File Review Specialist
The IMA Group
- Remote job
The IMA Group is seeking a Registered Nurse (RN) to join our Payer Services division as a Clinical File Review Specialist. This remote, non-patient-facing role focuses on clinical analysis and documentation, supporting physician reviewers with organized medical records and precise case preparation. Ideal candidates have an active RN license, 3+ years of clinical experience, and strong written communication. The position offers a fully remote setup with competitive compensation and benefits. #J-18808-Ljbffr The IMA Group
$90k - $120k
The IMA Group is seeking a Registered Nurse (RN) to join our Payer Services division as a Clinical File Review Specialist . This role is ideal for nurses looking to transition away from bedside care into a fully remote, non-patient-facing position focused on clinical analysis...Remote jobLocal areaWork from homeHome officeFlexible hours- ...CVS Health Corporation is seeking an RN Concurrent Review Nurse to join a remote team delivering inpatient clinical expertise to ensure medically necessary care across the continuum. This role offers work-from-home scheduling, Monday–Friday, with some weekend coverage...Remote workWork from homeMonday to FridayWeekend work
$69.39k - $88.61k
...Cincinnati Children’s is seeking an experienced Utilization Review professional for a remote role in the United States. The position supports case... ...a Bachelor’s degree in a related field, an active RN/Social Work/Clinical Counselor license, and 2+ years of related experience...Remote workFull time$65k - $85k
...Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning... ...looking for an experienced Utilization Review Specialist (RN) to join our remote home health team.... ...Package What You’ll Do Review home health clinical documentation for accuracy and...Remote workMonday to FridayWeekend workWeekday work- ...healthcare employer to recruit a Case Manager - Utilization Review Specialist for a fully remote role in the United States. The position focuses on... ...patient care and financial performance. The role leverages clinical nursing expertise, analytical thinking, and strong...Remote job
- Intermountain Healthcare Inc. is seeking an RN Utilization Review Care Management I for a fully remote, part-time role. You will review records, apply clinical guidelines, and collaborate with providers and members to ensure appropriate, cost-effective care across multiple...Remote jobPart timeWeekend work
$66k - $68k
...solutions company, seeks an Appeals Nurse to review first-level appeal cases, assess medical necessity... ...and adherence to CMS guidelines. Strong clinical background and communication skills are essential. The role offers remote work options across approved states, with a base...Remote job- WPS is seeking an Appeals Nurse to review medical records and Medicare claim information for first-level appeal... ...and compliant with CMS guidelines. Required RN license, ASN/BSN, and 1+ year clinical experience. Remote work is permitted in several states, including New...Remote job
- ...healthcare organization to hire a Case Manager - Utilization Review Specialist for a full-time remote role based in the United States. You will oversee... ...patient care and financial performance. You will apply clinical nursing expertise to evaluate records, collaborate with...Remote jobFull time
- Centene Management Company LLC in Florida seeks a qualified clinical reviewer to conduct comprehensive file assessments and ensure adherence to state contracts... ...standards. The role requires a nursing licensure (RN or equivalent) with 3+ years of clinical experience and...Remote jobFlexible hours
- ...organization, seeks an experienced Case Manager - Utilization Review Specialist for a fully remote role in the United States. This position focuses on... ...patient care and financial performance.You will apply clinical nursing expertise to evaluate records, collaborate with...Remote job
- ...compensation medical-legal review, where our agentic... ...the most document-heavy files in the industry for national... ...them. You will be the clinical conscience of the... ...What we look for Active RN license and 5+ years of... ...opportunity employer. Location: Remote (United States)...Remote workFull timeFlexible hours
- UnitedHealth Group is seeking a Senior Clinical Administrative RN to support Texas remote reviews of appeals and fair hearings. The role emphasizes clinical review, chart audits, and collaboration with cross-functional teams to ensure accurate determinations and compliance...Remote job
- ...seeks an experienced Case Manager - Utilization Review Specialist to oversee admission and concurrent reviews remotely in the United States. You will evaluate medical... ...and financial performance. You will apply clinical nursing expertise, support quality improvements...Remote job
- ...Sedgwick is seeking a Telecommuter RN for Utilization Review in the United States. The role requires an active RN license, an associate degree... ...utilization review. Certification is a plus. The position offers remote work with a comprehensive benefits package and competitive...Remote work
- Comagine Health is seeking an experienced Registered Nurse for a remote Clinical Reviewer role supporting a Washington L&I contract. The position emphasizes evaluating medical necessity, quality, and appropriateness of care using established criteria and guidelines. You...Remote jobContract workWork from home
- ...a Registered Nurse for Utilization Management in a remote-capable role. This position focuses on reviewing admissions and service requests for medical necessity... ...planning across the organization. The role requires Texas RN licensure and a nursing diploma, with benefits...Remote work
- ...Cincinnati Children e s Hospital Medical Center is seeking a Remote Utilization Review professional to perform admission and continued stay reviews using InterQual, ensuring medical necessity and appropriate level of care.The role collaborates with Admitting, Financial...Remote work
$85k - $92k
...Equivalent: ~$41–$44/hr Location: Remote Schedule: Must work AZ hours (typically... ...) Active, unrestricted license: RN Minimum 3+ years clinical experience (med/surg and/or... ...DESIRED) Clinical Quality / Utilization Review / Case Review experience...Remote workHourly payDay shift$35 - $50 per hour
...seeks an experienced Registered Nurse for a remote role providing clinical technology services. This position is for... ...contractors, focusing on chart reviews and clinical data analysis. Candidates should have an active RN license, at least 3 years of adult health...Remote workHourly payContract workFor contractors- ...an experienced Registered Nurse to join our Washington State remote clinical review team. You will assess medical necessity and care quality, using... ...to support decision-making. The role requires an active WA RN license, at least five years of bedside nursing, and strong documentation...Remote job
- ...Job Summary The Appeal Specialist II reviews, analyzes, and resolves insurance... .... Essential Functions Files medical necessity and level... ...as needed. Files other clinical appeals on in scope denial types... ...and Certifications RN - Registered Nurse - State Licensure...Remote workFull timeContract workWork at office
- The IRR Clinical Claim Review Nurse at UnitedHealth Group performs claim reviews to verify coding and charges, researching guidelines to determine... ..., MA with a full-time day shift, the position supports remote work anywhere in the U.S. while complying with HIPAA, state...Remote jobFull timeDay shift
$60 - $70 per hour
OpenTrain AI, Inc. is seeking an Inpatient Clinical Documentation Reviewer (Registered Nurse) to review inpatient... ...for accuracy and safety. This remote contractor role offers hourly pay of $... ...requires inpatient bedside experience and RN licensure. You will annotate notes,...Remote jobHourly payFor contractors- NTT DATA, Inc. is seeking a Clinical Reviewer Specialist for a fully remote position based in Florida. You will perform clinical and medical necessity reviews... ...regulatory and NCQA compliance. The role requires RN licensure (Florida or compact), 3+ years in appeals or...Remote job
- HonorHealth is seeking an RN Utilization Review Specialist to review and monitor health care service utilization, ensuring appropriate levels of care and medical necessity across admissions and payer types. You will coordinate medical necessity reviews for Medicare, AHCCCS...Remote jobDaily paid
- WNS HealthHelp (A Capgemini Company) is seeking a licensed registered nurse to perform concurrent inpatient utilization reviews from a remote setting. You will collaborate with attending physicians and care teams to determine medical necessity and appropriate level of care...Remote job
- Elevance Health, Inc. is seeking a Clinical Review Nurse I to review claims for medical necessity and coverage within Wellpoint Federal. The... ...alignment with program requirements. Candidates should have an RN license, at least one year of clinical experience, and AS in...Remote jobWork at office
- ...Professional Practice Specialist (PPS) works directly with... ...protocol/standard work review and revisions, as... ...Details This position is remote/hybrid. Must be based in... ...field. Licensure : RN with current unrestricted... ...- 5 years ambulatory (clinic) experience....Remote workFull time
- WPS Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims for first-level Medicare appeal cases, assessing... ...ASN or BSN and an active RN license, with at least 1 year of clinical experience, strong communication, and solid understanding of...Remote job
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