RN Clinical Reviewer - Remote

Job Description

Job Description

Job Summary

We are seeking an RN Clinical Reviewer - Remote for a temp-to-hire opportunity supporting clinical claims review within the healthcare services industry. This role is ideal for a Puerto Rico Registered Nurse or certified coding professional who enjoys reviewing medical documentation, applying clinical judgment, and ensuring claims are accurate, compliant, and supported by medical records.

This remote position offers the opportunity to contribute to a collaborative healthcare operations team focused on accuracy, compliance, and continuous improvement. The work environment supports professional development, ongoing education, teamwork, and clear communication with internal partners. Candidates who are detail-oriented, analytical, and comfortable working independently in a production-focused setting can build valuable experience in clinical review, claims analysis, and healthcare compliance.

Key Responsibilities

- Perform clinical reviews of professional or facility claims against medical records to determine whether claims are supported or unsupported.
- Maintain departmental standards for productivity, accuracy, documentation quality, and data integrity.
- Provide clear, concise clinical rationale to providers or internal partners when needed.
- Investigate, recover, and resolve claims for health plans, commercial customers, and government entities.
- Ensure adherence to state and federal compliance policies, reimbursement guidelines, and contract requirements.
- Participate in internal customer meetings, provide feedback, and support continuous process improvement.

Compensation and Benefits

- Pay rate: $21 per hour.
- Job type: Temp-to-hire.
- Work arrangement: Remote.
- Location: San Juan, PR.

Equal Opportunity Employer / Disabled / Protected Veterans

The Know Your Rights poster is available here:

-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here:

- transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.

verify.uscis.gov/web/media/resourcesContents/E - Verify_Participation_Poster_ES.pdf

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

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\nCompany Description

This company offers growth and a great group of people to work with.

Company Description

This company offers growth and a great group of people to work with.