Senior Medical Review RN — Utilization & Claims
Palmetto GBA, LLC
Palmetto GBA, LLC is seeking a registered nurse to perform medical claim reviews using clinical information and established guidelines. You will document decisions and support medical claims and utilization practices. This full-time, remote role operates Monday–Friday, 8:00 AM–5:00 PM ET. A private, quiet home workspace and reliable internet are required. The position requires an active RN license and at least two years of clinical RN experience. #J-18808-Ljbffr Palmetto GBA, LLC
- ...BlueCross BlueShield South Carolina subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim reviews and determine medical necessity using... ...guidelines. The role documents decisions and supports utilization review across multiple services. The position is remote...MedicalClaimsRemote jobFull time
$29 - $52 per hour
.... Connecting. Growing together. The Clinical Claim Review RN will be responsible for performing compliance reviews of medical and administrative documentation to identify... ...submit claims for payment. This position will utilize information from claims data analysis, plan members...MedicalClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaRemote workMonday to FridayShift work$44.63 - $53.55 per hour
## Utilization Management Nurse, RNApplylocations: Remotetime... ...Physicians, Altais Medical Group Riverside, and Family... ...Utilization Management RN, you'll work closely... ....* Perform Utilization Review activities prospectively... ..., Network Management, Claims, Customer Service, Quality...MedicalClaimsLocal areaFlexible hours- ...RN - Utilization ReviewNumber of Positions: 1Remaining Positions: 1Duties: 1 year of non-acute utilization review experience - required RN experience - preferred This is the pay range that... ...for clinical traveler workers only), Medical, Dental, Vision, 401K.Skills: 1 year...Medical
$2,940.02 per month
...Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 19018147 Job Title RN -... ...Evaluates the appropriateness and efficiency of medical treatments, ensuring that patients receive necessary care...MedicalWeekly payShift workDay shift$55 - $65 per hour
...Registered Nurse With Utilization Review Experience A healthcare organization is seeking a Registered... ...and requires an active New York State RN license. The ideal candidate will have... ...reviewing healthcare services for medical necessity, appropriateness, and utilization...MedicalHourly payContract work- J29, Inc. is seeking a Medical Reviewer, RN to support Medicare FFS claims reviews remotely. You will apply CMS guidelines to assess overpayments and proper payments, documenting findings for each claim. The ideal candidate has 5+ years of medical coding/billing in healthcare...MedicalClaimsRemote jobWork experience placement
$60.2k - $107.4k
Optum is a global healthcare organization empowering care through technology. The Utilization Management Nurse role involves reviewing medical records, extracting case details, and crafting defensible appeal letters according to process instructions and guidelines. The...MedicalRemote jobFull timeMonday to Friday- Broadway Ventures is seeking an experienced Registered Nurse to perform medical review of complex claims, pre-authorization requests, appeals, and fraud and abuse referrals. This remote, full-time role requires applying clinical expertise and established guidelines to...MedicalClaimsRemote jobFull time
- Review and make complex medical determinations about whether claims meet the member's benefits Assess the necessity and reasonableness... ...Current unrestricted RN license required Applicants for... ...preferred Medical management or Utilization Review experience preferred Availability...MedicalClaimsMonday to Friday
- 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...MedicalClaimsRemote jobFull timeLocal area
$70k - $85k
Description: Medical Reviewer, RN Location: Remote Salary: $70,000-85,000 annually, based on years of experience About J29 J29, Inc. (J29) has... ...on providing processing, review, and analysis of medical claims, records, data, and audits between areas of compliance, policy...MedicalClaimsFor contractorsLocal areaRemote work- Medical Management - Medical Review Examiner Nurse 135-1009 Tulsa, OK, USA Job Description... ...provider and facility claims. Identifying issues related... ...practice as Registered Nurse (RN) or Licensed Practical... ...clinical operations (for example utilization review, quality...MedicalClaimsWork experience placement
- Centene Corporation is seeking a licensed nurse (LPN or RN) in Oklahoma for a remote role focused on authorization reviews and utilization management. Responsibilities include assessing medical necessity, coordinating with healthcare providers, and ensuring timely care...MedicalRemote job
$66k - $106k
...performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and... ...and to apply sound clinical judgment to claim payment decisions. Responsibilities may... ...review sophisticated data model output, and utilize a variety of tools to detect situations...MedicalClaimsContract workRemote workShift workNight shift- ...care.? Requirements The Nurse Reviewer performs complex medical record reviews of Medicare Part A/B and DMEPOS claims that require clinical... ...licensure as a Registered Nurse (RN); active compact multistate... ...claims reviews and/or utilization review Preferred Qualifications...MedicalClaimsContract workFor contractorsLocal areaRemote work
- ...Job Description Join our team as a day shift/variable, full time, RN Case Manager - Utilization Review, at INTEGRIS Baptist Medical Center, Oklahoma City, OK. Join our team as a day shift/variable, full time, RN Case Manager - Utilization Review, at INTEGRIS Baptist Medical...MedicalFull timeWork at officeDay shift
- INTEGRIS Baptist Medical Center in Oklahoma City, OK is seeking a day shift/variable, full-time RN Case Manager - Utilization Review. You will assess patients, coordinate transfers, and develop discharge plans to optimize resources and patient outcomes. Qualifications include...MedicalFull timeDay shift
- Commonwealth of Kentucky seeks a Disability Adjudicator III in the Medical Relations Branch to provide expert consultation to SSA adjudicators and professional adjudication for disability applicants. This FFTL position is federally funded for the grant duration, designated...SeniorMedicalClaimsPermanent employment
- Medical Review Nurse - CMS/RAC Auditor, Government Audits Remote - US Machinify... ...) primarily performs medical claims audit reviews for government... ...Needed Experience with utilization management systems or clinical... ...Qualifications Active unrestricted RN license in good standing, is...MedicalClaimsRemote jobContract workFor contractorsFor subcontractorWork at office
- ...Peraton subsidiary, is seeking a Nurse Reviewer to join our team. You will conduct medical record reviews and apply clinical judgment to claim payment decisions, researching claims data... .... The ideal candidate will have RN experience and be able to present findings...MedicalClaimsRemote job
- Commence is seeking a Nurse Reviewer to perform complex medical record reviews of Medicare Part A/B and DMEPOS claims. The role requires clinical judgment to assess payment validity... ...and adherence to medical standards. An RN license and 2-4 years of clinical experience...MedicalClaimsRemote job
- Machinify seeks a Medical Review Nurse to conduct CMS/RAC audits for government payer claims. This remote US-facing role requires nursing licensure and expertise in medical review. The MR Nurse will audit inpatient and outpatient claims, document findings, and support...MedicalClaimsRemote job
$23.76 - $51.49 per hour
...for clinical member services review assessment processes. Responsible... ...verifying that services are medically necessary and align with... ...Molina care model. Adheres to utilization management (UM) policies and... ...experience. Registered Nurse (RN). License must be active and...MedicalHourly payWork experience placementWork at office$120k - $165k
...has an opportunity for a Senior Product Manager . The... ...Benefits : Health insurance (medical, dental, vision),... ...uptake of Candid profile claims, Seals, and other... ...value ways to increase the utility and ubiquity of Candid... ...further information, please review the Know Your Rights...SeniorMedicalClaimsTemporary workSummer workLocal areaRemote workMonday to FridayFlexible hours$80k - $125k
...innovative and growing Claims team where you’ll get... ...Hartford, CT The Role: The Senior Claims Examiner... ...rights and denial letters Reviews and analyses claim... ...manage deployment and utilization of defense counsel Identifies... ...dental and FSA plans (medical, limited purpose, and...SeniorMedicalClaimsPermanent employmentTemporary workWork at officeRemote work2 days per week- ...Senior Revenue Accountant-(Revenue Cycle) Patient... ...compliance, including reviewing hospital contracts to... ...monthly financial data utilizing spreadsheet and database... ...Support investigation into claims patterns, payor mix... ...the largest academic medical systems in the New...SeniorMedicalClaimsFull timeWork at officeLocal area
$128k - $192k
## Staff or Senior Staff Attorney , Workers' CompensationApplylocations... ...legal career. • **Utilization of progressive AI... ...Attorneys and Claims professionals in a... ...Inclusive Benefits Package:** Medical, Dental, Life and... ...appellate briefs in reviewing courts. The role includes...SeniorMedicalClaimsTemporary workCasual workRemote workFlexible hours- ...comprehensive benefits including medical, dental, vision, paid... ...make a difference The RN Discharge Planner H... ...daily clinical care, utilization management, and care... ...-eligible individuals, reviewing and approving reentry care... ...utilization data, claims reviews, and referral activity...MedicalClaims
$85k - $110k
...every decision we make. The Senior Claims Adjuster will play a critical... ...administration of statutory medical and indemnity benefits... ...The use of AI in Application Review: To support a fair, efficient... ...acknowledge and consent to Pie utilizing these AI technologies to assist...SeniorMedicalClaimsWork experience placementRemote work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Senior Medical Review RN — Utilization & Claims. Be the first to apply!
- unique rn Brooklyn, NY
- rn non bedside Brooklyn, NY
- med surg medical surgical rn registered nurse Brooklyn, NY
- travel registered nurse rn Brooklyn, NY
- rn outpatient surgery Brooklyn, NY
- cath-lab rn Brooklyn, NY
- rn no experience Brooklyn, NY
- behavioral rn Brooklyn, NY
- injection rn Brooklyn, NY
- pediatric icu rn Brooklyn, NY

