Remote RN Clinical Review Specialist I
Elevance Health, Inc.
- Remote job
Elevance Health, Inc. is seeking a Clinical Review Nurse I to review claims for medical necessity and benefit eligibility. The role supports Wellpoint Federal's federal programs, with a virtual-eligible setup and required in-person onboarding as needed. The candidate will assess item necessity in claims using medical policy and participate in adjudication. A valid RN license and 1+ year of clinical experience are required, with strict residency criteria for federal roles. #J-18808-Ljbffr Elevance Health, Inc.
- 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...Remote job
$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- ...Medical Management is seeking a Clinical Quality Assurance Coordinator. This 100% remote role supports Pacific Time Zone operations... ...on high-quality utilization reviews and adherence to evidence-based... .... The ideal candidate is an RN with UMR/IRO experience, strong medical...Remote job
- ...A health accreditation organization is seeking a Part-Time Clinical Review Specialist who will play a key role in supporting accreditation processes... ...and a background in quality assurance. This role is fully remote, allowing candidates from anywhere in the United States to...Remote workPart time
- ...Remote Clinical Review SpecialistNew England Life Care (NELC) is one of the fastest growing home infusion therapy companies in New England and... ...England Life Care currently has a Remote Clinical Review Specialist opportunity available. This is a remote position with an ideal...Remote workTemporary workLive inLocal areaMonday to Friday
- Soleo Health is seeking an Infusion Clinical Review Coordinator to support our Specialty Infusion Pharmacy and work remotely in the USA. This role focuses on researching and providing timely clinical reviews on complex patient cases to secure approvals and reduce denials...Remote job
- Soleo Health is hiring an Infusion Clinical Review Coordinator to support our Specialty Infusion Pharmacy and work Remotely in the USA. This role requires Monday-Friday, 8:30am-5pm MST/PST with experience in denial support, clinical reviews, and appeals for infusions and...Remote jobMonday to Friday
- Sedgwick is seeking a Telecommuter Clinical Specialist to perform standard clinical evaluations on claims requiring additional review based on medical condition and client requirements. You will discuss clinical status with providers and employees, ensure documentation...Remote job
- ...currently seeking a full time Clinical Clearance Specialist Registered Nurse to work... ...this exciting opportunity, review the job specifications below... ...Clearance Specialist (RN) is responsible for medical... ...standards. This is a fully remote position requiring strong clinical...Remote jobFull timeTemporary workWork at officeWork from homeMonday to FridayShift work
- ...healthcare accrediting organization is looking for a Full-time Clinical Review Specialist who will support the accreditation process for community... .... Strong communication skills and the ability to work remotely are essential. Traveling 15-20% will be required. #J-18808...Remote jobFull time
- ...currently recruiting a personable and detail-oriented Full-time Clinical Review Specialist to perform the associated duties which support and... ...Must be willing to travel (15-20%) This position is 100% remote and can be located anywhere nationwide. In order to be considered...Remote workFull timeWork at office
$69.59k - $88.73k
...Accessibility Accomodation for Applicants page. UM Clinical Specialist RN-Physical Health (Full Time, Remote, North Carolina Based) Posted on October 13, 2026 Locations... ...consumer treatment through ongoing and continuous review to ensure that services are delivered based on...Remote jobFull timeWork at officeImmediate startHome officeFlexible hours$76k
...to receive an alert: Create Alert The Clinical Reviewer Specialist is responsible for performing clinical... ...required benefits. Position is fully remote only in the state of Florida. Must live... ...& Licensure Active Registered Nurse (RN) license required. (Not encumbered only...Remote workTemporary workLive inImmediate startRelocationFlexible hours- You will apply your clinical expertise to evaluate AI-generated conversations... ..., and more. This fully remote contract role focuses on... ...solutions. Key Responsibilities: Review recorded and simulated healthcare... ...Hold an active, unrestricted RN license in the United States;...Remote jobHourly payContract workFor contractorsFlexible hours
- ...Nurses with at least 5 years of clinical experience to join our... ...data annotation team. You will review agent conversations spanning primary... ..., and scheduling. This is a remote, contract position (1099) with... ...Qualifications: Active, unrestricted RN license in the United States;...Remote jobHourly payContract workFlexible hours
$38k - $76k
Join a remote clinical annotation team reviewing AI-driven patient conversations for accuracy, safety, and guideline adherence. The work centers on primary... ...annotation standards. Required Active, unrestricted RN license in the United States. At least 5 years of hands-...Remote workHourly payContract workWork at officeFlexible hours$40 - $46 per hour
...Solutions is immediately hiring for a RN Clinical Appeals Specialist Position type: Full time Contract... ...Location: Philadelphia PA 19103 (Remote) As a RN Clinical Appeals Specialist... ...intake through resolution including case review outreach documentation gathering...Remote workHourly payFull timeContract workTemporary workFor contractorsWork experience placementWork at officeImmediate startWorldwideFlexible hours- ...Nurses with at least 5 years of clinical experience — bedside nursing,... ...clinical agents. You will review agent conversations spanning primary... ...adherence. This is a remote, contract position (1099). We... ...Qualifications Active, unrestricted RN license in the United States....Remote workHourly payContract workFlexible hours
- AI Trainer Jobs is seeking an Emergency Response Specialist for a remote clinical-review track evaluating AI outputs touching clinical review. Reviewers grade differential reasoning, dosing logic, and guideline adherence; flag patient-safety issues; and document corrected...Remote job
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- AI Trainer Jobs seeks a Member of Technical Staff, Medical Research to remotely review AI outputs in regulated clinical contexts. You will evaluate differential reasoning, dosing logic, and guideline adherence, flag patient-safety issues, and document corrected reasoning...Remote jobHourly payFor contractors10 hours per weekFlexible hours
- VieMed, LLC in Lafayette, LA seeks a detailed RN reviewer to assess patient records for prescribed therapies and equipment, ensuring regulatory and payer requirements are met. You will evaluate physician documentation and support referrals through accurate chart review....Full time
- ...Network focused on value-based care for Senior and Medicaid populations. The Prior Authorization Registered Nurse (RN) conducts initial clinical reviews, pre-screens requests, applies eligibility criteria, and prepares cases for UM review in collaboration with Medical...
$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the Appeals and Grievances Clinical Specialist - RN, LPN... ...effectively with colleagues and prepare cases for review and appeals. Minimum Qualifications: RN, LPN, or...Remote jobFull timeMonday to FridayShift work- VieMed Healthcare seeks a Registered Nurse reviewer in Lafayette, LA to conduct clinical chart reviews for therapies, equipment, and payer documentation. You will assess medical records, determine completeness, and communicate deficiencies to providers and intake leadership...
$38.91 - $60.31 per hour
...and does not offer a hybrid or remote option Summary: Measures,... ...and facilitates improvement in clinical performance and outcomes. Responsibilities... ...as a Registered Nurse (RN). 2 years of relevant nursing... ...and cost of living. Market reviews: All UCHealth positions are...Remote workFull timeTemporary workLocal areaFlexible hoursShift work- ...an alternative application process. RN Clinical Operations Specialist FullTime Nurse Admin Bldgs, Vero Beach... ...based on clinical need. Review and route laboratory results, imaging... ...performance. Support Chronic Care Management, Remote Patient Monitoring, Transitional Care...Remote workFull timeWork at office
- ...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
- AI Trainer Jobs is seeking professionals for a remote Healthcare Attorney review track. You will assess AI-generated clinical outputs, score differential reasoning and dosing, and flag safety issues using a structured rubric. A licensed clinician signs off on outputs to...Remote jobFor contractorsFlexible hours
- Medpace, based in Cincinnati, OH, seeks a Clinical Data Associate to join the Coding & Support team. This full... ...expertise and progression within clinical data review and trial processes. The position requires a BSN and RN license with 3-4 years of nursing experience and...Full timeWork at officeFlexible hoursShift work
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