Remote RN Medical Reviewer II - Utilization & Claims
Southcarolinablues
- Remote job
Palmetto GBA, a BlueCross BlueShield South Carolina subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim reviews and determine medical necessity using established guidelines. The role documents decisions and supports utilization review across multiple services. The position is remote, full-time, with standard hours 8:00 AM–5:00 PM ET, training, and potential overtime. RN license, associate degree, and 2+ years of clinical RN experience required. #J-18808-Ljbffr Southcarolinablues
$26 - $30 per hour
...About the Role: The Medical Coding Specialist II is responsible for correctly... ...coding healthcare claims and analyzing denials... ...Coder II Location: Remote Schedule: 8am – 5pm... ...and State standards utilizing CCI edits, Medicare bulletins... ...information, please review the Know Your Rights...Remote workClaimsHourly pay- Title - Medical Coder II, Certified Shift - (Remote working after on-site training (2-4 weeks)... ...coding position focused on review of documentation and... ...ensure accurate coding and claim submission and conformity... ...specialties as assigned. Utilize available coding tools and...Remote workClaimsPermanent employmentFlexible hoursShift work
$88.85k
...and to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Claims Review Nurse RN II is responsible for conducting clinical review of medical claims to ensure services were medically necessary, appropriately documented,...ClaimsFull time- ...and monitoring the utilization of behavioral... ...appropriate cases to the Medical Director for review. Refer to and... ..., researching claims to ensure accurate... ...management. Level II (in addition to... ...degree and active NYS RN license required.... ...opportunity for remote work within all...Remote workClaimsContract workWork at office
- ...Utilization Management RNThere's no place like... ...monitoring focusing on medical necessity... ...Management Reports to be reviewed by Executive... ...reimbursement and claim denials/appeals.Use... ...License, (Compact, RN preferred)1–5 years... ...communicates instructions to remote users.Visit for...Remote workClaimsWork at office
- Cotiviti is seeking a senior auditing RN to perform retrospective chart reviews on Readmission and Place of Service Claims, applying clinical guidelines and considering claims... .... The ideal candidate has 5-7+ years in Utilization/Case Management with an ICU/CCU background,...Remote jobClaims
$88.85k
RN Job Utilization Management Nurse Specialist RN II Shift: Full Time Pay Range: $88,854.00 (Min.)... ...coordinates, and approves medically necessary referrals that... ...and concurrent review, and collaborates with onsite... ...service and retrospective claims medical review. Monitors...ClaimsFull timeShift work- ...position is responsible for reviewing medical records for... ...audits acute inpatient claims. Integrates medical chart... ...payment by independently utilizing DRG grouper, encoder,... ...by management. Level II (in addition to Level... ...may be opportunity for remote work within all jobs...Remote workClaimsWork experience placement
$42 per hour
...Ascension Texas Utilization Management Department (Fully Remote) Provides health care services... ...planning and utilization review. Reviews admissions and... ...concurrent and retrospective medical necessity and/or... ...precertification, reimbursement and claim denials/appeals....Remote jobClaims- Summary Performs medical reviews using clinical/medical information provided by physicians/providers... ...support and review of medical claims and utilization practices. Logistics Palmetto GBA- one... ...Position, You'll Need License Active RN licensure in state hired, OR, active compact...ClaimsFull timeFor contractorsWork experience placementLive inWork at officeLocal areaWork from homeHome officeMonday to FridayShift work
$42.68k - $64.02k
...Utility Worker IIThe word RIGHT stands for what we VALUE... ...such as- full medical, dental, and vision benefits... ...Summary:The Utility Worker II is responsible for... ...sewage is possible, but remote. Occasional exposure to... ...clearcompany.com. Any outreach claiming to be from Middlesex...Remote workClaims$30.64 - $45.8 per hour
...Utilization Review NurseThe Utilization Review Nurse gathers... ..., certifies the medical necessity and... ...CorVel. This is a remote position.Essential... ...to the appropriate claims staff/customerCollects... ...required; RN is required unless... ...leveled roles (I, II, III, Senior, Lead...Remote workClaimsMinimum wageFull timeWork at officeLocal areaFlexible hours$2,210 per week
...benefits, including medical, dental, vision,... ...Work-life balance. Remote/hybrid setting (once... ...This individual will utilize clinical knowledge... ...to a second level reviewer. This individual interfaces... ..., benefit and claim concerns, and... ...is not limited to RN, LMSW, LMHC. Successful...Remote workClaimsFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours$88.85k
...Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization... ...for receiving/reviewing admission requests and higher... ...on clinical criteria for medical necessity. Assures timely... ...service, and retrospective claim medical review processes...ClaimsFull timeNight shift- ...Most of the training will be remote however you will be required... ...required to start onsite A Utilization Review (UR) Nurse is a registered nurse... .... They evaluate patient medical records to ensure treatments... ...(retrospective) to prevent claim denials and ensure accurate...Remote workClaimsWork experience placementFlexible hoursShift workWeekend work
- ...RN Integrated Care Coordinator (UM) The RN... ...are required to address utilization review cases. Roles and Responsibilities... ...of cases involving medical decisions and quality... ..., reimbursement, and claim denials/appeals.... ...This is a remote position. Our whole company...Remote workClaimsLive inFlexible hoursWeekday work
$35 - $43 per hour
...changing decisions, one review at a time? Why This... ...on an answer to the Medical Director who depends on... ...Current, unrestricted RN license in the United States... ...similar setting) ~ Utilization review/utilization management... ...coding and medical claims Ability to interpret...Remote workClaimsHourly payImmediate startMonday to FridayFlexible hours- Gainwell Technologies is seeking a Medical Reviewer (Registered Nurse) to support California healthcare programs.... ...to review medical records, healthcare services, claims, and authorization requests. You will work remotely within California with flexible hours, contributing...Remote jobClaimsFlexible hours
- ...Description Job Description The utilization review and management (UM)... ...MedHealth contracted facilities are medically necessary, clinically... ...logging and documentation of claims along the process chain. #... ...This is an in-office, no remote work capability position...Remote workClaimsWork at office
- J29, Inc. is seeking a Remote Medical Reviewer (RN) for a temporary assignment to audit Medicare FFS claims, including Part A/B, DMEPOS, and Home Health/Hospice as needed. You will apply CMS rules, document findings, and ensure accuracy in each review while maintaining...Remote jobClaimsTemporary workWork experience placement
$88.85k
...Utilization Management Nurse Specialist RN II (Outpatient) Job Category: Clinical Department:... ...coordinates, and approves medically necessary referrals that... ...admission and concurrent review, and collaborates with onsite... ...and retrospective claims medical review. Monitors...ClaimsFull time- ...seeks an experienced Registered Nurse to perform medical review of complex claims, pre-authorization requests, appeals, and fraud... ...support accurate payment determinations. The role is remote and full-time, requiring an active RN license and at least two years of clinical...Remote jobClaimsFull time
- J29, Inc. is seeking a Medical Reviewer, RN Coder for a remote, temporary position (approximately 3-6 months). The role requires active RN license in... ...extensive experience in medical coding and Medicare FFS claims. You will perform automated and complex reviews, ensure...Remote jobClaimsTemporary work
- ...in Wake Forest, NC is seeking a skilled Medical Coder II to join the Radiology coding team. You... ...procedure coding and timely submission of claims. The role requires CPC or CCS... ...Teaching Physician Rules, in a primarily remote position with on-site visits as needed....Remote jobClaims
- A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and...Remote workClaimsFull time
- The Utilization Review Nurse gathers demographic and clinical... ..., certifies the medical necessity and... ...CorVel. This is a remote position. ESSENTIAL... ...to the appropriate claims staff/customer... ...operation required;RN is required unless... ...leveled roles (I, II, III, Senior, Lead...Remote workClaimsMinimum wageWork at officeLocal areaFlexible hours
$30.64 - $45.8 per hour
...Description The Utilization Review Nurse gathers demographic... ..., certifies the medical necessity and... ...CorVel. This is a remote position.... ...to the appropriate claims staff/customer... ...operation required; RN is required unless... ...leveled roles (I, II, III, Senior, Lead...Remote workClaimsHourly payMinimum wageFull timeWork at officeLocal areaFlexible hours$45 - $50 per hour
...for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical... ...of accredited nursing programs with an active New York RN license. #J-18808-LjbffrRemote workHourly pay- ...Memorial Health is seeking a Coder II to accurately apply ICD-10CM... ...services, ensuring clean claims and accurate data for billing.... ...with the Revenue Cycle team in a remote MN/WI environment. At least 3... ...certification are required. #J-18808-Ljbffr North Memorial Medical CenterRemote jobClaims
$102k - $158.39k
...**This position is remote. Candidates must be local... ...Improvement (CDI) Specialist II assists with the... ...providers as supported by medical record documentation to... ...Description: Concurrently reviews inpatient records to... ...Certification & Registration: RN License Clinical...Remote workWork at officeLocal area
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN Medical Reviewer II - Utilization & Claims. Be the first to apply!


