Remote Clinical Review Nurse - Medical Claims & Compliance
Santa Barbara Cottage Hospital
New York, NY
- Remote job
ARC Group is seeking a Clinical Review Nurse for a 100% remote position. The role focuses on reviewing health claims, determining medical necessity, and ensuring alignment with national and local policies and standards of care. Must hold a nursing degree and RN license, with strong communication and CMS guideline knowledge. The position involves evaluating pre- and post-pay claims, providing or guiding education to providers, and supporting special projects as needed. #J-18808-Ljbffr Santa Barbara Cottage Hospital
Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Remote Clinical Review Nurse - Medical Claims & Compliance in New York, NY vacancy
$29 - $52 per hour
...Program Integrity Clinical Compliance AuditorOptum Insight... ...performing compliance reviews of medical and administrative documentation... ...who submit claims for payment. This... ...schedule.This position is Remote in Massachusetts.... ...care, for example, nursing facility care...Remote workMedicalClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift workUMR
Boston, MA3 days ago- ...Elevance Health is seeking a Clinical Review Nurse I - Medicare Part B to review claims for medical necessity under Part B policies. The role is remote with required in-person training and follows a 8 am–5 pm EST Monday–Friday schedule. It’s part of Wellpoint Federal,...Remote workMedicalClaimsMonday to Friday
Elevance Health
South Portland, ME3 days ago - ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director... ...cycle operations by reviewing denied claims for clinical accuracy and medical necessity, developing evidence... ...outcomes, and ensuring compliance with payer policies and...Remote workMedicalClaims
Health Business Solutions
Florida, NY4 days ago - ...Clinical Review Nurse - RemoteARC Group has multiple positions open for Clinical... ...Nurses! These positions are 100% remote. These are direct hire FTE... ...responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in...Remote workMedicalClaimsPermanent employmentWork at officeLocal area
American Recruiting & Consulting Group
Jacksonville, FL3 days ago - ...healthcare platform, the full-time Medical Review Nurse will ensure compliance with CMS regulations for durable medical... ...data security while working remotely. Key Responsibilities Review DMEPOS... ...utilization management reviews, or claim audits Proficiency with medical review...Remote workMedicalClaimsFull timeFlexible hours
Virtual Vocations Inc
United States3 days ago - Commence is seeking a Nurse Reviewer to perform complex medical record reviews of... ...Part A/B and DMEPOS claims. The role requires clinical judgment to assess payment... .... The position is remote, offering flexibility... ...documentation skills and HIPAA compliance. #J-18808-Ljbffr...Remote jobMedicalClaims
- ...physicians to conduct Independent Medical Exams (IME) and Peer Reviews. This opportunity allows you... ...JOB SUMMARY: Utilizes clinical expertise, and reviews disability claims by providing an... ...healthcare professionals in compliance with state regulations and guidelines...Remote workMedicalClaimsFor contractorsMonday to Friday
Dane Street
United States5 days ago - ...leading healthcare intelligence company. The Medical Review Nurse II audits home health claims, working remotely with a multi-location team to ensure compliance and high-quality documentation. The role emphasizes strong clinical judgment, coding accuracy, and regulatory...Remote jobMedicalClaimsWork from home
$40 per hour
...20-30 hours week) – Remote Work Environment... ...00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical... ...for Medicaid claims. This involves meticulous... ...medical records to ensure compliance with established... ...0, CPT and HCPCS Clinical criteria (InterQual...Remote workMedicalClaimsContract workWork at officeLocal areaImmediate startHQSI
Tampa, FL2 days ago- ...Clinical Medical Review NurseWe are seeking Licensed Practical Nurses (LPN) or Registered Nurses (RN) to join the Quality team as... ...contract position requiring both remote work and regular onsite... ...records to ensure accuracy and compliance with quality standards.Key responsibilities...Remote workMedicalContract workWork at office2 days per week3 days per week
Lumen Solutions Group Inc.
Baltimore, MD3 days ago $21 per hour
...Error stopped claims by gathering information... ...for further review in a production... ...: Clinical Case Reviews -... ...facility) claims vs. medical records to determine... ...and federal compliance policies,... ...Certificate and/or Nursing Licensure Complete... ...to hybrid or remote after the 8-...Remote workMedicalClaimsHourly payFull timeContract workTemporary workMonday to Friday- ...The utilization review and management (... ...facilities are medically necessary, clinically appropriate, evidence... ...regulatory compliance and organizational... ...of claims along the process... ...~ Registered nurse with active, unincumbered... ...an in-office, no remote work capability...Remote workMedicalClaimsWork at office
MedTrust LLC
Oklahoma City, OK9 days ago $69.3k - $78k
...healthcare payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and Commercial Payers.... ...auditing claims and documenting findings, all in a remote work environment. This role offers a...Remote jobMedicalClaims- ...Description: Manager of Clinical Utilization... ...Type: Hybrid (85% remote, 15% onsite in Northridge... ...- Denial Compliance. This role is pivotal... ...tasks, performance reviews, and any necessary... ...reviewers, medical directors, and other... ...accredited Registered Nursing Program; RN preferred...Remote workMedicalPermanent employmentFull timeTemporary workFlexible hours
Vivo HealthStaff
Burbank, CA25 days ago $60.1k - $85.8k
...It takes great medical minds to create powerful... ..., Itemized Bill Review Quality Auditor to... ..., healthcare claims, itemized medical... ...ensure accuracy, compliance, and proper billing... ...audits completed by clinical and coding review... ...Information Management, Nursing, Healthcare...Remote workMedicalClaimsFull timeWork from homeFlexible hoursGainwell Technologies LLC
Texas5 days ago$29 - $52 per hour
...Clinical Review ClinicianOptum is a global organization that delivers care, aided by technology, to help millions... ...possess a comprehensive understanding of the claim review process including clinical claim review, medical record review, and a broad knowledge of applicable...Remote workMedicalClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal areaUnitedHealth Group
Minneapolis, MN3 days ago$86.8k - $124k
...receive an alert: Clinical Policy Specialist - Itemized Bill Review (Remote) Date: Aug 25, 20... ...It takes great medical minds to create powerful... ...billing, UB-04 claim processing,... ...methodologies to ensure compliance and program... ...administration, business, nursing) Active,...Remote jobMedicalClaimsFull timeFlexible hours$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant, we’re focused on... ...primarily performs medical claims audit reviews. As a MR Nurse... ...Payers. You will work remotely in a fast paced and dynamic... ...contractor and subject to compliance with client contractual and...Remote workMedicalClaimsFor contractorsWork at officeWork from homeHome officeShift work$65k - $75k
...Nurse - Clinical Review Performs utilization review of cases to determine if the request meets medical necessity criteria in accordance with medical policies... ...as necessary, to ensure compliance with review timeframes.... ...7:00pm CST Location: Remote Compensation...Remote workMedicalLocal areaMonday to FridayHealthHelp
United States5 days ago- ...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 workMedicalClaimsFull time
Innovative Systems Group
Richardson, TX2 days ago - ...Management Department (Fully Remote) Provides health care... ...planning and utilization review. Reviews admissions and... ...concurrent and retrospective medical necessity and/or compliance with reimbursement policy... ..., reimbursement and claim denials/appeals. Assesses...Remote workMedicalClaims
3B Healthcare, Inc.
Austin, TX3 days ago - ...Clinical Appeals Specialist The Clinical Appeals Specialist completes... ...the appeal case for physician review by compiling clinical, contractual, medical policy and claims information along with... ...prioritize appeal requests using nursing expert knowledge and all available...Remote workMedicalClaimsWork at office
Ageatia Global Solutions
United States3 days ago - ...Role: Physician ED Claims Reviewer Duration: 12 months Required skills:... ...licensed with experience in with medical coding (CPT/HCPCS) and managed care to conduct clinical review of claims and UM... ...independently in a fast paced environment. This is a remote position....Remote workMedicalClaims
Vytwo
Prosper, TX5 days ago - ...A healthcare organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The role involves examining claims, maintaining... ...This position offers a chance to work in a remote setup with competitive hours. Benefits include...Remote workMedicalClaims
Healthcare Quality Strategies
Florida, NY3 days ago - ...Registered Nurse: Review and EvaluationAre you a registered... ...integrity through compliance management. Here, you'... ...What You'll Do:Conduct clinical reviews and ensure quality... ...judgment to analyze medical records, documentation... ...improvement, compliance, or claims review is a plus—but...Remote workMedicalClaimsWork from home
The CKHobbie Group
Harrisburg, PA3 days ago - ...Zelis Healthcare Inc. is seeking a Clinical Nurse Reviewer in Saint Petersburg, Florida. This position involves conducting thorough claim reviews based on medical guidelines and billing rules, ensuring compliance with organizational policies. The ideal candidate has a...MedicalClaims
Zelis Healthcare
Saint Petersburg, FL1 day ago - ...planning, and utilization review. Reviews admissions and service... ..., and retrospective medical necessity and compliance with reimbursement policy criteria... ..., reimbursement, and claim denials/appeals. Assesses and... ...technologies simultaneously. - Remote work experience preferred....Remote workMedicalClaimsWork experience placement
Cynet Health
Austin, TX3 days ago $62.4k - $93.6k
...The Opportunity The Clinical Review Nurse – Prior Authorization is responsible for... ...authorization requests to ensure medical necessity, appropriate level of care, and compliance with health plan and... ...Collaborate with UM Coordinators, Claims, Eligibility, and Operations Who...MedicalClaimsAkido Labs Inc
Chino, CA4 days ago- ...Title Location: 100% Remote – Any US State Shift:... ...correspondence letters based on review outcomes in accordance... .... Performs clinical review of outcomes including... ...to resolve denial claims Assists with issues... ...an accredited school of nursing or A.D. or bachelor's in...Remote workClaimsLocal areaShift work
Axelon
United States5 days ago - ...Working remotely, the Claims Examiner Assistant will review, research, and resolve medical and dental claims while ensuring compliance and exceptional customer support in a full-time capacity. Key responsibilities Review, research, and resolve claims in accordance with...Remote workMedicalClaimsFull timeWork at office
Virtual Vocations Inc
United States4 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Clinical Review Nurse - Medical Claims & Compliance. Be the first to apply!
Related searches
- nicu nurse manager New York, NY
- nurse practitioner per diem New York, NY
- assistant director of nursing New York, NY
- clinical nurse New York, NY
- cath lab nurse manager New York, NY
- occupational nurse practitioner New York, NY
- remote nurse practitioner New York, NY
- dialysis nurse manager New York, NY
- assistant nurse manager New York, NY
- neonatal nurse practitioner New York, NY