Remote RN: Medical Claims Review Specialist
Axius Technologies Inc.
An established industry player is seeking a Medical Review Nurse to join their dynamic team in Phoenix. This role involves reviewing and adjudicating medical claims, ensuring compliance with industry standards, and working collaboratively with healthcare providers. The ideal candidate will possess a strong nursing background, excellent organizational skills, and the ability to analyze complex medical documentation. In this position, you will contribute to the efficiency of healthcare delivery while enjoying the flexibility of a primarily remote work environment. If you are passionate about making a difference in healthcare, this opportunity is perfect for you. #J-18808-Ljbffr
- ...established industry player is seeking a Medical Review Nurse to join their dynamic team in... ...involves reviewing and adjudicating medical claims, ensuring compliance with industry standards... ...enjoying the flexibility of a primarily remote work environment. If you are passionate...Remote workMedical
- AHCCCS is seeking a Claims Medical Review Nursing Consultant to monitor and adjudicate medical and behavioral health service payments under the... ...CFRs. Requirements include a current Arizona medical license (RN or higher) or Arizona Behavioral Health license, plus 3 years...Remote jobMedical
- Claims Review Specialist / Medical Coding ** Largely Remote ** Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of the largest health delivery systems in California, seeks an accomplished Claims Review Specialist / Medical...Remote jobMedicalContract workTemporary work
- ...Management Clinician to evaluate inpatient medical necessity, monitor treatment, and... ...across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and... ...care management to ensure timely reviews, document outcomes, and maintain regulatory...Remote workMedicalFull time
$30 - $38 per hour
...A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Remote workMedicalHourly payPart time- ...seeking experienced nursing professionals to review medical records and ensure appropriate admission... ...Candidates must have a valid California RN license and at least two years of... ...in a related field. The position offers remote work with emphasis on critical thinking...Remote workMedical
- ...Management Department (Fully Remote)Job Summary:• Provides health... ...discharge planning and utilization review.Responsibilities:• Reviews... ...concurrent and retrospective medical necessity and/or compliance with... ...precertification, reimbursement and claim denials/appeals.• Assesses and...Remote workMedical
- ...Cohere Health seeks an experienced RN Reviewer to perform prospective, concurrent, and retrospective reviews ensuring medical necessity and high-quality care. You will collaborate... ..., and Medicaid lines. The role is fully remote, requires strong communication, and entails...Remote workMedicalFlexible hours
- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant patient... ...-oriented environment. Requirements include active RN or LVN licensure, a minimum of two years in utilization...Remote workMedicalWork at office
- ...BJC HealthCare seeks a PRN Utilization Review RN to support hospital resource utilization from a remote location within one hour of St. Louis, MO. You will review admissions for medical necessity and educate providers on appropriate care levels. Two years UR experience...Remote workMedicalFull timeReliefShift work
- ...Job Title In this remote role, you will perform utilization reviews, ensuring compliance with clinical guidelines and patient care standards. Collaborate... ...and facilitate care coordination. Your expertise in medical necessity determination and familiarity with charting...Remote workMedicalWeekly pay
- ...Providing timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions, treatment planning, and... ...compliance Collaborate with physicians, claims examiners, and other stakeholders to...Remote workMedicalFull timeWork experience placement
$1,949.74 per month
...Specialty Utilization Review Job ID 17979666... ...Title Utilization Review RN Weekly Pay $1949.74... ...) Job Description Remote Utilization Review RN responsible for concurrent reviews, medical necessity determinations, prior...Remote workMedicalWeekly payShift work- ...To support a mission-driven health organization, the full-time Utilization Review Nurse - RN will conduct medical necessity reviews, escalate non-certifications for secondary clinical review, and analyze clinical records to ensure timely and compliant care determinations...Remote workMedicalFull time
$47 - $52 per hour
100% REMOTE PAY: $47-$52/hr REQUIRED: ~ Must have current RN licensing ~ Post market medical device experience in either medical assessment, complaint handling, post market... .... Job Description: Collect, review, assess and process complaints/reports with...Remote workMedical- ...The Preservice Review RN position at UnitedHealth Group in Hawaii involves assessing customer needs, interpreting medical records, and applying protocols to support medical determinations. This remote role in Hawaii offers a meaningful impact on healthcare delivery with...Remote workMedicalFull timeDay shift
- ...TEEMA is seeking a Registered Nurse for a remote role with Arizona hours (1st shift). You will review medical records for quality, safety, and utilization issues, identify... ...with Medical Directors. Must hold an active RN license, have 3+ years of clinical experience in...Remote workMedicalDay shift
- ...HonorHealth is seeking an Utilization Review RN Specialist to review medical necessity, monitor care, and coordinate UR reviews for Medicare, AHCCCS, self-pay, and other payers, both on admission and concurrently throughout the stay. You will collaborate with care...Remote workMedical
- ...A leading medical service provider in Washington, DC is seeking a DME Medical Reviewer to ensure compliance with nursing standards and provide... ...candidate must hold an active RN license and have at least two... ...audits. The role emphasizes remote work capabilities and...Remote workMedical
- ...Job Details POSITION SUMMARY - RN Utilization Review POSITION DUTIES - Review patient medical records to assess the appropriateness and medical necessity... ...(hospital-based) ~ Skilled experience with remote work LENGTH OF ASSIGNMENT - 13 weeks...Remote workMedicalTemporary workShift workWeekend work
- ...Optum is seeking Telephonic Oncology Preservice Review Nurses for full-time remote work. The role entails pre-service clinical coverage review using guidelines, benefit plans, and medical policy to determine medical necessity for outpatient services. You'll evaluate...Remote workMedicalFull time
- ...Guidehealth is seeking a Utilization Management Registered Nurse (RN) for a fully remote, full-time position. The role involves applying medical necessity criteria to reviews, documenting findings, and interfacing with providers and members to ensure timely, compliant...Remote workMedicalFull time
- ...RN Utilization Review Review patient medical records to assess the appropriateness and medical necessity of hospital admissions, continued stays, and... ...experience (hospital-based) ~ Skilled experience with remote work Length of assignment: 13 weeks Shift / hours...Remote workMedicalShift workWeekend work
- ...Holding Company, Inc. is seeking an experienced nurse for utilization review in a remote-friendly setting with occasional onsite work in Somerville, MA. The role emphasizes clinical knowledge, medical necessity determinations, and collaboration with diverse health plan...Remote jobMedicalCasual work
- UnitedHealth Group is seeking a Remote Appeals Clinician in Texas. You will conduct comprehensive reviews of Medicaid-related assessments (H6516/H... ...provide independent clinical judgments on medical necessity. Requirements include a Texas RN license and 2+ years in Medicaid...Remote jobMedicalFlexible hours
$26.41 - $51.49 per hour
...complact license. The Care Review Clinician will provide prior authorization... ...work schedule. This is a remote position. Home office with... ...verifying that services are medically necessary and align with... ...experience. Registered Nurse (RN). License must be active and...Remote workMedicalHourly payWork experience placementWork at officeHome officeMonday to Friday- ...both inside our hospitals and out in the community. Job Summary and Responsibilities As our Utilization Review RN, you will meticulously review medical records to confirm appropriate admission status and continued hospitalization, utilizing established criteria...Remote workMedical
- ...delivery and patient outcomes. Our talented remote workforce spans the country and plays... ...Overview We are seeking an RN to perform Clinical Review work and QIDP reviews work. Team member... ...and guidelines to determine the medical necessity of health care services....Remote workMedicalContract work
- Comagine Health is seeking a Clinical Utilization Review Nurse (RN) for a 100% remote, full-time role supporting Alaska contracts. The nurse will assess medical necessity and care quality through prospective, concurrent, and retrospective reviews, applying InterQual criteria...Remote jobMedicalFull time
- Premera is seeking a Telecommuter Utilization Review Clinician to evaluate clinical requests and determine medical necessity across inpatient, outpatient, and out-of-network... ...and internal policies. The role requires RN licensure, a Bachelor's or equivalent experience,...Remote jobMedical
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN: Medical Claims Review Specialist. Be the first to apply!



