Remote RN: Clinical Claims Review & Trainer
California Nursing Students Association Incorporated
- Remote job
CVS Health is seeking a licensed RN to review clinical documentation, apply decision-making for post-service claims, and coordinate resolutions with clinician support. The role includes training staff and guiding customer service and claims teams while staying compliant with HIPAA and state requirements. This full-time, remote-position requires a dedicated home office, reliable wired internet, and a quiet workspace. #J-18808-Ljbffr California Nursing Students Association Incorporated
$93.35k - $132.43k
City/State Norfolk, VA Work Shift First (Days) Overview: Sentara Health Plans is hiring a Clinical Claims Reviewer/ RN - Remote! Status: Full-time, permanent position (40 hours) Standard working hours: 8am to 5pm EST, M-F. Remote opportunities available in the following...Remote workClaimsPermanent employmentFull timeTemporary workWork at officeShift work$69.3k - $78k
...integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and... ...The position requires an active RN license and a minimum of five years... ...documenting findings, all in a remote work environment. This role...Remote jobClaims- ...as hybrid, onsite or remote. While the majority of... ...to: Customer Service, Claims Processors, and Correspondence... ...OF THE JOB The Clinical Trainer and Auditor is... ...or AHCCCS Operational Review ~ Prior audit experience... ...Licensure Compact (NLC) as an RN within the first 60...Remote workClaimsFull timeWork experience placement1 day per week
- Medix is seeking an RN-Coder Clinical Validation Reviewer to support payment integrity and clinical validation workflows in a hybrid setup. The role emphasizes reviewing medical records against claims to determine support for billed services, with documentation of clear...Remote jobClaimsWork at office
$68.97k - $113.31k
...outcomes? Guardian is seeking an RN Clinical Consultant to serve as a... ...and long-term disability claims. In this role, you will analyze... ...management systems You will Review short-term and long-term... ...Bethlehem, PA, Holmdel, NJ, or fully remote Travel ~ Occasional 0-...Remote workClaimsFull timeTemporary workH1bWork at officeVisa sponsorshipWork visaFlexible hours- ...States is seeking a registered nurse to join as an RN Clinical Consultant. You will review disability claims, analyze medical information, assess functional capacity... ...high-quality client service. The position is fully remote with occasional travel, offering a competitive...Remote jobClaims
$40 - $50 per hour
...Job Description Job Description Clinical Appeals RN – 100% Remote $40-$50/hour | Part-Time & Full-Time... ...and have experience appealing denied claims, we'd love to hear from you. As a... ...you'll use your clinical expertise to review and appeal insurance denials related...Remote jobClaimsPermanent employmentFull timeTemporary workPart time- Machinify is seeking a Medical Review Clinical Appeals Auditor (RN) to conduct Appeals reviews of new evidence in medical review audits and support... ...productivity. The candidate will document results, analyze claims data, and collaborate with leadership to improve audit...Remote jobClaims
- Gainwell Technologies LLC is seeking an Associate Manager, Clinical Claim Review to supervise day-to-day prepay, post-pay, prior authorization... ...while ensuring service levels and quality targets are met in a remote, United States-based role. This position emphasizes...Remote jobClaims
- ...Utilizing clinical expertise to educate and support healthcare professionals, the full-time RN Clinical Trainer will develop and deliver engaging training content in a remote setting, focusing on enhancing clinical knowledge and operational practices. Key responsibilities...Remote workFull timeWork at office
$76k
...Position Summary The Clinical Reviewer Specialist is responsible for... ...benefits. Position is fully remote only in the state of Florida.... ...Active Registered Nurse (RN) license required. (Not encumbered... ...for the appeal. Review claim and service appeals for reconsideration...Remote workClaimsPermanent employmentTemporary workLive inImmediate startRelocationFlexible hours- ...Utilization Management Department (Fully Remote)Job Summary:• Provides health care services... ..., discharge planning and utilization review.Responsibilities:• Reviews admissions and... ...documentation, precertification, reimbursement and claim denials/appeals.• Assesses and...Remote workClaims
$78k - $85k
Overview Medicaid Medical Review RN (Medical Reviewer III) - REMOTE The Medicaid Medical Review RN (Medical Reviewer... ...be responsible for conducting clinical reviews of medical records during the... ...information contained in Standard Claims Processing System files (e.g.,...Remote workClaimsFor contractorsH1bH2bWork at officeLocal areaHome office- ...and holidays. We are searching for a new RN to join our team. Our Nurses enjoy the flexibility to work remotely and do not have face-to-face Patient... ...and documentation skills in addition to clinical experience. Please review the roles and responsibilities of this position...Remote workHome officeMonday to FridayWeekend work
- ...Clinical Quality Reviewer - BCBAOnos Health's mission is simple but ambitious: ensure every healthcare... ...review platformsExperience analyzing claims, utilization, or outcomes dataLocation... ...Francisco office (Financial District), remote-first cultureUnlimited vacation policyPaid...Remote workClaimsWork at officeHome officeFlexible hours2 days per week3 days per week
- ...Utilization Review Nurse Rising Medical Solutions has an opening for a Utilization Review... ...by reducing the cost of healthcare claims through bill review, case management, and... ...met Maintain organized files containing clinical documentation of interactions with all parties...Remote workClaimsFull time
- Blue Shield of California is seeking a Clinical Coding Analyst RN, Consultant to lead a small clinical coder team and review post-service claims for coding accuracy and medical necessity. The role supports the Facility Compliance Review program, leveraging ICD-10-CM/PCS...ClaimsWork at office
- ...Solutions in Columbus, OH, is seeking an Appeals Nurse to review medical records and Medicare claims for first-level appeals to determine medical necessity... ...to prepare timely redeterminations, document clinical rationales, and ensure compliance with CMS guidelines....Remote workClaims
$29 - $52 per hour
...Connecting. Growing together. The Clinical Review Clinician serves as a subject matter expert... ...a comprehensive understanding of the claim review process including clinical claim... ...Qualifications: Active and unrestricted RN license OR LPN in the state of residence...Remote workClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal area$35 - $63 per hour
...together. In this position as a Clinical DRG RN auditor , you will apply your... ...in the auditing of inpatient claims. Employing both industry and... ...MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG... ...Ability to work independently in a remote environment and deliver...Remote workClaimsHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal area- Sedgwick is seeking a Telecommuter RN for Utilization Review in Michigan. This full-time role focuses on evidence-based review of treatment plans... ...medical records, and coordinating with providers and claims teams. The position emphasizes accuracy, adherence to guidelines...Remote jobClaimsFull time
$78k - $88k
...a talented individual for a Nurse Reviewer who will be responsible for performing clinical reviews to determine if the medical... ...required CEUs to maintain RN license. Responsible for attending... ...trains to perform reviews of multiple claim types to provide a flexible...Remote workClaimsFull timeContract workWork from homeFlexible hoursWeekend work- ...Clinical Validation Reviewer Focused review of professional claims related to Fraud Waste and Abuse, documentation review to support services provided from billing... ...Required Licensure / Education: Registered Nurse (RN). License must be active and unrestricted in...Remote workClaimsWork at office
- ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical Appeals Position Overview... ...supports HBiz’s revenue cycle operations by reviewing denied claims for clinical accuracy and medical necessity,...Remote workClaims
$78k - $88k
...Summary We are seeking a Nurse Reviewer (RN) who will be responsible for performing clinical reviews to determine whether... .... Cross-trains on multiple claim types to support business needs.... ...Monday through Friday work schedule.Remote role available to employees...Remote workClaimsFull timeMonday to FridayFlexible hours- ...Clinical Reviewer – Registered Nurse (RN) Comagine Health | Washington State | Remote / Work From Home Department: Care Management Contract: Washington Labor & Industries (L&I) Location: Washington State – Remote Employment Type: Full-Time This is an...Remote workFull timeContract workLocal areaWork from homeHome office
- ...Clinical Utilization Review Nurses (RN) Based In Alabama Comagine Health is a national, mission-driven, nonprofit organization that has engaged in... ...improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our...Remote workFull timeContract work
- ...HolidaysWork-life balance.Remote settingRole Description... ...will utilize clinical knowledge and communication... ...decision to a second level reviewer. This individual... ...'s status, benefit and claim concerns, and validation... ...but is not limited to RN, LMSW, LMHC.Must have Mental...Remote workClaimsTemporary workWork at officeMonday to FridayFlexible hours
$66.66k - $96.1k
...as assigned* Job Summary: Reviews all medical (and other) documentation in claim files to answer the specific... ...be appropriately addressed by the Clinical Nurse Specialist. If not, refer the... ...for employment depends solely on your qualifications. #LI-Remote .Remote workClaimsWork at officeImmediate startFlexible hoursShift work$68.97k - $113.31k
...RNClinicalConsultant to serve as a clinical expert supporting the... ...term and long-term disability claims. In this role, you will analyze... ...RequiredQualifications: ActiveRegisteredNurse(RN)license Minimumof5... ..., PA, Holmdel, NJ, or fully remote Travel Occasional 0-10% of the...Remote workClaimsFull timeTemporary workH1bFlexible hours
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