Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Remote RN: Clinical Claims Review & Trainer

California Nursing Students Association Incorporated

Sacramento, CA
  • 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

Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Remote RN: Clinical Claims Review & Trainer in Sacramento, CA vacancy
  • $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 work
    Claims
    Permanent employment
    Full time
    Temporary work
    Work at office
    Shift work

    Sentara Health

    Ohio
    3 days ago
  • $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 job
    Claims

    Performant Healthcare, Inc.

    New York, NY
    2 days ago
  •  ...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 work
    Claims
    Full time
    Work experience placement
    1 day per week

    Blue Cross Blue Shield of Arizona

    Remote
    18 days ago
  • 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 job
    Claims
    Work at office

    Medix

    New York, NY
    10 hours ago
  • $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 work
    Claims
    Full time
    Temporary work
    H1b
    Work at office
    Visa sponsorship
    Work visa
    Flexible hours

    Guardian Life Insurance

    Remote
    16 days ago
  •  ...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 job
    Claims

    Guardian Life

    Austin, TX
    3 days ago
  • $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 job
    Claims
    Permanent employment
    Full time
    Temporary work
    Part time

    TRC Talent Solutions

    Winter Park, FL
    7 days ago
  • 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 job
    Claims

    Precision Labs

    Brooklyn, NY
    3 days ago
  • 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 job
    Claims

    Gainwell Technologies LLC

    Columbus, OH
    3 days ago
  •  ...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 work
    Full time
    Work at office

    Virtual Vocations Inc

    United States
    2 days ago
  • $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 work
    Claims
    Permanent employment
    Temporary work
    Live in
    Immediate start
    Relocation
    Flexible hours

    NTT DATA Services

    Oregon State
    4 days ago
  •  ...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 work
    Claims

    First Connect Health

    Austin, TX
    2 days ago
  • $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 work
    Claims
    For contractors
    H1b
    H2b
    Work at office
    Local area
    Home office

    CoventBridge Integrity Systems

    Grove City, OH
    1 day ago
  •  ...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 work
    Home office
    Monday to Friday
    Weekend work

    Managed Medical Review Organization

    Idaho County, ID
    4 days ago
  •  ...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 work
    Claims
    Work at office
    Home office
    Flexible hours
    2 days per week
    3 days per week

    Onos Health

    San Francisco, CA
    3 days ago
  •  ...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 work
    Claims
    Full time

    Rising Medical Solutions

    United States
    2 days ago
  • 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... 
    Claims
    Work at office

    Blue Shield of California

    Sacramento, CA
    1 day ago
  •  ...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 work
    Claims

    WPS Health Solutions

    Columbus, OH
    10 hours ago
  • $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 work
    Claims
    Hourly pay
    Minimum wage
    Full time
    Temporary work
    Work experience placement
    Local area

    UnitedHealth Group

    Plymouth, MN
    3 days ago
  • $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 work
    Claims
    Hourly pay
    Minimum wage
    Full time
    Temporary work
    Work experience placement
    Work at office
    Local area

    UnitedHealth Group

    Plymouth, MN
    4 days ago
  • 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 job
    Claims
    Full time

    Sedgwick

    Detroit, MI
    3 days ago
  • $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 work
    Claims
    Full time
    Contract work
    Work from home
    Flexible hours
    Weekend work

    Gainwell Technologies LLC

    Ohio
    15 days ago
  •  ...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 work
    Claims
    Work at office

    BigR.io

    United States
    20 hours ago
  •  ...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 work
    Claims

    Health Business Solutions

    Cooper, FL
    1 day ago
  • $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 work
    Claims
    Full time
    Monday to Friday
    Flexible hours

    Gainwell Technologies LLC

    Ohio
    3 days ago
  •  ...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 work
    Full time
    Contract work
    Local area
    Work from home
    Home office

    COMAGINE HEALTH

    Oregon State
    4 days ago
  •  ...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 work
    Full time
    Contract work

    Comagine

    United States
    2 days ago
  •  ...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 work
    Claims
    Temporary work
    Work at office
    Monday to Friday
    Flexible hours

    Hines

    Rockford, IL
    3 days ago
  • $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 work
    Claims
    Work at office
    Immediate start
    Flexible hours
    Shift work

    Reliance Matrix

    Oregon State
    1 day ago
  • $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 work
    Claims
    Full time
    Temporary work
    H1b
    Flexible hours

    Guardian

    New York, NY
    2 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote RN: Clinical Claims Review & Trainer. Be the first to apply!