Clinical Review Nurse I - Impactful Claims Adjudication
Elevance Health
Elevance Health in Harrisburg, PA seeks a Clinical Review Nurse I to assess the necessity and reasonableness of items in claims and to adjudicate them using medical policy. The role requires clinical experience and an active RN license in the United States, with a Monday–Friday schedule and full-time hours. Join a Fortune 25 healthcare company offering comprehensive benefits, incentive programs and a 401(k) plan as you help ensure members receive appropriate care while navigating complex claim #J-18808-Ljbffr Elevance Health
- About This Role The Clinical Review Nurse I is responsible for reviewing and making medical determinations regarding claims to ensure they meet the benefits carried by members. This... ...levels who are passionate about making an impact on their members and communities. #J-1...ClaimsFull timeTemporary workFlexible hours
- Elevance Health is seeking a Clinical Review Nurse I to review and make medical determinations on claims to ensure members receive the benefits described in their plans in a flexible, virtual environment. The role emphasizes assessing the necessity and reasonableness of...ClaimsRemote jobFlexible hours
$26.01 - $68.55 per hour
...community at a time. This role requires the nurse to exercise clinical judgment and perform the following duties: Review and interpret clinical documentation obtained... ...clinical criteria and policies for post-service claims Coordinate clinical resolutions independently...ClaimsHourly payFull timeTemporary workLocal area- Itemized Bill and Medical Record Reviewer job at Alaffia Health. New... ...have experience reviewing claim forms and auditing provider documentation... ...revenue codes against clinical documentation Confirmation... ...on a mission to make a major impact at the core of U.S....ClaimsRemote workFlexible hours
$69.3k - $78k
A healthcare payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and Commercial Payers. The position requires an active RN license and a minimum of five years nursing experience. Responsibilities...ClaimsRemote job- ...opportunity available as an Clinical Appeals Nurse. This position will be Remote... ...that are received after claim submission. Responsible for... ...denials. Participate in the review of audit findings as needed.... ...believes in making a positive impact not only within our industry...ClaimsFull timeRemote workWork from homeMonday to Friday
$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant, we’re focused on helping our clients achieve their goals by providing technology... ...Nurse II - Clinical Validation primarily performs medical claims audit reviews. As a MR Nurse, you will join a team of...ClaimsFor contractorsWork at officeRemote workWork from homeHome officeShift work$27.02 - $48.55 per hour
About This Role The Clinical Review Nurse performs concurrent reviews to assess members' overall health, evaluate the necessity of care, and contribute... ...the care they need to live healthier lives, making a real impact every day through meaningful challenges and a dedicated team...Hourly payFull timeRemote workFlexible hoursDay shift$27.02 - $48.55 per hour
...Purpose: Performs concurrent reviews, including determining member'... ...Seeking a Licensed Practical Nurse (LPN) or Registered Nurse (RN)... ...medically necessity based on clinical policies and guidelines Reviews... ...the work you do here makes that impact real every day. You’ll take on...Hourly payFull timePart timeWork at officeRemote workMonday to FridayFlexible hours- Centene is seeking a Clinical Review Nurse for a remote role supporting members in Pennsylvania. The candidate will perform concurrent reviews... ...time work with competitive pay and benefits, and the chance to impact patient care across the network. RN licensure and acute care...Remote jobFull timeShift workDay shift
- Tokio Marine HCC - Cyber & Professional Lines Group is seeking a Claims Examiner I to resolve and settle insurance claims by... ...losses and applying policy guidelines. You will interview claimants, review records, and determine liability, while coordinating benefits with...Claims
- RN / Medical Reviewer / Remote Job Details Professional... ...: Registered Nurse Specialty : Utilization... ...regarding benefits and clinical criteria and assess and... ...clinical proficiency and claims knowledge. This is a... ...and proper claims adjudication Perform other duties as...ClaimsRemote jobFull timeContract workLocal areaShift work
- ...for a Telephonic Nurse Case Manager to join... ...making on medical claims. You will be... ...achieve the goals Clinically evaluate the recovery... ...need for utilization review procedures to... ...Organization for adjudication. Maintain patient... ...location, which may impact the final offer. We...ClaimsRemote jobTemporary workFor contractorsLocal area
$80k - $120k
Overview:The Claims Liability Manager will ensure all claims; RIG... ...of the claims adjudication processProvide regular feedback... ...and approve process changes impacting the Claim Domain operationsStrategic... ...that your application may be reviewed using AI tools.Job SummaryJob...ClaimsPermanent employmentRemote work- ...direction across insurance, claims, partner integration, and our... ...beneath you and no architecture review process to inherit beyond the... ...our AI systems across claims adjudication, customer support, and... ...asks for real dedication and impact, and gives you genuine flexibility...ClaimsWork at office
- R1 RCM Inc. is seeking a Clinical Coding Appeals Nurse to review medical records and draft appeals of denied or underpaid claims. You will apply clinical judgment to DRG downgrades and prepare persuasive letters using ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance. This...ClaimsRemote job
- Mutual of Omaha Insurance Co. is seeking a knowledgeable Clinical Nurse Consultant - Long-Term Care to provide clinical expertise and support claims management through medical reviews, analysis, and return-to-work guidance. The role evaluates medical information related...ClaimsRemote job
$146.88k
...Disability Assistance, Office of Title: Disability Review Psychologist (NY HELPS)Occupational Category:... ...Psychologist would participate as a member of a disability adjudication team, in the granting or disapproval of disability claims under the Social Security law. The duties of...ClaimsPermanent employmentFull timeTemporary workWork at officeRemote work$31 - $35 per hour
Clinical Review & Correspondence RN The Clinical Review & Correspondence... ...What you'll need: Registered Nurse with active, unencumbered... ...authorization data with post-service claims validation, we're creating a... ...teams make the most impactful work. Cohere is deeply invested...ClaimsFull timeRemote workFlexible hoursShift work- ...forward‑thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation... .... We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical...ClaimsFull timeTemporary workRemote workWork from home
- Medical Writer II (MLR Reviewer) Syneos Health® is a leading fully-... ...and accelerate progress. Our Clinical Solutions team members act with... ...the ability to dramatically impact someone’s life. • We are... ...standards and guidelines, verifying claims against referenced sources,...Claims
- MUST ALREADY HAVE EXPERIENCE DOING BILL AUDIT REVIEWS FOR DIFFERENT STATES. We are seeking an experienced CPC-certified medical coder... ...forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’...ClaimsTemporary workPart timeRemote work
- Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical Appeals Position... ...Nurse supports HBiz’s revenue cycle operations by reviewing denied claims for clinical accuracy and medical necessity, developing...ClaimsRemote work
- New York Workers' Compensation Report Reviewer / Quality Analyst Job Summary The New York Workers' Compensation Quality Analyst is responsible... ...‑thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers'...ClaimsTemporary workRemote workWork from home
- ...to their in-service injury claims. The role involves reviewing the claim, performing... ...examinations we aim to positively impact each Veteran. These... ...health issues. Our valuable clinical insights will play a significant... ...a school of professional nursing accredited by an...ClaimsFor contractorsFor subcontractorWorldwideMonday to Friday
$120 per hour
...(MSc. or PhD) — AI Technical Reasoning Review is a remote review track for evaluating... ...derivations, calculations, or experimental claims. Flag dimensional, methodological, and... ...example so the modeling team can train on it. Adjudicate disputed answers against textbooks,...ClaimsHourly payFor contractorsRemote work10 hours per week- ...Role We're seeking a Mobile Casino Game Reviewer who is passionate about gaming and deeply... ...measuring load times, stability, battery impact, permissions, and device compatibility. Comprehensive... ...potential deal-breakers. Evidence-Based Claims: Back impressions with observations (e.g....ClaimsSeasonal workRemote work
$30 per hour
...Development Manager at Modis(An Adecco Group Company) Job Title: Clinical Claims Nurse (Healthcare Provider) Job Type : 4-month Contract to Hire... ...as patients, beneficiaries, and healthcare providers by reviewing submitted documentation to evaluate the validity of appeals...ClaimsContract workTemporary workLocal areaRemote work$80k - $88k
...Physical Therapy Utilization Review Advisor PRIMARY PURPOSE Counsels... ...services; monitors the impact of physical therapy services provided... ...future treatment. Provides clinical opinions regarding physical therapy... ...clinical team on difficult claims and provides recommendations...ClaimsWork at officeFlexible hours$18 per hour
Medical Benefits Review Associate Pay: Starting at $18.00/hour (based on experience), which may be below your state's minimum wage... ...support to CPIS overpayment programs via access to the client claims systems related to Medicare, Medicaid and Commercial claim overpayments...ClaimsMinimum wageLive inCurrently hiringWork at officeLocal areaRemote workMonday to FridayFlexible hours
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