Remote Post-Service Clinical Review RN (Claims)

Medasource

Remote job

Medasource is seeking a Post-Service Clinical Review Nurse (RN) based in California for a remote full-time contract role. You'll evaluate medical claims to ensure alignment with clinical guidelines and reimbursement policies in a fast-paced environment. Ideal candidates have experience in post-service review and are proficient in CPT, ICD-10, and HCPCS coding. Strong independent judgment and the ability to meet strict turnaround times are essential. #J-18808-Ljbffr Medasource

Apply

Vacancy posted 4 days ago

Similar jobs that could be interesting for youBased on the Remote Post-Service Clinical Review RN (Claims) in California, MO vacancy

Medical Necessity & Post-Service Clinical Review Nurse
Job Title: Nurse RN 5 - Medical Necessity & Post-Service Clinical Review Nurse Location: Remote Duration: 3+ Month (Possible Extensions & Conversion) Schedule: Monday... ...-service clinical reviews and retrospective claims evaluations. This role is responsible for...
Remote work
Claims
Contract work
Monday to Friday
Pacer Group
United States
4 days ago
Remote RN - Clinical Claim Review & Coverage Decisions
$29 - $52 per hour
...UnitedHealth Group is seeking a qualified Registered Nurse in Massachusetts to perform clinical coverage review services. As part of this role, you will communicate benefit determinations and work closely with healthcare providers to explain coverage. We offer telecommuting...
Remote work
Claims
Hourly pay
UnitedHealth Group
Boston, MA
18 hours ago
Remote RN Clinical Services Manager
EMC is seeking a RN-led Clinical Services leader to oversee daily operations across nurse case management, pharmacy, and claim review. The role drives performance, integrates clinical services... ...designation preferred. Eligible for remote work in the US. #J-18808-Ljbffr EMC...
Remote job
Claims
EMC Insurance
New York, NY
18 hours ago
Clinical Claim Review RN
$29 - $52 per hour
...Responsibilities: Perform clinical coverage review services, which require... ...degree ~ Current unrestricted RN license in the state of Massachusetts... ...*All employees working remotely will be required to adhere... ...Deadline: This will be posted for a minimum of 2 business...
Remote work
Claims
Hourly pay
Minimum wage
Full time
Work experience placement
Local area
UMR
United States
3 days ago
Remote RN: Clinical Claims Review (Short-Stay)
...Stryker Corporation is looking for a Clinical Claims Review RN to perform reviews of inpatient hospital claims. This role supports a high-volume environment and allows for telecommuting from anywhere in the U.S. The ideal candidate must have an RN license, a minimum...
Remote work
Claims
Stryker
Minneapolis, MN
18 hours ago
Medical Review Clinical Appeals Auditor (RN)
$80k - $90k
...$80-90k The Medical Review Clinical Appeals Auditor (RN) is responsible for... ...research, analyzes claims data, applies knowledge... ...independently in remote setting with minimum... .../or drug screenings post-hire, may be required... ...citizenship status, military service status, political...
Remote work
Claims
For contractors
Immediate start
Home office
Flexible hours
Shift work
Machinify, Inc.
Plantation, FL
18 hours ago
Remote RN: Clinical Claims Review (Short-Stay)
...UnitedHealth Group is looking for a Clinical Claims Review RN to conduct administrative reviews of short-stay inpatient hospital claims. This role offers the flexibility of telecommuting from anywhere in the U.S. Qualified candidates should have an Associate's degree and...
Remote work
Claims
Council Of State and Territorial Epidemiologists
Minneapolis, MN
3 days ago
Remote RN: Medical Claims Clinical Reviewer
$36 - $48 per hour
...Santa Barbara Cottage Hospital is seeking a Medical Claims Clinical Review Nurse for a remote position. This role involves conducting clinical reviews of... ...compliance with regulations. The ideal candidate will have an RN license in California and a minimum of three years of...
Remote work
Claims
Hourly pay
Santa Barbara Cottage Hospital
New York, NY
4 days ago
Remote RN: Clinical Claims Review (Short-Stay)
$28.94 - $51.83 per hour
Crains Cleveland is seeking a Clinical Claims Review RN to perform administrative reviews of short-stay inpatient hospital claims. This role supports a production-driven environment and allows telecommuting from anywhere in the U.S. The ideal candidate must have an associate...
Remote job
Claims
Hourly pay
Crains Cleveland
Minneapolis, MN
4 days ago
Remote RN: Clinical Claims Review (Short-Stay)
Optum, part of the UnitedHealth Group, is looking for a Clinical Claims Review RN to conduct administrative reviews of short stay inpatient hospital claims. This position is open to telecommuting from anywhere in the U.S. and is situated in a high-volume, production-driven...
Remote job
Claims
Registered Nurse
Minneapolis, MN
4 days ago
Medical Claims Clinical Review Nurse
...MedPOINT Management as a Medical Claims Clinical Review Nurse in Sherman Oaks, CA,... ...the medical necessity of services rendered. Document findings... ...Requirements: Registered Nurse (RN) license in California is... ...in the lives of patients every day. This is a remote position.
Remote work
Claims
MedPOINT Management
Sherman Oaks, CA
18 hours ago
Remote RN Clinical Review Nurse — Claims & Policy Analysis
CareFirst, Inc. is seeking a full-time RN Clinical Medical Review Nurse to work remotely from the greater Baltimore metropolitan area. This role involves managing the review of professional and institutional claims, analyzing medical information for enrollment eligibility...
Remote job
Claims
Full time
Work experience placement
CareFirst, Inc.
New York, NY
4 days ago
Clinical Services Manager (RN)
...deliver coordinated clinical and social care... ...The Clinical Services Manager (CSM)... ...operating reviews, and provide support... ...Nurse (RN) license in the... ...community, or remote environments, depending... ...Nothing in this job posting or any other... ...communications claiming to represent...
Remote work
Claims
Contract work
Temporary work
Fixed term contract
Work at office
Local area
Flexible hours
Habitat Health
San Leandro, CA
4 days ago
Clinical Medical Review Nurse
...and Business consulting services. We are in search of a... ...Team. Job Title: Clinical Medical Review Nurse. Location: Baltimore... ...and institutional claims and provider appeals that... ...incumbent will handle pre and post claim medical review... ...: ~ RN - Registered Nurse - State...
Remote work
Claims
Work at office
Immediate start
Ampcus
United States
5 days ago
Clinical Review Nurse - Remote
...Clinical Review Nurse - Remote ARC Group has multiple positions open... ...the validity of health claims and levels of payment... ...necessity, level of services and appropriateness of... ...payment medical review or post-payment medical... ...unrestricted Registered Nurse (RN) license PREFERRED...
Remote work
Claims
Permanent employment
Work at office
Local area
American Recruiting & Consulting Group
United States
3 days ago
Clinical RN Chart Reviewer, (Remote) CIC or CCS certified
$90k - $110k
...Description Description: Job Role The Clinical RN Chart Reviewer will perform clinical reviews of... ...documentation to validate issues of claims coding accuracy, medical necessity,... ...appropriateness of treatment settings and services delivered. The Clinical RN Chart...
Remote job
Claims
Temporary work
Casual work
Work at office
ProgenyHealth LLC
Plymouth Meeting, PA
11 days ago
SSBV Clinical Claim Review RN 2357192 | Plymouth, MN | Remote
$28.94 - $51.83 per hour
...Ssbv Clinical Claims Review Rn Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits...
Remote job
Claims
Hourly pay
Minimum wage
Full time
Temporary work
Work experience placement
Work at office
Local area
Home office
Genoa Telepsychiatry
Minneapolis, MN
2 days ago
Medical Review Nurse II - Clinical Validation
$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant... ...-enabled services which identify improper... ...performs medical claims audit reviews. As... .... You will work remotely in a fast paced... ...unrestricted RN license in good standing... ...drug screenings post-hire, may be...
Remote work
Claims
For contractors
Work at office
Work from home
Home office
Shift work
Performant Healthcare, Inc.
New York, NY
4 days ago
Remote Appeals Clinical Reviewer LPN
$28 - $33 per hour
...UM/Appeals LPNs // Fully Remote!! The Appeals Clinical Reviewer serves as an Appeals Utilization... ...decisions, and claims outcomes. This role applies... ...utilization of healthcare services. This is a remote opportunity... ...Retirement Plan Pre-tax and Roth post-tax contributions...
Remote job
Claims
Permanent employment
Contract work
Temporary work
Work at office
Work from home
Monday to Friday
Actalent
Saint Louis, MO
2 days ago
Clinical Review Nurse - Novitas - Remote, FL
...people who rely on its services. Benefits Medical... ...STATEMENT The Clinical Review Nurse is... ...validity of health claims and levels of payment... ...medical review or post‑payment medical review... ...Registered Nurse (RN) license PREFERRED... ...Disabled Employer. Remote Work Locations...
Remote job
Claims
Permanent employment
Temporary work
Work at office
Local area
Immediate start
Novitas Solutions, Inc.
Florida, NY
4 days ago
Remote Clinical Review Nurse - Claims & Appeals
CareFirst, Inc. is seeking a full-time Clinical Medical Review Nurse to work remotely. In this role, you will manage the... ...of professional and institutional claims and provider appeals to determine... ...Nursing or equivalent experience, RN licensure in VA, DC, or MD, and at...
Remote job
Claims
Full time
CareFirst, Inc.
New York, NY
4 days ago
Remote RN Medical Review Specialist II
Health Care Service Corporation seeks a Medical Reviewer II to perform accurate and timely medical review of claims suspended for medical necessity, contract interpretation... ...ideal candidate holds an active RN license, with 3 years of clinical experience, and demonstrates...
Remote job
Claims
Contract work
Health Care Service Corporation
Richardson, TX
18 hours ago
Remote Clinical Utilization Reviewer
...seeking a qualified Utilization Reviewer who can work remotely from home. The ideal... ...referrals. The role requires clinical judgment to ensure medical... ...with providers and claims adjusters, and staying current... ...improve review quality. #J-18808-Ljbffr Genex Services, LLC
Remote job
Claims
Work from home
Genex Services, LLC
New York, NY
3 days ago
Remote Clinical Review Nurse: Med Claims Specialist
...Solutions, Inc. is looking for a Clinical Review Nurse in the Town of Florida,... ...for reviewing medical claims and making determinations on... ...Qualifications include a valid RN license, 2 years of clinical... ...1(k) plan. Opportunities for remote work may also be available based...
Remote job
Claims
Novitas Solutions, Inc.
Florida, NY
4 days ago
Medical Review RN IV
$50 per hour
...Medical Review RN IV – Commercial Appeals & Grievance Nurse Location: Remote – Candidate Must Reside in California... ...member-generated pre-service and post-service appeals, grievances, and clinical determinations. This role... ..., Quality, Pharmacy, Claims, and Customer Service...
Remote work
Claims
Contract work
Work at office
Local area
Monday to Friday
Pacer Group
United States
1 day ago
RN / Medical Reviewer / Remote
...RN / Medical Reviewer / Remote Job Details Professional Discipline... ...eligibility regarding benefits and clinical criteria and assess and... ...clinical proficiency and claims knowledge. This is a... ...coverage for appropriate services within benefit and medical...
Remote work
Claims
Full time
Contract work
Local area
Shift work
InGenesis
United States
18 hours ago
RN Clinical Consultant
$68.97k - $113.31k
...The RN Clinical Consultant serves as a clinical resource... ...comprehensive medical reviews and analysis of long‑term... ...short‑term disability claims. The Clinical... ...work based on customer service needs and departmental... ...Holmdel, NJ, or fully remote Travel Occasional 0-10...
Remote work
Claims
Temporary work
Work at office
Visa sponsorship
Work visa
Flexible hours
Guardian Life
Atlanta, GA
3 days ago
SSBV Clinical Claim Review RN
$28.94 - $51.83 per hour
Optum, part of the UnitedHealth Group, is seeking a Clinical Claims Review RN (SSBV) to perform administrative reviews of short‑stay inpatient hospital claims and document determinations. The role supports a high‑volume, production‑driven environment and is eligible for...
Remote work
Claims
Hourly pay
Full time
Temporary work
Work at office
Home office
Stryker Corporation
Minneapolis, MN
1 day ago
Remote Home Health RN - Medical Claims Reviewer
$60k - $63k
...Remote Home Health RN – Medical Claims Reviewer At Broadway Ventures, we transform challenges... ...As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small... ...conducting pre- and post-payment medical reviews to... ...compliance with established clinical criteria and guidelines....
Remote work
Claims
Full time
For contractors
Work at office
Home office
Monday to Friday
Broadway Ventures
United States
18 hours ago
Clinical Review Dentist
$112.7k - $193.2k
...Clinical Review Dentist At UnitedHealthcare, we're simplifying the health... ...the dental director on claims review. Strong knowledge of... ...enjoy the flexibility to work remotely from anywhere within the U.S... ...adverse determinations for dental services related to benefit design...
Remote work
Claims
Minimum wage
Full time
Work experience placement
Local area
Weekend work
UnitedHealth Group
United States
4 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Post-Service Clinical Review RN (Claims). Be the first to apply!