Remote RN: Medical Claims Review Specialist
Broadway Ventures LLC
Broadway Ventures LLC is looking for a dedicated Registered Nurse (RN) to join its Medical Review team. This remote position involves conducting pre- and post-payment medical reviews and requires an active RN license and relevant clinical experience. Ideal candidates will have strong analytical and decision-making skills, along with proficiency in Microsoft Office. Join us to empower clients with tailored solutions in healthcare. #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
- Optum is looking for a detail-oriented individual for a role in medical claim review, where your work will directly contribute to improving health outcomes. This position offers the flexibility to work remotely from anywhere within the U.S., with specific office...Remote jobMedicalWork at office
- ...A healthcare organization is seeking a Clinical Services Specialist RN to perform reviews of patient records for medical necessity compliance. This full-time role involves analyzing records according to policies and facilitating communication with various stakeholders....Remote workMedicalFull timeWork from home
- ...Medix™ is seeking a dedicated Appeals Nurse (RN) to join our team in a fully remote capacity. This role involves clinical reviews and appeal determinations while collaborating with Medical Review Analysts and Physician Consultants to ensure compliant outcomes. The ideal...Remote workMedical
- ...Management Council, Inc is looking for a Remote RN to join their team. The role requires 2 years of RN experience and Utilization Review expertise, supporting various units in a... ...flexible scheduling with benefits that include medical, dental, and retirement contributions...Remote workMedicalWork from homeFlexible hours
- ...company is seeking a Registered Nurse (RN) Intern to conduct clinical reviews and support healthcare initiatives. This... ...military spouses, providing key training in a remote work setting. Key responsibilities include performing medical necessity reviews, documentation, and...Remote workMedicalInternship
- ...Centene Corp. is looking for a Clinical Review Nurse - Prior Authorization to work remotely. This position entails analyzing... ...requests to determine medical necessity, working with healthcare... ...must have an active New York State RN licensure and a degree from an Accredited...Remote workMedicalMonday to Friday
- ...seeking a clinical professional for a fully remote role focused on medical management. The position requires an active New York State RN licensure and involves analyzing... ...with healthcare providers, conduct clinical reviews, and ensure that members receive the appropriate...Remote workMedicalFlexible hours
- ...Molina Healthcare is looking for a Registered Nurse (RN) to join their team in Akron, Ohio. This role involves clinical review to ensure medical necessity and appropriate care levels, while also managing appeals for denied prior authorizations. With a focus on utilization...Remote workMedical
- ...Avosys Technology is hiring a Remote Registered Nurse - Medical Review Specialist in Texas, responsible for performing clinical reviews and ensuring compliance... ...of two years' clinical experience and an active RN license. Join us in providing excellent healthcare service...Remote workMedicalShift work
$29.05 - $67.97 per hour
...Molina Healthcare is seeking an experienced Registered Nurse for clinical review roles based in Jacksonville, Florida. This position involves reviewing documentation for medical necessity, handling appeals, and ensuring compliance with coding regulations. The ideal candidate...Remote workMedicalHourly pay- ...professional in Miami to perform utilization reviews and ensure proper coding for... ...regulations. The candidate will evaluate medical claims and facilitate appeals, contributing to... ...assurance and regulatory compliance. An active RN license is essential, along with analytical...Remote workMedical
- A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and...Remote workMedicalFull time
$29.05 - $67.97 per hour
...Molina Healthcare is seeking a Clinical Review Nurse to review medical documentation ensuring medical... ...for authorizations, validating medical claims, and working with various stakeholders... ...including utilization review, an active RN license, and strong analytical skills....Remote workMedicalHourly pay$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$29.05 - $67.97 per hour
...Healthcare is seeking a Clinical Reviewer in Columbia, South Carolina. This... ...advanced clinical knowledge to assess medical necessity and ensure appropriate coding for claims. Candidates should have at least... ...applicant will hold an active RN license and must possess strong...Remote workMedicalHourly pay$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- ...Stryker Corporation is seeking a Clinical Claim Review Nurse to perform detailed reviews of claims against medical records. The position offers the flexibility to telecommute... ...possess an Associate's degree and an active RN license. Responsibilities include ensuring...Remote workMedical
- ...management, discharge planning and utilization review. Review admissions and service... ...prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement... ..., precertification, reimbursement and claim denials/appeals. Assess and coordinate...Remote workMedical
$29.05 - $67.97 per hour
...Molina Healthcare is seeking a qualified Registered Nurse with clinical experience to perform utilization reviews and ensure medical necessity of claims. The role involves reviewing medical documentation, facilitating appeals for authorizations, and validating claims...Remote workMedicalHourly pay$29.05 - $67.97 per hour
...Molina Healthcare is seeking a clinical nurse specialist responsible for reviewing documentation to ensure medical necessity and appropriate level of care. This role... ...utilization management. Candidates must have an active RN license and at least 2 years of clinical nursing...Remote workMedicalHourly pay$26.41 - $43 per hour
...Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical... ...education and experience. • Registered Nurse (RN). License must be active and unrestricted in...Remote workMedicalHourly payWork experience placementWork at office- ...Southcarolinablues is seeking a RN Medical Reviewer III (Remote in SC) to perform medical reviews using clinical information and established guidelines. This role involves reviewing complex medical claims and educating teammates on healthcare processes. The ideal candidate...Remote workMedicalWork from home
- ...healthcare solutions provider is seeking a Nurse Reviewer (Registered Nurse) for a remote role in the US. The ideal candidate will... ...experience and must hold an active RN license. Responsibilities include reviewing medical records, performing prior authorizations, and...Remote workMedicalFull time
- ...Behavioral Health Registered Nurse Intern to assist with medical necessity reviews in a remote setting. The role involves collaborating with healthcare... ...transitioning military members or spouses and hold an active RN license in Kentucky or have an enhanced compact license....Remote workMedicalInternship
$29.05 - $67.97 per hour
...looking for a Clinical Nurse with experience in utilization review. The role includes reviewing medical claims and ensuring compliance with guidelines to support accurate reimbursement. Candidates must have an active RN license and at least 2 years of clinical experience....Remote workMedicalHourly pay$85k - $92k
...is seeking a Clinical Quality Reviewer to support a federal healthcare... ...This role involves reviewing medical records, conducting case analyses... ...Candidates must have a valid RN or LCSW license with at least... .... The position may be remote or onsite based on business requirements...Remote workMedicalWork at officeHome office- ...Clover Health, LLC is seeking a Registered Nurse (RN) Medicare Quality Assurance Reviewer to support clinical processes remotely. You will leverage your expertise in Medicare... ...reviews, and work collaboratively with medical directors to improve care delivery. This role...Remote workMedical
$30 - $34 per hour
...healthcare services company is seeking an experienced Utilization Review Nurse to work remotely. The ideal candidate must hold an active LVN license in... ...management. Responsibilities include approving or denying medical services based on established criteria. Competitive hourly...Remote workMedicalHourly pay- ...consulting firm is seeking a dedicated Registered Nurse (RN) to join the Medical Review team. This role involves conducting pre- and post-payment... ...communication skills are essential. This position offers a remote work environment with all necessary equipment provided. #J...Remote workMedical
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