Remote RN: Clinical Claims Review for Inpatient Care
Registered Nurse
- Remote job
UnitedHealthcare, part of the UnitedHealth Group family, invites you to join as a SSBV Clinical Claims Review RN. This role is a multifaceted position with autonomy and responsibility, focusing on administrative reviews of inpatient hospital claims and documenting determinations. You can telecommute from anywhere in the U.S. The role requires an associate degree, an RN license, and 5+ years of clinical documentation experience, plus proficiency with Microsoft Office and writing. #J-18808-Ljbffr Registered Nurse
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims, document determinations, and maintain... ...in the U.S. and a chance to impact member care. The position expects an Associate's degree,...Remote jobClaims
$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... ...Perform administrative reviews of short stay inpatient hospital claims in accordance with Federal, State...Remote jobClaimsHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal areaHome office- ...Optum Waste and Error Claims Investigator Optum is... ...organization that delivers care, aided by technology to... ...the claim for further review in a production... ...Primary Responsibilities: Clinical Case Reviews - 75%... ...) + CPC A Certified Inpatient Coder (CIC) Certified...Remote jobClaimsContract workWork at officeLocal areaMonday to Friday
$93.35k - $132.43k
...Sentara Health Plans is hiring a Clinical Claims Reviewer/ RN - Remote! Status: Full-time, permanent position... ...as authorization review covering inpatient, outpatient, concurrent and retrospective... .... Must possess 3 years of acute care clinical experience. Previous Utilization...Remote workClaimsPermanent employmentFull timeTemporary workWork at officeShift work- ...Clinical Review Nurse - RemoteARC Group has multiple... ...positions are 100% remote. These are direct... ...validity of health claims and levels of... ...medical standards of care. The incumbent applies... ...issues (e.g., Inpatient Rehab Facility)Strong... ...Registered Nurse (RN) licensePreferred...Remote workClaimsPermanent employmentWork at officeLocal area
$29 - $52 per hour
...friction and drive alignment between care providers and payers, and ultimately consumers... ...Connecting. Growing together. The Clinical Claim Review RN will be responsible for performing... ...your schedule. This position is Remote in Massachusetts. You will have the...Remote workClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a... ...help support high-quality care, regulatory compliance, and... ...applications This is a 100% remote role, and requires robust... ...data with post-service claims validation, we're creating...Remote workClaimsFull timeFlexible hoursShift work$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier... ...understanding of the claim review process including clinical... ...degree ~ Active and unrestricted RN license OR LPN in the state of...Remote jobClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal area$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant... ...- quality of care and healthier... ...performs medical claims audit reviews. As... ...Payers. You will work remotely in a fast paced... ...provided in both inpatient and outpatient... ...Active unrestricted RN license in good...Remote workClaimsFor contractorsWork at officeWork from homeHome officeShift work- ...The IRR Clinical Claim Review Nurse at UnitedHealth Group performs claim reviews to verify coding and charges, researching guidelines to determine... ..., MA with a full-time day shift, the position supports remote work anywhere in the U.S. while complying with HIPAA, state...Remote workClaimsFull timeDay shift
- ...CVS Health is seeking a Clinical Claims Review Nurse to interpret clinical documentation and apply decision... ...cases. The ideal candidate has RN licensure with 2–3 years of RN... ...hold a bachelor’s degree. This full-time, remote position is based in North Dakota. #J...Remote workClaimsFull time
- UnitedHealth Group seeks a Clinical Review Clinician to act as a subject matter expert in itemized bill reviews... ...team preparing Forensic Reviews for clients. Remote work is available nationwide, with responsibilities spanning claim review, medical record evaluation, and...Remote jobClaims
$26.01 - $68.55 per hour
...About This Role The Clinical Claims Review Nurse at CVS Health is responsible... ...1 - $68.55/hour Location: Remote, ND Schedule: Full-time... ...Education Nursing degree (RN) required Bachelor’s degree... ...delivering exceptional patient care. They prioritize safety and quality...Remote workClaimsFull time$63.1k - $94.65k
...for a Utilization Review RN based in the United... ...In this part-time, remote role, you will apply your clinical expertise to evaluate... ..., and ensure care aligns with established... ...concerns and minimize claim denials. You will... ...clinical reviews of inpatient admissions,...Remote workClaimsTemporary workPart timeWork at officeWork from homeFlexible hoursShift workAfternoon shift- ...integrated health care plans and... ...LTSS department. RN will be responsible... ...and concurrent review. Provides... ...medical necessity of inpatient admissions,... ...resources. Applies clinical knowledge to... ...care and accurate claims payment. May... ...Info: *possible remote opportunity...Remote workClaimsContract workMonday to FridayFlexible hours
- ...Reimbursement With Your RN Expertise ERISA... ...utilization management, clinical review, and denial appeals to... ...to move beyond bedside care and apply their clinical... ...’ll Do Analyze denied claims and clinical documentation... ...necessity reviews (inpatient & outpatient cases)...ClaimsRelocation
- ...evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex... ...responsibilities Perform clinical assessments and... ...Collaborate with physicians, claims examiners, and other... ...negotiate appropriate care levels Maintain...Remote workClaimsFull timeWork experience placement
$223.8k - $313.1k
...relies on medical background and reviews health claims. The Medical Director work assignments... ...to advancing the quality of inpatient care through clinical expertise and thoughtful medical necessity... .... Travel: While this is a remote position, occasional travel to Humana...Remote workClaimsBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work$78k - $99.2k
...a Senior Nurse Reviewer based in the United... ...quality and claims accuracy by applying your clinical expertise to complex... ...levels of care. You will use clinical... ...feedback. This remote opportunity... ...will have a strong inpatient clinical background... ...Nurse (RN) license in the...Remote workClaimsFull timeWork from homeFlexible hours- ...managed health care, focused on what... ...balance. ~ Remote setting ROLE... ...will utilize clinical knowledge and communication... ...treatment or inpatient confinement.... ...a second level reviewer. This... ...status, benefit and claim concerns, and... ...not limited to RN, LMSW, LMHC....Remote workClaimsTemporary workWork at officeMonday to FridayFlexible hours
- TalentLNX LLC seeks a remote Clinical Claims Review RN to audit hospital claims line by line against medical records, ensuring charges are ordered, documented, and supported. The role blends acute care nursing judgment with chart auditing, coding, and revenue integrity...Remote jobClaims
- ...Description The utilization review and management (UM)... ...medically necessary, clinically appropriate, evidence-based... ...appropriate level of care, while supporting... ...logging and documentation of claims along the process chain... ...is an in-office, no remote work capability position...Remote workClaimsWork at office
- ...Clinical Validation Reviewer Focused review of professional claims related to Fraud Waste and Abuse, documentation... ...clinical reviews of inpatient and outpatient claims... ...appropriate for the level of care delivered. Identifies... .... Registered Nurse (RN). License must be...Remote workClaimsWork at office
$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$63k - $65k
...with us, experience our caring culture, and enjoy work... ...Insurance Utilization Review RN As a nurse at Sedgwick,... ...patients in a nontraditional clinical setting. Apply your RN... ...-being of others in a remote work environment. Enjoy... ...with physicians, claims examiners, clients, vendors...Remote workClaimsWork experience placementFlexible hours- ...that has engaged in health care quality consulting and quality... ...outcomes. Our talented remote workforce spans the country... ...Overview We are seeking an RN to perform Clinical Review work and QIDP reviews work.... .../IID, swing bed, PEC, and inpatient psychiatric facilities...Remote workContract work
$112.7k - $193.2k
...alignment between care providers and... ...Director of Clinical Operations is responsible... ...Itemized Bill Review (IBR)... ...support accurate claim adjustments, and... ...discussions involving inpatient and outpatient... ...to work remotely * from anywhere... ...Registered Nurse (RN) license 5+...Remote jobClaimsMinimum wageFull timeWork experience placementLocal area- ...Utilization Review Nurse Join our team at... ...responsible for reviewing clinical information to... ..., and levels of care in accordance with... ...concurrent reviews of inpatient cases using Milliman... ...Review medical claims and pre-determinations... ...Current, unrestricted RN license (State...Remote workClaimsFull timeTemporary workSummer workWork at officeFlexible hours
$2,300 per month
...The Clinical Review Nurse (RN) supports the organization’s care management function by conducting clinical reviews, ensuring... ...outcomes for members. This is a remote role open to candidates residing... ...medical necessity reviews for inpatient, outpatient, and ancillary...Remote workPart timeWork at office- ...Position Summary: The RN Integrated Care Coordinator (UM)... ...the operation of our Clinical Team and the overall experience... ...address utilization review cases. Roles and... ...certification, reimbursement, and claim denials/appeals.... ...This is a remote position. Our whole company...Remote workClaimsLive inFlexible hoursWeekday work
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