Remote RN Medical Claims Reviewer & Utilization Expert
$67.7kBroadway Ventures LLC
A specialized consulting firm is seeking a Medical Claims Reviewer to conduct medical reviews and provide guidance on claims. This remote role requires an active RN license, a bachelor's degree in nursing, and at least five years of clinical experience. Ideal candidates will work full-time Monday to Friday, with a salary of $67,700 per year. Join a team that values integrity and operational success. #J-18808-Ljbffr
- ...Carolina is looking for a qualified applicant to perform medical reviews and support medical claims processing. The role involves reviewing complex claims... ...established clinical guidelines. Applicants must hold an active RN license and have at least two years of clinical...Remote workClaimsFull time
$65k - $75k
...Technologies LLC is seeking a Nurse Reviewer (RN) to perform clinical reviews remotely in the United States. Responsibilities include reviewing medical records, documenting findings,... ...experience, and 2+ years in utilization review or claims auditing. This full-time...Remote workClaimsFull time- ...traditional bedside setting to review and audit claims, support program... ...judgment to analyze medical records,... ...unrestricted Registered Nurse (RN) license Strong... ...records Experience in utilization review, case... ...vulnerable populations Remote work – enjoy the...Remote jobClaimsFull timeTemporary workWork at officeWork from home
- ...opportunities with expert program management,... ...0 PM Location : Remote (U.S. – Work from home... ...Registered Nurse (RN) to join our Medical Review team . This role involves... ...medically complex claims, pre‑authorization... ...: Home Health Utilization/Medical Review Quality...Remote workClaimsFull timeFor contractorsWork at officeHome officeMonday to Friday
- ...traditional bedside setting to review and audit claims, support program... ...judgment to analyze medical records,... ...unrestricted Registered Nurse (RN) license Strong... ...records Experience in utilization review, case... ...vulnerable populations Remote work - enjoy the convenience...Remote workClaimsFull timeTemporary workWork at office
- ...healthcare organization is seeking a registered nurse for a remote position focused on utilization review. Candidates should have 2 years of experience in a hospital setting and expertise in evaluating medical necessity. Responsibilities include assessing care levels and...Remote work
$49.34 - $76.59 per hour
...A leading healthcare organization is seeking a Utilization Review RN for a fully remote role in Oregon. Candidates must hold an Oregon Registered Nurse... ...in collaboration with physicians. This position manages medical management programs to optimize patient care....Remote work- ...NeuroPsychiatric Hospitals is seeking a Utilization Review Nurse (RN) to coordinate patient services across multiple hospitals. The role supports... ...collaborating with teams for better outcomes. Located remotely with a preference for candidates in Indiana, Michigan, or...Remote work
$47.06k - $70.24k
...solutions provider is seeking a Utilization Review Nurse in Fort Worth, TX. This remote role involves analyzing medical bill appropriateness, documenting... ..., and communicating with claims examiners. Candidates must have a current RN license and at least four years...Remote workClaims- L.A. Care Health Plan in Los Angeles is hiring a Utilization Management Claims Review Nurse RN II responsible for conducting clinical reviews of medical claims. The position requires a minimum of 5 years in clinical nursing, with experience in Medi-Cal and Medicare managed...Claims
- ...Concierge Home Care is seeking a Utilization Review Specialist (RN) for a remote opportunity. This position requires a Florida RN License, OASIS Certification... ...or weekend options, along with a full benefits package, including medical and dental insurance. #J-18808-Ljbffr...Remote workFlexible hoursWeekend workWeekday work
- ...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 workClaims
$45.9 - $71.4 per hour
...Description Utilization Review RN - Remote. The RN Care Coord‑Qual Med Mgmt will provide administration of medical management programs that include prior authorization, concurrent hospital... ...medical policy development and medical claims audits. These programs are developed to...Remote workClaimsHourly payLocal area$116.3k - $264.6k
...Angeles, CA, USA Onsite or Remote Flexible Hybrid... ...for Medicare Advantage Utilization Management, you'll... ...Letters Concurrent Review Continuity of Care Retro Claims Retrospective Review... ...Current unrestricted RN licensure in CA required...Remote workClaimsMonday to FridayFlexible hours$30 - $38 per hour
...Job Summary We are seeking Utilization Review Nurse RN to join our team on a part‑... ...assessments and review for the medical necessity of treatment... ...medical necessity; and post claim or post service reviews. Staff... ...successfully perform in a remote healthcare environment....Remote workClaimsHourly payFull timePart timeWork at officeMonday to FridayWeekend work$45.9 - $71.4 per hour
...Description Utilization Review RN - Remote The RN Care Coord-Qual Med Mgmt will provide administration of medical management programs that include: prior authorization, concurrent... ...medical policy development and medical claims audits. These programs are developed to...Remote workClaimsMinimum wageFull timeLocal areaShift work- UnitedHealth Group is seeking a Clinical Review Clinician in Plymouth,... ...reviews of hospital bills and claims while ensuring compliance with... ...Associate's degree, an active RN or LPN license, and at least 2... ...include paid time off, medical plans, and a comprehensive benefits...Remote jobClaims
$68.97k - $113.31k
Guardian Life is seeking an RN Clinical Consultant to serve as a resource for disability claims. This role involves reviewing medical information to assess claims and collaborating with... ...on experience and qualifications. Remote work flexibility is supported. #J-18808...Remote workClaims- ...looking for a Clinical Auditor to perform clinical reviews and audits on medical records, ensuring compliance with company... ...assurance guidelines. This role requires an active RN license and the ability to analyze claims data and regulations effectively. The candidate...Remote jobClaims
- Rising Medical Solutions, LLC is seeking a Legal Nurse to evaluate medical... ...necessity within various claims such as auto, general... ...Degree in nursing and an active RN license, with a minimum of 5 years... ...include analyzing demand packages, utilizing evidence-based guidelines, and...Claims
- ...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...Remote workClaimsFull time
- ...Santa Barbara Cottage Hospital is seeking a Medical Review Nurse to provide support for medical claims and internal appeals review activities. This role ensures alignment... ...2 years of clinical nursing experience, an active RN license, and strong skills in analysis and...Remote workClaimsWork at office
- ...A leading staffing agency is looking for a Utilization Review Registered Nurse to work remotely with a major health insurance client. This role involves evaluating... ...cases and ensuring requested services align with medical necessity while adhering to confidentiality policies...Remote work
- ...and monitoring the utilization of behavioral... ...appropriate cases to the Medical Director for review. Refer to and... ..., researching claims to ensure accurate... ...the functions. Expert and resource for... ...degree and active NYS RN license required.... ...opportunity for remote work within all...Remote workClaimsContract workWork at office
$35 - $45.94 per hour
...Oscar Health is looking for a Utilization Review Nurse to join their team. The role involves performing medical necessity reviews and working... ...must hold an active RN license and have at least one... ...or acute care settings. This remote position offers a competitive...Remote workHourly pay$50 per hour
...an experienced Registered Nurse Clinical Reviewer for a fully remote position with an hourly rate of $50. This role involves conducting utilization reviews and ensuring healthcare... ...Candidates should have an active New York State RN license and 1-3 years of experience in acute...Remote jobHourly pay$50 per hour
Greenlife Healthcare Staffing is seeking a qualified nurse to perform utilization reviews and clinical data collection in New York. The ideal candidate will have an active New York State RN license and 1-3 years of experience in acute care. This role offers competitive...Remote jobHourly pay- TEXAS INDEPENDENCE HEALTH PLAN INC is seeking a Utilization Management Nurse to evaluate the... ...Responsibilities include performing authorization reviews and collaborating with healthcare teams. The position is hybrid remote, requiring residence in Texas areas such as...Remote job
- ...Barbara Cottage Hospital is hiring a Utilization Review Nurse for a remote position. The role involves gathering clinical information, certifying medical necessity, and making decisions on treatment... ...a strong nursing background with RN licensure and at least 4 years of...Remote work
- ...seeking a Professional Fee Coder to work from home and ensure the accuracy and compliance of billing claims. The coder will handle various work queues including Charge Review and Follow Up while maintaining industry standards in CPT and ICD-10 coding. Candidates must have...Remote jobClaimsFull timeWork from home
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