Remote RN: Inpatient Claims Review Specialist
University of Minnesota School of Nursing
UnitedHealth Group is seeking a SSBV Clinical Claims Review RN for a remote role nationwide. You will perform administrative reviews of inpatient hospital claims, document determinations, and ensure accurate use of screening criteria to support member care and cost management.The role offers autonomy with accountability in a fast-paced production environment, requiring office setup at home and strong MS Office and writing skills. Telecommuting from anywhere in the U.S. is supported.J-18808-Ljbffr
$55 - $65 per hour
...SaidGig is seeking an inpatient nurse to help develop and evaluate clinical AI products through ongoing annotation, review, and product-improvement work. This role benefits from consistent... ...and continuity over time. Remote, hourly engagement with a reliable commitment...Remote workHourly pay10 hours per week- ...Epitec seeks a Registered Nurse Review Analyst to support inpatient precertification and utilization management in a fully remote environment. You will perform prospective, concurrent, and retrospective medical reviews to determine medical necessity, level of care, intensity...Remote work
$77.91k - $116.86k
...but saving them. Together.Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. As an inpatient review... ...and maintain an active, valid, and unrestricted LVN or RN license in California (Non-Compact)Immediately upon hire...Remote workImmediate startMonday to Friday- Alignment Health is seeking an experienced inpatient review nurse to join the remote utilization management team. You will review inpatients with complex medical needs and coordinate care across physicians, facilities, and community providers, ensuring appropriate and cost...Remote job
- ...established industry player is seeking a Medical Review Nurse to join their dynamic team in... ...reviewing and adjudicating medical claims, ensuring compliance with industry standards... ...enjoying the flexibility of a primarily remote work environment. If you are passionate about...Remote job
- ...Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will assist patients through the continuum of care in collaboration with the patient’s primary care physician, facility case manager, discharge planner and contracted...Remote work
- ...Seeking a California Licensed Inpatient Review Nurse, the full-time remote position will manage patient care through collaboration with healthcare providers... ...qualifications Active, valid, and unrestricted LVN or RN license in California Minimum 3 years of general case...Remote workFull time
- Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. You will assess inpatients and collaborate with physicians... ...level. Qualified candidates will hold an active LVN or RN license, have at least 3 years in case management, and...Remote job
- Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will guide patients through the continuum of care, coordinating with physicians, case managers and service providers to ensure safe, cost-effective care aligned with...Remote job
- ...CVS Health is seeking an experienced radi-? nurse for a 100% remote Concurrent Review RN position. The role supports inpatient reviews, discharge planning, and care transitions across the continuum. Required is an active Louisiana RN license (or Compact), with 5+ years...Remote workWeekend work
- ...HealthEdge Software, Inc. is seeking a highly motivated Utilization Review RN to join our team. The RN will perform prospective, concurrent and retrospective reviews of inpatient, outpatient, and ancillary services to ensure medical necessity, appropriate length of...Remote workContract work
- ...connects elite AI research labs with nursing professionals. The company is seeking an Adult Inpatient Nurses (RN) for a remote contract role, offering competitive hourly pay. You will review AI-generated clinical outputs, validate documentation, annotate data for AI training,...Remote workHourly payContract work
- ...Provides support for clinical member services review assessment processes. Responsible for... ...experience in hospital acute care, inpatient review, prior authorization, managed care... ...education and experience. Registered Nurse (RN). License must be active and unrestricted...Remote workWork at office
- ...Longmont United Hospital in Colorado is seeking an Utilization Review RN to review medical records and confirm admission status and... ...Access, and Care Coordinators to verify payer sources and obtain inpatient authorization. You will perform admission, concurrent and post...Remote work
- ...licensed Registered Nurse for a fully remote contract role based in the United States. You will apply inpatient clinical expertise to annotate and review nursing documentation to train AI... ...Candidates must be US-based, hold an RN license, and bring broad inpatient experience...Remote workContract work
- ...Sentara Health Plans is seeking a Clinical Claims Reviewer/RN for a remote, full-time position. Responsibilities include utilization management,... ...payment claim reviews, and authorization assessments across inpatient and outpatient cases, with regulatory compliance...Remote workFull time
- ...Working remotely in a dynamic environment, the full-time RN Medical Review Nurse will perform medical claims audit reviews, focusing on retrospective and prepayment audits for Government... ...of diversified nursing experience in inpatient or outpatient settings At least one...Remote workFull time
- ...State is seeking an experienced Registered Nurse to join our remote Clinical Reviewer team. The role focuses on assessing medical necessity,... ...through prospective, concurrent, and retrospective reviews for inpatient and outpatient services. You will work with physician...Remote jobContract workWork from home
$52 - $56 per hour
...We're hiring a contract RN for a New York health plan (Medicare... ...utilization management. 100% remote (U.S.) | Contract | $52–$56/hr... ..., investigation, clinical review, decision and notification... ...long‑term care background (not inpatient only) ~ Working knowledge of...Remote workContract workAfternoon shift$30.37 - $59.21 per hour
...Provides support for clinical member services review assessment processes. Responsible for... ...experience in hospital acute care, inpatient review, prior authorization, managed care... ...education and experience. - Registered Nurse (RN). License must be active and unrestricted...Remote workHourly payWork experience placementWork at office- ...To support a growing healthcare technology organization, the remote RN Inpatient DRG Validation Specialist will review inpatient claims and medical records to ensure accurate DRG assignments, leveraging clinical expertise and judgment to enhance payment integrity processes...Remote work
- ...Executive Staff Recruiters / ESR Healthcare seeks a Remote Registered Nurse contractor in the United States to annotate and review inpatient documentation and AI outputs for accuracy and safety. Ideal candidates are US-licensed RNs with recent bedside experience, broad...Remote workFor contractors
- ...caseload, the full-time Massachusetts Licensed Clinical Reviewer RN will perform utilization management activities for inpatient settings, determining medical necessity and facilitating discharge planning while working remotely. Key responsibilities Provide utilization...Remote workFull time
$63.1k - $94.65k
...*Must have current compact RN license, or be willing to obtain... ...Information: Our Utilization Review team provides coverage seven... ...offsite location Provides inpatient and observation (if indicated)... ...Abilities Required: This is a remote role which requires access to...Remote workTemporary workPart timeWork at officeLocal areaFlexible hoursShift work- ...Responsibilities As our Utilization Review RN, you will meticulously review medical records... ...documenting interactions, and obtaining inpatient authorization from insurance providers,... ...status. This position is open to remote/out of state candidates residing in only...Remote work
- ...United States is seeking a Utilization Review Case Manager to gather demographic... ...appropriate length of stay for inpatient and outpatient treatment. This remote role requires strong CPT/ICD... ...analysis, and collaboration with claims staff, attorneys and providers to...Remote work
$47.37 per hour
Lancesoft is seeking a Care Review Clinician for a remote 3-month assignment. You will work with the Utilization Management team to review inpatient cases, authorize care, and ensure compliance... ...regulations. The role requires an active RN/LPN/LVN license and 2-4 years of...Remote jobHourly pay- CVS Health Corporation is seeking a Concurrent Review Nurse (RN) for a 100% remote role. The position involves reviewing inpatient stays, collaborating with care teams, and ensuring appropriate care levels in a remote setting. Requires 5+ years inpatient nursing, strong...Remote job
- ...Description Position Title: Utilization Review Nurse Position Code: RN-6027 Department: Case Management... ...for all patients upon admission to inpatient or observation status and complete... ...with Case Managers and Insurance Specialist to ensure that appropriate and...Remote workWork at officeFlexible hours
- ...Travel RN - Case Management/Utilization Review - Case ManagementAmerican TravelerSan Francisco, California, United... ...complex case management across inpatient and community settings, requiring CA... ...with 2 days onsite and 3 days remote per weekDay shift schedule, 5x8-hour...Remote workWeekly payContract workLocal areaShift workDay shiftWeekday work
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