Remote Clinical Review Nurse I — Medical Claims Evaluator
Elevance Health
- Remote job
Elevance Health is seeking a Clinical Review Nurse I to review and make medical determinations on claims to ensure members receive the benefits described in their plans in a flexible, virtual environment. The role emphasizes assessing the necessity and reasonableness of items in claims using medical policy, with a current RN license and nursing education required. The position is based in Atlanta, GA, and offers strong benefits and growth opportunities. #J-18808-Ljbffr Elevance Health
$36.49 - $41.49 per hour
...49hr Job Overview: The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical... ...verbal and written communication skills. Remote EMR access experience is essential....Remote workMedicalClaimsWork at office- Elevance Health is seeking a Clinical Review Nurse I to review and determine whether a claim meets the benefits the member carries. This virtual, full-time role offers... ...within commuting distance. The role focuses on medical necessity assessment and adherence to policy,...Remote jobMedicalClaimsFull time
- Elevance Health is seeking a Clinical Review Nurse I to work virtually full-time with required in-person training sessions. You will review claims to determine if benefits apply, using medical policy and criteria. The role requires an active RN license and at least 1 year...Remote jobMedicalClaimsFull timeFlexible hours
- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical... ...responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in... ...experience with evaluating medical and health care delivery...Remote workMedicalClaimsPermanent employmentWork at officeLocal area
- ...services. Benefits ~ Medical, dental, vision, life... ...Statement The Clinical Review Nurse is responsible for... ...the validity of health claims and levels of payment... ...Demonstrated experience with evaluating medical and health... ...is open to remote work in the following...Remote workMedicalClaimsPermanent employmentTemporary workWork at officeLocal areaImmediate start
- ...Clinical Review Nurse I Clinical Review Nurse I Virtual: This role enables associates to work virtually full-time,... ...Review Nurse I is responsible for reviewing and making medical determinations as to whether a claim meets the benefits the member carries. How you...Remote workMedicalClaimsFull timeTemporary workWork at officeLocal areaDay shift1 day per week
- ...Job Title: Clinical Review Nurse - Concurrent Review Location: Remote Duration: 12 months XXXX: XXXXXXXXXXX/... ...type of care being delivered, evaluating medical necessity, and contributing to... ...Process denial management systems (claims, correspondence platform,...Remote workMedicalClaimsHourly payShift work
$69.3k - $78k
...healthcare payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and Commercial Payers.... ...auditing claims and documenting findings, all in a remote work environment. This role offers a...Remote jobMedicalClaims- Peraton is seeking a Nurse Reviewer Team Lead for SafeGuard Services to oversee medical reviews, ensure quality, mentor staff, and coordinate with investigations for... ...skills, and the flexibility to work remotely from anywhere in the United States. #J-18808-Ljbffr...Remote jobMedicalClaims
- Nurse, Clinical Medical ReviewOur client, a Health Insurance company, is looking... ...for a Nurse, Clinical Medical Review for their Baltimore, MD /... ...professional and institutional claims and Provider appeals that... ...Skills: Ambulatory Practice, Remote EMR AccessWhy Should You Apply...Remote workMedicalClaimsWork at officeImmediate start
- ...Novitas Solutions is looking for a Clinical Review Nurse - Novitas - Remote, FL to join their Remote team. This... ...who rely on its services. Benefits Medical, dental, vision, life and supplemental... ...as to the validity of health claims and levels of payment in meeting national...Remote workMedicalClaimsFull timeTemporary workLocal areaImmediate start
$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant, we’re focused on helping our clients... ...Validation primarily performs medical claims audit reviews. As a MR Nurse, you... ...and Commercial Payers. You will work remotely in a fast paced and dynamic environment...Remote workMedicalClaimsFor contractorsWork at officeWork from homeHome officeShift work- ...Role: Physician ED Claims Reviewer Duration: 12 months Required skills:... ...licensed with experience in with medical coding (CPT/HCPCS) and managed care to conduct clinical review of claims and UM... ...independently in a fast paced environment. This is a remote position....Remote workMedicalClaims
$25 - $35 per hour
...Companies is seeking a Clinical Appeals Nurse to join a... ...organization for a contract remote opportunity... ...appeals team, reviewing complex cases,... ...Nurse include: • Evaluate complex member... ...Obtain and assess medical documentation... ...coordinating necessary claim adjustments. •...Remote workMedicalClaimsHourly payContract work- ...Clinical Appeals Specialist The Clinical Appeals... ...basic analysis, and evaluation of member and provider... ...appeal case for physician review by compiling clinical, contractual, medical policy and claims information along... ...requests using nursing expert knowledge and...Remote workMedicalClaimsWork at office
$61.44k - $78.33k
...The PNE Targeted Reviewer I is responsible for... ...of clinical services delivered... ...required to review claims data, clinical documentation... ...PNE I-Targeted is a remote position; however,... ...includes clinical and medical records, personnel... ...Provider Network Evaluation, PNE Targeted Team...Remote workMedicalClaimsHourly payFull timeContract workWork at officeTrial periodFlexible hours- R1 RCM Inc. is seeking a Clinical Coding Appeals Nurse to review medical records and draft appeals of denied or underpaid claims. You will apply clinical judgment to DRG downgrades and... ..., CPT, HCPCS, and NCCI guidance. This remote, production-driven role requires...Remote jobMedicalClaims
- ...Board Certified Physicians for a remote Disability Peer Review team. This role allows for evaluating and reviewing disability claims from home, providing flexible... ...must have a current medical license and at least 5 years of clinical practice experience. The position...Remote workMedicalClaimsFlexible hours
- ...based utilization review services, the... ...Review RN will work remotely to manage complex medical conditions, treatment... ...Perform clinical assessments and evaluate patient conditions... ...with physicians, claims examiners, and other... ...Bachelor's degree in nursing (BSN) from an...Remote workMedicalClaimsFull timeWork experience placement
- ...Management Department (Fully Remote)Job Summary:• Provides health... ...discharge planning and utilization review.Responsibilities:• Reviews... ...concurrent and retrospective medical necessity and/or compliance with... ...precertification, reimbursement and claim denials/appeals.• Assesses and...Remote workMedicalClaims
- ...a highly experienced DRG Clinical Physician Reviewer to join our growing clinical... ...team. This is a fully remote opportunity for a physician... ...supported, and compliant Evaluate medical records, diagnostic findings... ...with DRG Validation, CDI, or claims review strongly preferred...Remote workMedicalClaims
$34 - $35 per hour
...Utilization Management - Clinical Nurse - Work from Home!... ...and concurrent review of... ...management principles, and medical necessity criteria... ...Medicaid manual changes Evaluate discharge planning... ...Authorization Remote Registered Nurse (... ...Manager Clinical Claims Nurse (Healthcare...Remote workMedicalClaimsFull timeWork at officeWork from homeNight shift- ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical Appeals... ...supports HBiz’s revenue cycle operations by reviewing denied claims for clinical accuracy and medical necessity, developing evidence-based...Remote workMedicalClaims
- Spectraforce is seeking a Contract Medical Reviewer for a fully remote, part-time engagement. The role centers on high-quality medical and scientific... ...advanced life sciences degree and can interpret complex clinical data, guidelines, and publications while delivering...Remote jobMedicalContract workPart timeFlexible hours
$66.66k - $96.1k
...* Job Summary : Reviews all medical (and other) documentation in claim files to answer the specific... ...functional capacity evaluations. Duties and... ...appropriately addressed by the Clinical Nurse Specialist. If not,... ...on your qualifications. #LI-Remote #LI-MR1...Remote workMedicalClaimsWork at officeImmediate startFlexible hoursShift work$50k
...us! Job Title Casualty Evaluator Requisition Number R8039... ...Casualty Specialist Evaluator - Remote Your Role: Assigned as... ...limit of up to $50,000. Handles claims in multiple states including... ...-based injury claim (Medical Payment and PIP)) Your Work...Remote workMedicalClaimsHourly payWork experience placementH1bWork at officeWork from homeFlexible hoursWeekend work- ...Remote Medical Case Reviewer (Contract) Location: Remote About the Opportunity... ...healthcare program focused on evaluating vaccine- and countermeasure-related injury claims. These programs provide... ...least 5 years of experience in clinical practice or case review....Remote workMedicalClaimsHourly payContract work
- ...Gainwell Technologies is looking for a Nurse Reviewer to join their Remote team. This Full-Time role comes... ...The position focuses on reviewing medical claims, UB-04 forms, and itemized bills to... ...and proper billing, with emphasis on clinical review expertise and coding...Remote workMedicalClaimsFull timeWork from home
- ...established industry player is seeking a Medical Review Nurse to join their dynamic team in Phoenix.... ...reviewing and adjudicating medical claims, ensuring compliance with industry standards... ...the flexibility of a primarily remote work environment. If you are passionate...Remote jobMedicalClaims
- ...To support clinical staff in a team environment, the full-time Utilization Review Coordinator will manage utilization... ...while working remotely. Key responsibilities... ...UR information into claims or clinical management... ...service experience in the medical field preferred...Remote workMedicalClaimsFull timeWork at office
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