Remote Clinical Review Nurse I
Elevance Health
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 flexibility with in-person training sessions and potential alternate locations within commuting distance.
The role focuses on medical necessity assessment and adherence to policy, with a current unrestricted RN license and a minimum of 1 year of clinical experience required.
#J-18808-LjbffrVacancy posted 5 days ago
Similar jobs that could be interesting for youBased on the Remote Clinical Review Nurse I in United States vacancy
- ...Novitas Solutions, Inc. seeks a Clinical Review Nurse to review and substantiate medical determinations for health claims. You will assess medical necessity, service levels, and appropriateness of care under national and local policies, including cases requiring prior...Remote workLocal area
Novitas Solutions
United States5 days ago - ...is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The role of Clinical Review Clinician focuses on itemized bill reviews and analyzing hospital facility bills, documenting, researching and identifying adjustments...Remote work
Optum
United States13 hours ago - ...Market Place/Ambetter members, the full-time Michigan Licensed Clinical Review Nurse will perform concurrent reviews to evaluate member health,... ...care, and contribute to discharge planning while working remotely from home. Key responsibilities Conduct concurrent reviews...Remote workFull timeWork from home
Virtual Vocations Inc
United States2 days ago - ...Conducting clinical reviews and authorizing prior approvals, the New Jersey Licensed Clinical Review Nurse will evaluate medical records, collaborate with healthcare providers,... ...regulatory standards, with the possibility of remote work during standard business hours. Key...Remote work
Virtual Vocations Inc
United States2 days ago - ...Overview Clinical Review Nurse - Concurrent Review TX Location: 100% Remote - TX: RN only with TX license SHIFT: Tuesday – Saturday 8am-5pm CST- schedule is firm- no flexibility Duration: 6 months, contract to hire. Job Purpose: This is a fast-paced role. The nurse will...Remote workContract workShift work
Executive Staff Recruiters / ESR Healthcare
Austin, TX12 hours ago - ...Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse for remote concurrent review responsibilities. The role assesses member health status, medical necessity, and appropriate care levels, contributing to discharge planning within care policies and guidelines...Remote work
Spectraforce Technologies
United States2 days ago - ...Analyzing prior authorization requests for medical necessity, the full-time Florida Licensed Clinical Review Nurse will work remotely to ensure appropriate levels of care in accordance with national standards, while also providing recommendations to the medical team and...Remote workFull time
Virtual Vocations Inc
United States2 days ago - ...Supporting the Ambetter marketplace members in Georgia, the full-time remote Georgia Licensed Clinical Review Nurse will perform concurrent reviews to evaluate members' overall health, assess the necessity of care, and contribute to discharge planning according to established...Remote workFull time
Virtual Vocations Inc
United States3 days ago - ...Time Off and Paid Sick Leave Summary Statement The Clinical Review Nurse is responsible for reviewing and making medical determinations... ...Veteran/Disabled Employer." This opportunity is open to remote work in the following approved states: AL, AR, FL, GA, ID, IN...Remote workPermanent employmentTemporary workWork at officeLocal areaImmediate start
Novitas Solutions
United States1 day ago - ...support patient care coordination, the full-time State Licensed Clinical Review Nurse will perform concurrent reviews of inpatient services,... ...and collaborate with healthcare providers, all while working remotely. Key responsibilities Conduct timely inpatient utilization...Remote workFull time
Virtual Vocations Inc
United States2 days ago - Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization to perform clinical reviews of authorization requests... ...documenting decisions, and meeting turnaround times. This is a remote role with a 12-month duration and potential extension. #J-18...Remote work
Spectraforce Technologies
United States2 days ago - ...Clinical Reviewer – Registered Nurse (RN) Comagine Health | Washington State | Remote / Work From Home Department: Care Management Contract: Washington Labor & Industries (L&I) Location: Washington State – Remote Employment Type: Full-Time This is an...Remote workFull timeContract workLocal areaWork from homeHome office
- ...Elevance Health is seeking a Clinical Review Nurse I – Medicare Part B. This role supports federal programs with virtual work and required in-person onboarding; occasional office locations may apply within a commuting distance. You will review claims for medical necessity...Remote workWork at office
Elevance Health
South Portland, ME4 days ago - ...Position Title Clinical Review Nurse - Concurrent Review Work Location Remote-MS CST Assignment Duration 3 Months Contract to Hire Work Schedule 8 am-5 pm (Central). OT is voluntary; weekend rotation once every 2 months Work Arrangement Remote...Remote workContract workFlexible hoursWeekend work
Spectraforce Technologies, Inc.
Jackson, MS8 hours ago - ...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...Remote workFull timeFlexible hours
Elevance Health
United States5 days ago - ...Clinical Medical Review NurseAmpcus Inc. is a certified global provider of a broad range of Technology... ...).Qualifications:Registered Nurse (RN) – active state or compact license... ...professionalism and a collaborative mindset.Remote work environment with minimal physical...Remote work
Ampcus
Owings Mills, MD2 days ago - ...TEKsystems is seeking a Clinical Quality Assurance Nurse / Utilization Review Nurse for a fully remote contract-to-hire role. The position involves ensuring quality and regulatory compliance for case reports and supporting the QA department. Responsibilities include...Remote workContract work
TEKsystems
United States4 days ago - ...A-Line Staffing Solutions is seeking a Clinical Review Nurse for a concurrent review role in a remote-capable setting. The RN will assess member eligibility through chart review and coordinate with providers to gather necessary information. You will document findings...Remote work
A-Line Staffing Solutions
Mississippi8 hours ago - ...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...Remote workFlexible hours
Elevance Health
United States2 days ago - ...Position Title Clinical Review Nurse - Prior Authorization Work Location Remote; nationally sourced within approved U.S. states. Must be available during standard business hours for the assigned team. Assignment Duration 12 Months possibility of extension...Remote workWork at officeMonday to Friday
Spectraforce Technologies
Jacksonville, FL3 days ago - ...only will be considered ************** Title: HEDIS Clinical Medical Review Nurse Location: Columbia, MD 21044 (Hybrid) Duration... ...Contract Duration: 5 months Work Location: Primarily Remote (Hybrid focus for candidates residing in MD, DC, or VA; PA...Remote workContract workWork at officeLocal area
nTech Workforce
Reston, VA5 days ago - ...Centene Corporation is seeking a Nurse Reviewer for remote work in the United States. The role involves performing concurrent reviews to determine appropriate level of care and discharge planning, with emphasis on medical necessity and care setting.Requires active Nursing...Remote work
Centene Corporation
Lansing, MI2 days ago $41.49 per hour
...HEDIS Clinical Medical Review NurseLocation: Columbia, MD Type: Contract Compensation: $41.49 Work Model: Hybrid – onsite and remote Hours: 40.0ResponsibilitiesConduct thorough medical record... ...Registered Health Information Technician, Nursing, or a related clinical or...Remote workContract workWork at officeLocal areaSystem One Holdings, LLC
Columbia, MD5 days ago$35 - $40 per hour
...Job Title: Clinical Prior Authorization Reviewer Job Description This role focuses on reviewing prior authorization requests to determine the medical... ...Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated...Remote workContract workTemporary workWork at officeShift workActalent
Portland, OR2 days ago- Position Title Clinical Review Nurse - Concurrent Review Work Location Remote-MS CST Assignment Duration 3 Months Contract to Hire Work Schedule 8 am-5 pm (Central). OT is voluntary; weekend rotation once every 2 months Work Arrangement Remote Position Summary Performs...Remote workContract workFlexible hoursWeekend work
$27.02 - $48.55 per hour
About This Role The Clinical Review Nurse performs concurrent reviews to assess members' overall health, evaluate the necessity of care, and contribute to discharge planning. This remote position is ideal for those with experience in case management or utilization management...Remote workHourly payFull timeFlexible hoursDay shift$27.02 - $48.55 per hour
...Centene is seeking a Clinical Review Nurse - Concurrent Review to perform concurrent reviews, assess medical necessity, and contribute to discharge... ...supports Medicaid and Marketplace/Ambetter members in a remote setting. The position offers full-time hours, with a pay...Remote workHourly payFull timeCentene Corporation
United States5 days ago- Centene is seeking a Clinical Review Nurse for a remote role supporting members in Pennsylvania. The candidate will perform concurrent reviews, assess care necessity, and contribute to discharge planning, leveraging case management or utilization management experience....Remote jobFull timeShift workDay shift
$21 per hour
...for an accommodation or an alternative application process. Clinical Review Nurse San Juan, PR, PR Salary: $21.00 Annually Job Description: This... ...-site at San Juan, PR. Work model could change to hybrid or remote after the 8-week training. Willing or able to work from...Remote workHourly payFull timeContract workMonday to Friday$64.5k - $92.2k
Gainwell Technologies LLC is seeking a Clinical Quality Nurse Reviewer, Sr. Specialist for a remote role. You will conduct quality assurance audits of clinical staff's work and ensure compliance with medical records and guidelines. The position requires an active RN license...Remote workGainwell Technologies LLC
Tetonia, ID4 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Clinical Review Nurse I. Be the first to apply!
Related searches
- clinical nurse United States
- nurse practitioner np United States
- geriatric medicine nurse practitioner United States
- neurology nurse practitioner United States
- adult geriatric nurse practitioner United States
- spine nurse practitioner United States
- infusion nurse manager United States
- nurse practitioner - telehealth United States
- clinical nurse coordinator United States
- assistant nurse manager United States