Remote RN: Clinical Claims Review Specialist
Texas Health Institute
- Remote job
UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to join remotely from anywhere in the U.S. This multifaceted, rewarding role focuses on analyzing inpatient claim reviews within federal, state, and client requirements. You will handle documentation, apply screening criteria, and decision-making with autonomy in a fast-paced setting while contributing to outcomes that improve member care and health equity. #J-18808-Ljbffr Texas Health Institute
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to join our Remote team in the United States. You will perform administrative reviews of short stay inpatient hospital claims, document determinations, and maintain accurate screening criteria to support member...Remote job
$48 - $65 per hour
...Remote Registered Nurse – Clinical Review Fully Remote | $48–$65/hr | Monday–Friday, 9:00 AM–6:00 PM ET Medix is supporting a healthcare technology organization... ...with the work What we’re looking for ~ Active RN license ~ BSN preferred ~3+ years of RN experience...Remote workLong term contractMonday to Friday- ...Comagine Health is seeking Clinical Utilization Review Nurses (RN) licensed in Alabama for a remote, full-time role. You will assess medical necessity and quality of healthcare services through prospective, concurrent, and retrospective reviews to support compliant, cost...Remote workFull time
$35 - $50 per hour
...seeks an experienced Registered Nurse for a remote role providing clinical technology services. This position is for... ...contractors, focusing on chart reviews and clinical data analysis. Candidates should have an active RN license, at least 3 years of adult health...Remote workHourly payContract workFor contractors$45 - $50 per hour
...Healthcare Staffing is looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting... .... Candidates must be graduates of accredited nursing programs with an active New York RN license. #J-18808-LjbffrRemote workHourly pay- ...top healthcare organization to recruit a Clinical Quality Reviewer. You will review medical records for... ...recommendations for quality improvement. Remote or onsite options are available, with a... ...if remote. The role requires an active RN or LCSW license, 3+ years of clinical...Remote workHome office
- ...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 work
- ...improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our... ...professionally. Position Overview We are seeking an RN to perform Clinical Review work and QIDP reviews work. Team member will serve as the...Remote workContract work
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting... ...this role: This is a 100% remote role, and requires robust internet... ...authorization data with post-service claims validation, we're creating a...Remote workFull timeFlexible hoursShift work$29 - $52 per hour
...us to start Caring. Connecting. Growing together. The Clinical Claim Review RN will be responsible for performing compliance reviews of medical... ...will be aligned with your schedule. This position is Remote in Massachusetts. You will have the flexibility to work...Remote workHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work$2,300 per month
...The Clinical Review Nurse (RN) supports the organization’s care management function by conducting clinical reviews, ensuring appropriate utilization... ...-effective healthcare outcomes for members. This is a remote role open to candidates residing in Utah, Texas, or Arizona...Remote workWork at office- Comagine Health is seeking a Clinical Utilization Review Nurse (RN) for a 100% remote, full-time role supporting Alaska contracts. The nurse will assess medical necessity and care quality through prospective, concurrent, and retrospective reviews, applying InterQual criteria...Remote jobFull time
- A leading organization in healthcare quality is seeking a Clinical Quality Reviewer to review clinical cases and identify potential quality or safety concerns. This remote position is ideal for licensed clinical professionals with a strong analytical mindset and a minimum...Remote job
- Acentra Health is seeking a Clinical Review Advisor to join our remote US team. You will review medical records, prepare cases for physician review, and ensure... ...per MCC policies. Requirements include an active RN license, a related Bachelor's degree, and 2+ years of nursing...Remote jobHome office
$85k - $92k
...Equivalent: ~$41–$44/hr Location: Remote Schedule: Must work AZ hours (typically... ...) Active, unrestricted license: RN Minimum 3+ years clinical experience (med/surg and/or... ...DESIRED) Clinical Quality / Utilization Review / Case Review experience Experience...Remote workHourly payDay shift- Acentra Health, LLC is seeking a Clinical Review Advisor to join our team. The role focuses on reviewing medical records, preparing cases... ...selected cases with attention to MCC policies. The position is remote within the United States with standard Central Time business...Remote jobWork at office
- Acentra Health is seeking a Clinical Reviewer to join our growing team. You will apply clinical judgment to review medical records against established... ..., ensuring accuracy and compliance. The position is remote national scope, with on‑call weekends, holidays and evenings....Remote jobContract workWeekend workAfternoon shift
- MES Solutions is seeking a Clinical Quality Assurance Coordinator (RN/LPN) to review peer reports and ensure accuracy, compliance with client agreements, and regulatory standards. This 100% remote role aligns clinical expertise with quality control across cases. The position...Remote jobMonday to Friday
- TEEMA is partnering with a leading organization to recruit a Clinical Quality Reviewer (RN or LCSW) for USA-remote work in approved states. The role focuses on reviewing clinical cases, identifying quality, safety, and utilization concerns, and supporting improvement across...Remote job
- ...outcomes through technology, services, and clinical expertise. Our mission is to innovate... ...Acentra Health is looking for a Clinical Reviewer to join our growing team. Job Summary:... ...with contract requirements. *Position is remote* *Required Work Hours: On‑call weekends,...Remote jobContract workReliefWeekend workAfternoon shift
$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 with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits...Remote jobHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal areaHome office$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization that delivers care, aided by technology... ...a comprehensive understanding of the claim review process including clinical claim... ...Associate's degree ~ Active and unrestricted RN license OR LPN in the state of residence...Remote jobHourly payMinimum wageFull timeTemporary workWork experience placementLocal area- Job Description Fully remote- Must have state of MI unrestricted RN license. You will perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary... ...computer skills (Microsoft office) Clinical experience in ICU, ER, or medical...Remote workWork at officeFlexible hours
- ...among the first 25 applicants Job Title:Clinical Review Nurse (RN) - Utilization Management Location:... ...) Clinical Program Coordinator RN *Remote* Clinical Program Coordinator RN *Remote... ...) RN Clinical Document Integrity Specialist Oregon, United States $150,000.00-$30...Remote workContract work
- ...LV Home Care And Hospice Clinical Record Reviewer - Full-Time Days (Remote) Imagine a career at one of the nation's... ...indicated. HCS-D - Home Care Coding Specialist-Diagnosis - Board of Medical... ...Competency Board Within 1 Year and RN - Licensed Registered Nurse_PA - State...Remote jobFull timeContract workLocal area
- ...Optum Waste and Error Claims Investigator Optum is a global organization... ...of the claim for further review in a production environment.... ...Primary Responsibilities: Clinical Case Reviews - 75% Perform... ...(CPMA) Certified Coding Specialist (CCS) Demonstrated...Remote jobContract workWork at officeLocal areaMonday to Friday
- ...A healthcare organization is seeking a Clinical Review Nurse – Concurrent Review to perform utilization management functions remotely. The role requires conducting concurrent reviews, collaborating with medical teams, and ensuring quality healthcare outcomes. Candidates...Remote workWork at office
- ...A healthcare staffing company is seeking a Clinical Review Nurse for Prior Authorization Review. This remote role demands conducting reviews, collaborating with healthcare... ...ensuring compliance. Candidates need an active RN license and 2–4 years experience in Prior...Remote workContract work
- ...Job Title: Clinical Review Nurse - Concurrent Review Location:Remote- Nationally but must have Compact license if not in KY (ok with all time zones but must work... ...: BSN Licensure Required: LPN Preferred: RN Years of experience required: 2-4 years of related...Remote workShift work
- ...Job Title: Clinical Review Nurse - Concurrent Review - J00933 Address: Various, IL 99999 Job Description... ...Monday, 10:00 AM – 6:30 PM CST Remote or on-site flexible working environment... ...Licenses Needed Active nursing license (e.g., RN, LPN, or equivalent) Clinical review...Remote workFull timeFlexible hours
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