Remote RN: Clinical Claim Review & Compliance
Registered Nurse
- Remote job
Optum Insight is recruiting for a Clinical Claim Review RN to perform compliance reviews of medical and administrative documentation in Massachusetts. The role involves audits, data analysis, and collaboration with clients to ensure policy adherence. This remote Massachusetts position requires a MA license (RN/LPN), 2+ years of review experience, and travel up to 25% within the state. Full-time hours are 40/week with potential overtime and training aligned to your schedule. #J-18808-Ljbffr Registered Nurse
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims and document... ...U.S. while maintaining rigorous screening criteria and compliance with state/federal requirements. Qualified candidates will...Remote jobClaims
- Optum Insight is seeking a Clinical Claim Review RN to perform compliance reviews of medical and administrative documentation to identify fraud or wasteful... ...systems. The position is full-time (40 hours/week) with remote work options in Massachusetts and potential overtime....Remote jobClaimsFull timeLocal area
$29 - $52 per hour
...Program Integrity Clinical Compliance Auditor Optum Insight... ...performing compliance reviews of medical and administrative... ...providers who submit claims for payment. This... .... This position is Remote in Massachusetts. You... ...~ Nurse licensure (RN or LPN) with a current...Remote workClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work- UnitedHealth Group seeks an experienced SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims. The role requires documenting determinations and maintaining screening criteria, contributing to efficient, compliant health...Remote jobClaims
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims and to document all determinations. The role emphasizes adherence to Federal, State and client requirements in a telecommuting setting...Remote jobClaimsHome office
- Trillium Health Resources is seeking a Compliance Nurse to join our NC-based team. This exempt, full-time role focuses on clinical compliance reviews and claims evaluation to ensure regulatory... ...cases end-to-end. Candidates must be an RN with NC licensure and a valid driver...Remote jobClaimsFull time
- UnitedHealth Group seeks a Clinical Review Clinician to serve as the subject matter expert for itemized bill reviews and analysis of hospital... ...within a broad policy framework and must understand the claim review process, clinical review, medical record review, and billing...Remote jobClaims
- First Coast Service Options is seeking a Clinical Review Nurse to evaluate medical necessity, coverage, and payment levels for Medicare-related claims. The role applies clinical knowledge to determine the appropriateness of care in line with CMS policies and standards....Remote jobClaims
- ...Registered Nurse to perform medical review of complex claims, pre-authorization requests,... ...referrals. You will apply clinical expertise and established guidelines... ...determinations. The role is remote and full-time, requiring an active RN license and at least two years...Remote jobClaimsFull time
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims, documenting determinations and maintaining screening criteria. The role supports telecommuting from anywhere in the U.S. and requires...Remote jobClaimsWork at office
- ...provide strategic direction for teams performing advanced medical claim reviews. You will drive accuracy, regulatory compliance, and payment integrity by leveraging ICD-10, CPT/HCPCS coding, and clinical guidelines. The role leads standardization of processes, development...Remote jobClaims
$62.7k - $100.4k
...Clinical Care Reviewer II (Remote)(Must Have - Unrestricted Massachusetts RN License) remote type Remote locations Massachusetts WFH time type Full time... ...expertise to make every opportunity count. Each claim, each phone call, each consumer-centric...Remote workClaimsHourly payFull timeWork at office$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a... ...-quality care, regulatory compliance, and improved member outcomes... ...This is a 100% remote role, and requires robust... ...authorization data with post-service claims validation, we're creating...Remote workClaimsFull timeFlexible hoursShift work$137k - $150k
...Itasca, IL 60143, USA Remote, 1100 N Arlington... ...information. Description The Clinical Risk Specialist RN is responsible for... ...case management and claims management... ...COMPETENCIES REQUIREMENTS: Reviewing stop-loss cases,... ...visits. This includes compliance with all of the...Remote workClaimsFull timeTemporary workShift work- ...Description The utilization review and management (UM)... ...medically necessary, clinically appropriate, evidence-... ...supporting regulatory compliance and organizational... ...and documentation of claims along the process chain... ...This is an in-office, no remote work capability...Remote workClaimsWork at office
$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization that delivers... ...comprehensive understanding of the claim review process including... ...~ Active and unrestricted RN license OR LPN in the state of... ...with billing, charge master and compliance Experience working with...Remote workClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal area- ...comprehensive training curricula for clinical audit nurses and audit... ...covering IPF and IRF claim review, documentation requirements,... ...for effective delivery in a remote environment. Training Delivery... ..., including: the 60%/75% compliance rule and qualifying...Remote workClaimsFull timeWork at office
- ...Training Specialist, Medical Review Audit – Clinical RN based in the United States.... ...of post-acute medical claims auditing. You will combine... ...closely with operations, QA, compliance, and other stakeholders,... ...accessible, and effective for remote delivery. Deliver...Remote workClaimsFull timeWork at office
- ...Utilizing clinical expertise, the full-time Licensed Medical Review Nurse (LVN/LPN) will conduct medical reviews of claims and documentation to ensure medical necessity and compliance with regulations while working remotely on a MST/PST schedule. Key responsibilities...Remote workClaimsFull time
- ...leading healthcare intelligence company. The Medical Review Nurse II audits home health claims, working remotely with a multi-location team to ensure compliance and high-quality documentation. The role emphasizes strong clinical judgment, coding accuracy, and regulatory...Remote jobClaimsWork from home
$69.3k - $78k
...integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and... ...The position requires an active RN license and a minimum of five years... ...documenting findings, all in a remote work environment. This role...Remote jobClaims$29 - $52 per hour
...on some tough challenges. Primary Responsibilities Perform clinical coverage review services, which require interpretation of state and federal... ...Required Qualifications Associate's degree Current unrestricted RN license in the state of Massachusetts 3+ years of experience...Remote workClaimsHourly payMinimum wageFull timeWork experience placementLocal area$86.8k - $124k
...Summary The Clinical Policy Specialist – Itemized Bill Review is responsible for... ...facility billing, UB-04 claim processing, itemized... ...to ensure compliance and program alignment... ...Active, Unrestricted RN license from the United... ...role Location: Remote (U.S.-based) Travel...Remote workClaimsFull timeFlexible hours$40 per hour
...-30 hours week) – Remote Work Environment... ...Supports Medical Review Services. The Nurse... ...reviews for Medicaid claims. This involves... ...records to ensure compliance with established guidelines... ...regulations. The RN will work closely... ...CPT and HCPCS Clinical criteria (...Remote workClaimsContract workWork at officeLocal areaImmediate start- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These... ...determinations as to the validity of health claims and levels of payment in meeting... ...Valid unrestricted Registered Nurse (RN) license PREFERRED QUALIFICATIONS...Remote workClaimsPermanent employmentWork at officeLocal area
$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 workClaimsHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal areaHome office$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant,... ...primarily performs medical claims audit reviews. As a... .... You will work remotely in a fast paced and dynamic... ...Active unrestricted RN license in good... ...contractor and subject to compliance with client...Remote workClaimsFor contractorsWork at officeWork from homeHome officeShift work- Optum, a part of UnitedHealth Group, seeks a Clinical DRG RN auditor to review MS-DRG and APR-DRG coding for inpatient claims and identify overpayments. The role emphasizes... ...high-quality audit outputs. You will work remotely from anywhere in the U.S. and use proprietary...Remote jobClaimsRelocation package
- ...Technologies is seeking a Medical Reviewer (Registered Nurse) to support California... ...healthcare programs. You will use clinical judgment to review medical records, healthcare services, claims, and authorization requests. You will work remotely within California with flexible...Remote jobClaimsFlexible hours
- ...healthcare staffing company is seeking a Clinical Review Nurse for Prior Authorization Review. This remote role demands conducting reviews,... ...collaborating with healthcare teams, and ensuring compliance. Candidates need an active RN license and 2-4 years experience in...Remote workContract work
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