Remote RN: Clinical Claims Review & Utilization Specialist
Texas Health Institute
- Remote job
UnitedHealth Group seeks a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims, ensuring documentation and screening criteria are met, from a remote work setup across the U.S. This role emphasizes autonomy with responsibility, requiring an RN license in the state of residency and 5+ years of clinical documentation experience. The position offers comprehensive benefits and telecommuting options. #J-18808-Ljbffr Texas Health Institute
- 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
- 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
- ...New Horizons is seeking an Utilization Review Specialist , who will be responsible for following... ...appropriate level of care is met, and provide clinical to insurance company to obtain... ...Revenue or designee Trends disputed claims by payor Obtain & follow authorization...Remote workClaimsLocal area
- ...subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim reviews and determine... ...documents decisions and supports utilization review across multiple services. The position is remote, full-time, with standard... ...degree, and 2+ years of clinical RN experience required....Remote jobClaimsFull time
$65k - $85k
...Utilization Review Specialist (RN) – RemoteAt Concierge Home Care, we are growing and looking for an experienced... ...Review Specialist (RN) to join our remote home health team.This role is ideal... ...You'll DoReview home health clinical documentation for accuracy and complianceAudit...Remote workMonday to FridayWeekend work$55k - $70k
Utilization Review Specialist ? Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary: $55K - $70K Who We Are? Exact Billing Solutions... ...closely with clinical teams, insurance providers... ...service utilization or claims denials. Provide requested...Remote workClaimsFlexible hours- ...seeking a Senior Manager, Clinical Review to lead the daily operations... ...Management, overseeing Utilization Management and Claims Medical Management, and supporting... ...Review Program. Remote position; candidates must... ...Bachelor’s degree and an active RN license, with 7+ years in...Remote jobClaims
- ...Description Job Description The utilization review and management (UM)... ...facilities are medically necessary, clinically appropriate, evidence-based,... ...and documentation of claims along the process chain. #... ...This is an in-office, no remote work capability position...Remote workClaimsWork at office
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a... ...critical role in supporting utilization management operations by conducting... ...This is a 100% remote role, and requires robust... ...authorization data with post-service claims validation, we're creating...Remote workClaimsFull timeFlexible hoursShift work- Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires...Remote job
$29 - $52 per hour
...Program Integrity Clinical Compliance Auditor... ...performing compliance reviews of medical and... ...providers who submit claims for payment. This position will utilize information from claims... ...This position is Remote in Massachusetts. You... ...~ Nurse licensure (RN or LPN) with a...Remote workClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work$2,210 per week
...Holidays Work-life balance. Remote/hybrid setting (once... ...This individual will utilize clinical knowledge and... ...decision to a second level reviewer. This individual interfaces... ...s status, benefit and claim concerns, and... ...but is not limited to RN, LMSW, LMHC. Successful...Remote workClaimsFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours- ...and monitoring the utilization of behavioral... ...Medical Director for review and works closely... ...and post-service clinical reviews to determine... ...coding, researching claims to ensure accurate... ...and active NYS RN license required.... ...be opportunity for remote work within all jobs...Remote workClaimsContract workWork at office
- UnitedHealth Group is seeking a Clinical Review Clinician in Plymouth, Minnesota. This role involves... ...forensic reviews of hospital bills and claims while ensuring compliance with billing... ...have an Associate's degree, an active RN or LPN license, and at least 2 years of...Remote jobClaims
$29 - $52 per hour
UnitedHealth Group is seeking a qualified Registered Nurse in Massachusetts to perform clinical coverage review services. As part of this role, you will communicate benefit determinations and work closely with healthcare providers to explain coverage. We offer telecommuting...Remote jobClaimsHourly pay- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims and document determinations. This role offers telecommuting from anywhere in the U.S. while maintaining rigorous screening criteria and...Remote jobClaims
- Molina Healthcare is seeking a Registered Nurse with utilization management and appeals review experience to assess medical necessity and appropriate care... ...with medical directors, and assisting with complex claims and denial decisions while maintaining compliance with...ClaimsDay shift
- 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
$41.6k - $47k
...Utilization Review SpecialistAt Umpqua Health, we're more than a healthcare... ...community.The Utilization Review Specialist supports Umpqua Health... ...organized and productive in a remote, independent work... ...managed care, medical coding, claims processing, or a related fieldKnowledge...Remote workClaimsWork at officeLocal areaImmediate startMonday to FridayShift work- 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
- UnitedHealth Group's Optum unit is seeking a SSBV Clinical Claims Review RN. This full-time, remote role provides autonomy and accountability in reviewing inpatient claims and documenting determinations, with a demanding caseload in a production-driven environment. You...Remote jobClaimsFull timeWork at officeWork from homeHome office
- ...Ensures completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review Specialist as indicated. Maintains necessary... ...first week. This role will be remote BUT regular meetings/trainings require...Remote workReliefWeekend work3 days per week
- Comagine Health is seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This full-time remote role supports compliant, cost-effective care under Alabama...Remote jobFull timeContract work
$30.64 - $45.8 per hour
...Utilization Review NurseThe Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent... ...of CorVel. This is a remote position.Essential Functions... ...to the appropriate claims staff/... ...operation required; RN is required unless local...Remote workClaimsFull timeWork at officeLocal areaFlexible hours- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical... ...to the validity of health claims and levels of payment in meeting... ..., medical necessity, utilization and appropriateness of care... ...unrestricted Registered Nurse (RN) license PREFERRED...Remote workClaimsPermanent employmentWork at officeLocal area
- Optum Insight is seeking a Clinical Claim Review RN to perform compliance reviews of medical and administrative documentation to identify fraud... ...audit systems. The position is full-time (40 hours/week) with remote work options in Massachusetts and potential overtime....Remote jobClaimsFull timeLocal area
$35 - $42 per hour
...reference: Job Title: Clinical Review Nurse - Concurrent Review Location: Remote Duration: 12... ...Per hr on w2. (Depend on RN or PN License and Exp)... ...information to resolve denial claims Assists with... ...training needed within the utilization management team based...Remote workClaimsLocal area- Comagine Health is seeking a Clinical Utilization Review Nurse (RN) licensed in Alabama to assess medical necessity and quality of care through prospective... ...concurrent, and retrospective reviews. This full-time, remote position supports compliant, cost-effective care aligned...Remote jobFull timeContract work
$45 - $50 per hour
...looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical... ...nursing programs with an active New York RN license. #J-18808-Ljbffr...Remote jobHourly pay$84.06k - $118.67k
...role at a glance Location: Remote Facility: Ascension Network Services Department: Utilization Management Schedule: Days... ...make an impact in this role Review admissions and service... ...precertification, reimbursement and claim denials/appeals. Assess and...Remote workClaimsPart timeLocal area
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