Remote RN: Inpatient Clinical Claims Review
Palo Verde Community College District
- Remote job
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 compliance with state/federal requirements. Qualified candidates will hold an associate's degree and an active, unrestricted RN license, with 5+ years of clinical documentation experience and 3+ years as an RN in #J-18808-Ljbffr Palo Verde Community College District
- 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'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
- 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
- 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...Remote jobClaims
- ...Providing support for inpatient and outpatient clinical claim review activities, the full-time Remote Registered Nurse Clinical Reviewer will verify coded diagnoses, procedures... ...Active and unrestricted Registered Nurse (RN) license in the state of practice Advanced knowledge...Remote workClaimsFull time
$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 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
- 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
- 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
- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical... ...to the validity of health claims and levels of payment in meeting... ...delivery issues (e.g., Inpatient Rehab Facility) * Strong... ...unrestricted Registered Nurse (RN) license PREFERRED...Remote workClaimsPermanent employmentWork at officeLocal area
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting... ...applications This is a 100% remote role, and requires robust internet... ...authorization data with post-service claims validation, we're creating a transparent...Remote workClaimsFull timeFlexible hoursShift work$29 - $52 per hour
...challenges. Primary Responsibilities Perform clinical coverage review services, which require interpretation... ...'s degree Current unrestricted RN license in the state of Massachusetts... ...as an RN, including experience in an inpatient/acute setting 1+ years of clinical...Remote workClaimsHourly payMinimum wageFull timeWork experience placementLocal area$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 workClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work$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... ...: Perform administrative reviews of short stay inpatient hospital claims in accordance with Federal, State and client...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... ...provided in both inpatient and outpatient... ...Active unrestricted RN license in good standing...Remote workClaimsFor contractorsWork at officeWork from homeHome officeShift work- ...’s Wellpoint Federal division seeks a Clinical Review Nurse I to assess pre-claim reviews and claims for medical necessity and eligibility. This remote role emphasizes accuracy, policy knowledge... ...an AS in nursing and an unrestricted RN license, with a preferred BS in...Remote workClaims
- UnitedHealth Group is seeking a Clinical DRG RN auditor to apply expert MS-DRG/APR-DRG... ...and ICD-10 guidelines in inpatient claims audits. This remote role allows telecommuting from anywhere... ...Responsibilities include conducting coding reviews, verifying DRG assignments, and...Remote jobClaimsRelocation package
- 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
$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- ...Job Title: Clinical Review Nurse - Concurrent Review Location: Remote -Anywhere in US Shift : Tuesday - Thursday 9:30 am - 6... ...supplemental information to resolve denial claims Assists with issues and/or... ...Licensure Required: LPN or RN, active in any state Preferred: Compact...Remote workClaimsLocal areaShift work
$30.3 - $40.9 per hour
## Clinical Inpatient Pharmacy Technician - Audit & ReviewApplylocations: Boise, ID: Salt Lake City... ...Pharmacy Technician - Audit & Review**Work from home within Oregon, Washington... ...better. As a member of the Post Service Claim Review team, our Clinical Inpatient Pharmacy...ClaimsWork at officeImmediate startWork from homeFlexible hours$29 - $52 per hour
...Connecting. Growing together. The Clinical Review Clinician serves as a subject matter expert... ...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 workClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal area$29 - $52 per hour
About This Role The Clinical Claim Review RN at UnitedHealth Group is responsible for performing clinical coverage review services, interpreting... ...years of experience as an RN, including experience in an inpatient/acute setting 1+ years of clinical documentation...ClaimsHourly payFull timeDay shift$2,210 per week
...Work-life balance. Remote/hybrid setting (... ...individual will utilize clinical knowledge and... ...outpatient treatment or inpatient confinement. This... ...to a second level reviewer. This individual... ..., benefit and claim concerns, and validation... ...is not limited to RN, LMSW, LMHC....Remote workClaimsFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours- The Senior Clinical Coder serves as a subject matter expert in medical... ...reimbursement across inpatient and outpatient services. In... ...conduct detailed retrospective claims reviews, provide expert-level coding... ...thrives in a fast-paced, remote environment and is passionate...Remote workClaimsFull timeWork at officeWork from homeHome office
$85k - $109.2k
...individual for an Associate Manager, Inpatient/Outpatient Coding Review who is responsible for supervising a... ...team of Certified Coders, Clinical DRG Auditors, and Nurse Reviewers to... ...coding discrepancies and recoverable claim opportunities, and supporting regulatory...Remote workClaimsFull timeContract workWork from homeFlexible hours- ...Health Solutions is hiring an Appeals Nurse to review medical records and claims for first-level Medicare appeal cases to... ...medically reviewed. Qualifications include an active RN license (state of practice), 1+ years clinical experience, and strong communication skills....Remote jobClaims
- Elevance Health is seeking a Diagnosis Related Group Clinical Validation Auditor-RN to audit inpatient medical records, ensuring clinical documentation supports... ...are included. Requires extensive experience in claims auditing and clinical documentation improvement, with...Remote jobClaims
- Inova Health System is seeking a dedicated Registered Nurse (RN) Clinical Denials and Appeals to join the team as a Full-Time Remote role. The position supports review of denied claims, development and submission of timely appeals, and collaboration across UR, Coding, Billing...Remote jobClaimsFull time
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