Remote Clinical Review Specialist - payer & coverage expert
New England Life Care, Inc.
- Remote job
New England Life Care, Inc. is seeking a Remote Clinical Review Specialist to perform utilization management reviews and provide essential clinical information to confirm patient coverage. The role emphasizes regulatory compliance, complex specialty drug knowledge, and liaison work with providers. The position requires Medical Assistant certification and healthcare experience, with LPN as a preferred credential. Remote work is available for residents of Maine, Massachusetts, and New Hampshire. #J-18808-Ljbffr New England Life Care, Inc.
- ...BlueCross BlueShield of Tennessee, Inc. is seeking a Clinical Pharmacy Specialist to support Medicare and D-SNP coverage review activities, ensuring members have timely access to pharmacy benefits and services. This remote-friendly role collaborates with pharmacists and...Remote job
- ...Remote Clinical Review Specialist New England Life Care (NELC) is one of the fastest... ...in order to confirm coverage for each patient. Benefits... ...understanding of regulations, payer contracts, product lines,... ...Serves as subject matter expert on complex specialty drugs...Remote workTemporary workLive inLocal areaMonday to Friday
- ...Job Summary The PRN Remote Clinical Utilization Review Specialist is responsible for evaluating the necessity,... ...readmissions, and maintain compliance with payer requirements. Essential... ...with insurance companies to secure coverage approvals and mitigate concurrent...Remote workWork experience placementRelief
$76k
...Position Summary The Clinical Reviewer Specialist is responsible for performing clinical and... ...insurance, short- and long-term disability coverage, paid time off, employee assistance,... ...required benefits. Position is fully remote only in the state of Florida. Must...Remote workPermanent employmentTemporary workLive inImmediate startRelocationFlexible hours- ...hands-on Medical Bill Review (Working)... ...national repricing/payer systems, ensuring... ...a Subject Matter Expert (SME) and Expert Witness... ...audits, CCI edits, and clinical validation rules... ..., and vision coverage for you and your family... ...are provided for remote workspace. ABOUT...Remote workContract workTemporary work
- New England Life Care, Inc. is seeking a Senior Clinical Review Specialist in Canton, MA for a full‑time remote/onsite hybrid role with a strong emphasis on clinical criteria and payer policies. The ideal candidate has medical experience, understands utilization review...Remote jobFull time
- ...Technologies is seeking a Medical Reviewer (Prosthetic and Orthotic Devices Specialist) to support California healthcare... ...to ensure services meet coverage, medical necessity, and program requirements... ...of standards and regulations. Remote work is supported. #J-18808-Ljbffr...Remote job
- A health accreditation organization is seeking a Part-Time Clinical Review Specialist who will play a key role in supporting accreditation processes... ...and a background in quality assurance. This role is fully remote, allowing candidates from anywhere in the United States to...Remote workPart time
- ...Clinical Denials Specialist Role: Clinical Denial Specialist Schedule: M - F 8... ...authorizations, notifications, non-coverage, medical necessity, and... .... The specialist will review claims and make recommendations... ...clinical documentation, payer medical policies and contract...Remote workContract workLocal area
$71.39k - $132.79k
...partner is looking for a Clinical Denials Management Specialist based in the United... .... In this fully remote role, you will leverage... ...skills to review, investigate, and appeal... ...documentation, billing records, payer policies, and... .... Healthcare coverage from day one: Medical...Remote workFull timeHome office$70 - $100 per hour
...Dorsey . Position: Domain Expert - Healthcare(DendiLIS)... ...70–$100/hour Location: Remote Role Responsibilities Confirm... ...in a CLIA-certified clinical laboratory . ~ Ability to... ...****@*****.*** PS: Our team reviews applications daily. Please complete...Remote workContract workSummer work$100 per hour
A healthcare consulting company is seeking a Sr. Clinical Recruiter to join their Medical Consultant panel as an Expert Medical Independent Reviewer. This remote position requires Nurse Practitioners with at least 20 hours of direct patient care monthly, specifically in...Remote work- ...healthcare accrediting organization is looking for a Full-time Clinical Review Specialist who will support the accreditation process for community... .... Strong communication skills and the ability to work remotely are essential. Traveling 15-20% will be required. #J-18808...Remote jobFull time
- AuraOne is seeking a Medical Expert (German, Germany) for remote Clinical AI Review. You will assess AI-generated medical outputs against German clinical guidelines, grade differential diagnosis and dosing reasoning, and flag safety issues when needed. Ideal candidates...Remote jobFor contractors10 hours per week
- AuraOne is seeking a Medical Expert (Mandarin Chinese, mainland China) for a remote clinical AI review role as a CONTRACTOR. You will evaluate AI outputs for clinical accuracy, reasoning, dosing logic, and guideline adherence, signing off on outputs after structured review...Remote jobFor contractors
- Mercor seeks a Mandarin-speaking legal professional for a remote, part-time pilot role (about 21 hours/week). You will review and draft tasks in legal contexts, grounded in local practice and terminology. You bring legal practice experience, a mainland China law degree,...Remote jobHourly payPart timeLocal area
- AuraOne is seeking a Legal Expert (Spanish, Spain) to review AI-generated legal content remotely as a CONTRACTOR. You will assess citations, jurisdiction, and statutory reasoning for accuracy and policy adherence, providing clear notes and severity tags. Ideal candidates...Remote jobFor contractors10 hours per week
- AuraOne is seeking a Medical Expert, Spanish (Spain) for AI Clinical Review. This remote contractor role evaluates AI outputs, grades differential reasoning, dosing logic, and guideline adherence, flags patient-safety issues, and documents corrected clinical reasoning for...Remote jobFor contractors10 hours per week
- AuraOne is seeking a Legal Expert for Mandarin Chinese (mainland China) to remotely review AI outputs in legal workflows. You will assess citations, statutory reasoning, and policy adherence, flag risks, and document corrected analysis for training. This independent contractor...Remote jobFor contractors
$120 - $140 per hour
...practice law in the U.S. (Minnesota admission is not required; the questions turn on the record, not on state procedure) Role Highlights Fully remote; must be based in the United States Role starts immediately, and applications are reviewed on a rolling basis...Remote workHourly payContract workTemporary workImmediate start- ...AI labs to build and evaluate training data for complex legal domains. We seek a Law Review Cite-Checker to review citations, apply Bluebook rules, and create sample tasks for a remote project. Ideal candidates are current law students (2L/3L) or recent JD graduates with...Remote jobHourly payContract work
- A leading staffing agency is looking for a Utilization Review Registered Nurse to work remotely with a major health insurance client. This role involves... ...of experience in utilization review and significant clinical experience in an acute setting. Strong written and verbal...Remote work
- The Work You will use clinical judgment to review and improve healthcare AI training data. The work includes... ...residents may also be considered. Remote contractor work for candidates... ...content and rating model outputs. Clinical experts help make these systems more accurate...Remote workPart timeFor contractors
$85 per hour
...AI Evaluation — Pay: $85 / hr — Location: Remote — US-eligible — Contractor Legal Expert (Spanish, Spain) - AI Legal Content Review is a remote review track for evaluating AI... ...Remote — US-eligible. Remote - Independent specialist contractor. Employment type: CONTRACTOR....Remote workFor contractors10 hours per week$80 - $100 per hour
Leading AI Lab is seeking an experienced legal professional for a remote, short-term consulting engagement to evaluate AI content. You will review material for accuracy and context, identify gaps in reasoning, and provide practical, well-supported feedback that improves...Remote jobHourly payContract workTemporary workImmediate start$120 per hour
AuraOne is seeking a Medical Expert, Spanish (Spain) to remotely review AI outputs in clinical contexts. You will assess differential reasoning, dosing logic, and guideline adherence, and document corrected reasoning for model training. You will work with a structured rubric...Remote jobHourly payFor contractors- ...tasks. What you'll do Your work will include: Building workspaces: reviewing files, memos and records a real team would have for a project... ...technical documentation and data-heavy problem solving Details Remote, about 21 hours per week, hourly, pilot running Oct 23 to Nov 1...Remote workHourly payLocal area
- ...currently recruiting a personable and detail-oriented Full-time Clinical Review Specialist to perform the associated duties which support and... ...Must be willing to travel (15-20%) This position is 100% remote and can be located anywhere nationwide. In order to be considered...Remote workFull timeWork at office
- ...narration slips, so the underlying models can be made better. This is remote, part-time work at roughly 20 hours per week (about 4 hours per... ...each issue and mark the exact span where it occurs, using our review tooling. Report on overall listener satisfaction and where the...Remote workPart time
- ...healthcare AI systems by applying clinical judgment to medical... ...cases, and healthcare data. Review AI-generated medical content... ...it pays and takes This is a remote, part-time contractor role for... ...examples. In this role, clinical experts review medical information and...Remote workHourly payPart timeFor contractors
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