Remote RN Compliance Nurse — Claims & Policy Reviews
Trillium-Health-Resources
- Remote job
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 adherence and proper payments. You will assess documentation, enforce coverage requirements, and drive corrective actions while managing cases end-to-end. Candidates must be an RN with NC licensure and a valid driver's license, and be able to travel within the catchment. #J-18808-Ljbffr Trillium-Health-Resources
- ...The utilization review and management (UM... ...supporting regulatory compliance and organizational... ...documentation of claims along the process... ...with organizational policies and regulatory... ...Qualifications ~ Registered nurse with active,... ...an in-office, no remote work capability...Remote workPolicyClaimsWork at office
$29 - $52 per hour
...Integrity Clinical Compliance Auditor Optum... ...compliance reviews of medical and administrative... ...who submit claims for payment. This... ...compliance policies, reimbursement policies... ...This position is Remote in Massachusetts.... ...experience ~ Nurse licensure (RN or LPN) with a current...Remote jobPolicyClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work$40 per hour
...-30 hours week) - Remote Work Environment... ...Supports Medical Review Services. The Nurse Reviewer plays a critical... ...reviews and policy reviews for Medicaid claims. This involves meticulous... ...records to ensure compliance with established... ...regulations. The RN will work closely...Remote workPolicyClaimsContract workWork at officeLocal areaImmediate start- ...healthcare intelligence company is seeking a Nurse Itemized Bill Reviewer to analyze medical claims and ensure compliance with industry standards. This remote position allows candidates to work... ...candidates should possess an active RN, LPN, or LVN license, along with at...Remote workClaims
- UnitedHealth Group seeks a Clinical Review Clinician to serve as the subject matter expert for itemized bill reviews... .... You will enjoy limited supervision within a broad policy framework and must understand the claim review process, clinical review, medical record review...Remote jobPolicyClaims
- ...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... ...of care in line with CMS policies and standards. The incumbent will review...Remote jobPolicyClaims
- ...Health Solutions is hiring an Appeals Nurse to review medical records and claims for first-level Medicare appeal... ...to determine medical necessity and compliance with coverage guidelines. The role... .... Qualifications include an active RN license (state of practice), 1+ years...Remote jobClaims
- ...flexibility to customize schedules and a per-case compensation model. The physicians will conduct health claim reviews and ensure compliance with Concentra's policies. Candidates must have a TX license, current board certification, and active practice experience. Strong...Remote jobPolicyClaims
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims... ...the U.S. while maintaining rigorous screening criteria and compliance with state/federal requirements. Qualified candidates will hold...Remote jobClaims
- ...you a registered nurse ready to take your... ...through compliance management. Here,... ...bedside setting to review and audit claims, supportprogram integrity... ...Nurse (RN) license Strong... ...vulnerable populations Remote work - enjoy the... ...with MA policies and identify potential...Remote workPolicyClaimsFull timeTemporary workWork at officeWork from home
- ...you a registered nurse ready to take your... ...through compliance management. Here,... ...bedside setting to review and audit claims, supportprogram integrity... ...Nurse (RN) license Strong... ...vulnerable populations Remote work - enjoy the... ...MA hospice policies, regulations, and...Remote workPolicyClaimsFull timeTemporary workWork at office
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review &... ...care, regulatory compliance, and improved member... ...Registered Nurse with active, unencumbered... ...This is a 100% remote role, and... ...continuum–including policy, prior authorization... ...with post-service claims validation, we're...Remote workPolicyClaimsFull timeFlexible hoursShift work- 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
- ...Quality Assurance / Compliance Registered Nurse (QI/QA/Compliance RN) The Quality... ...Requirements, Federal Tort Claims Act (FTCA)... ...rural, frontier, and remote healthcare environments... ...in peer review and clinical case review... ...OSV) Assist with policy development, review...Remote workPolicyClaimsWork at office
- ...Combination ( RN) The position... ...leadership to develop policies and procedures... ...onsite (or remote as determined... ...medical record review of high-risk situations... ...a resulting claim. ·... ...procedures for skilled nursing facilities. ·... ..., Corporate Compliance Officer, Chief...Remote workPolicyClaimsWork at officeLocal areaImmediate start
- ...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, and timely decision-... ...in nursing and an unrestricted RN license, with a preferred BS in...Remote workPolicyClaims
$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization... ...a broad framework of policies and procedures.... ...comprehensive understanding of the claim review process... ...Active and unrestricted RN license OR LPN in the state... ..., charge master and compliance Experience working...Remote jobPolicyClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal area- ...members, ensuring compliance with internal and... ...Medical Director for review and works closely... ...and medical policies and contractual benefits... ..., researching claims to ensure accurate... ...degree and active NYS RN license required.... ...be opportunity for remote work within all...Remote workPolicyClaimsContract workWork at office
- ...Solutions is seeking a Payment Integrity Nurse I to perform post-service claims reviews, ensuring accurate coding, proper payment, and adherence to policies. The role supports patient care and... ...while working within a flexible remote model across certain western states....Remote jobPolicyClaimsFlexible hours
- ...risk assessment, claims management, regulatory compliance, and proactive... ...months of hire) and RN license** JOB... ...development and review of all aspects... ...content expert and policy steward for risk... ...'s Degree in Nursing, Healthcare Administration... ...Work Location: Remote (within Texas...Remote workPolicyClaimsFull timeTemporary workWork experience placementLocal areaWorldwideRelocation packageShift work
$85k - $109.2k
...Inpatient/Outpatient Coding Review who is responsible for... ...DRG Auditors, and Nurse Reviewers to audit inpatient... ...and recoverable claim opportunities, and supporting... ...program, creating policies and processes relating... ...initiatives. Support compliance and revenue integrity efforts...Remote workPolicyClaimsFull timeContract workWork from homeFlexible hours- ...organization is seeking a Nurse Reviewer to perform... ...reviews for Medicaid claims. The role involves examining... ...knowledge of Medicaid policies, and managing the screening... ...a BSN with an active RN license and have 3-5... ...a chance to work in a remote setup with competitive...Remote jobPolicyClaims
- WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level Medicare redeterminations to determine... ...documentation is prepared for CMS and internal policies. The role requires an RN license, ASN/BSN, and 1+ year clinical experience...Remote jobPolicyClaims
- ...inpatient and outpatient clinical claim review activities, the full-time Remote Registered Nurse Clinical Reviewer will verify... ...revenue codes to ensure accuracy and compliance with billing guidelines while... ...unrestricted Registered Nurse (RN) license in the state of practice...Remote workClaimsFull time
- ...Job Title: Clinical Review Nurse - Concurrent Review Location: Remote -Anywhere in US Shift : Tuesday... ...criteria/guidelines, and policy, including insurance... ...information to resolve denial claims Assists with issues and/... ...Licensure Required: LPN or RN, active in any state...Remote workPolicyClaimsLocal areaShift work
$27.07 - $53.08 per hour
...Optum Insight Quality Review Operations Specialist... ...the flexibility to work remotely * from anywhere within... ...knowledge to ensure compliance with quality standards... ...Observe and comply with policies and procedures for... ...plans as required Claims research and activation...Remote workPolicyClaimsHourly payFor contractorsWork experience placementShift workNight shiftWeekend work$41 per hour
...Medical Review Nurse (RN) Remote position, however, candidates must reside in the State of TX or State... ...and timely medical review of claims suspended for medical necessity, contract... ...be able to navigate MCG and medical policies with the reviews. HireOps Staffing...Remote jobPolicyClaimsContract work- ...quality organization is seeking a Nurse Reviewer to perform comprehensive... ...necessity reviews for Medicaid claims. The ideal candidate will have a BSN and an active RN license, along with experience... ...training. This is a part-time remote position, offering a flexible work...Remote jobPolicyClaimsHourly payPart timeFlexible hours
- ...Medical Review Nurse - Home Health Auditor Machinify... ...primarily performs medical claims audit reviews with a... ...Payers. You will work remotely in a fast-paced and... ...medical review guidelines, policies and rules. Document... ...(active/unrestricted RN license) is required....Remote workPolicyClaimsWork at office
- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical... ...as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical... ...Registered Nurse (RN) license PREFERRED QUALIFICATIONS...Remote workPolicyClaimsPermanent employmentWork at officeLocal area
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