Remote Utilization Review RN - Medical Claims & Appeals
Molina Healthcare of Illinois
Molina Healthcare, Inc. is hiring a full-time Licensed Medical Review Nurse to conduct reviews of medical documentation while working remotely. This role involves managing appeals and validating claims to ensure medical necessity and compliance with guidelines. Ideal candidates will have at least 2 years of clinical nursing experience, including utilization review, and a valid RN license in Florida or Kentucky. Strong analytical skills and proficiency in coding are preferred. #J-18808-Ljbffr
$45.9 - $71.4 per hour
...Description Utilization Review RN - Remote. The RN Care Coord‑Qual Med Mgmt will provide administration of medical management programs that include prior... ...skilled nursing review, appeals and grievance, delegation... ...development and medical claims audits. These programs are...Remote workMedicalClaimsHourly payLocal area$30 - $38 per hour
...Summary We are seeking Utilization Review Nurse RN to join our team on a... ...and review for the medical necessity of treatment... ...necessity; and post claim or post service reviews... ...consultants. Process appeals for non‑certification... ...perform in a remote healthcare environment...Remote workMedicalClaimsHourly payFull timePart timeWork at officeMonday to FridayWeekend work- ...Medical Review Clinical Appeals Auditor (RN) In October 2025, Machinify acquired Performant... ...conducts research, analyzes claims data, applies knowledge... .... Experience with utilization management systems or clinical... ...to work independently in remote setting with minimum...Remote workMedicalClaimsFlexible hours
$47.06k - $70.24k
...solutions provider is seeking a Utilization Review Nurse in Fort Worth, TX. This remote role involves analyzing medical bill appropriateness, documenting... ..., and communicating with claims examiners. Candidates must have a current RN license and at least four years...Remote workMedicalClaims$65k - $75k
...Technologies LLC is seeking a Nurse Reviewer (RN) to perform clinical reviews remotely in the United States. Responsibilities include reviewing medical records, documenting findings,... ...experience, and 2+ years in utilization review or claims auditing. This full-time...Remote workMedicalClaimsFull time- ...healthcare services firm based in the US is seeking a remote Medical Claim Review Nurse. In this role, you will conduct clinical... ...have a minimum of 3 years of experience in clinical appeals review and an active RN license. This full-time position offers a structured...Remote workMedicalClaimsFull time
- ...RN Utilization Review Manager, responsible for overseeing the daily operations of Utilization Management staff in a full-time, salaried position... ...experience or direct management experience preferred Knowledge of medical claims and coding (ICD-10, CPT, HCPCS) is essential...Remote workMedicalClaimsFull time
- ...a qualified Registered Nurse to conduct reviews of medical documentation to ensure compliance with healthcare... ...nursing experience, including a year in utilization review. Responsibilities include facilitating medical reviews of claims, resolving utilization management...MedicalClaims
$29.05 - $67.97 per hour
...Healthcare in Omaha, NE is seeking a Utilization Review Nurse to ensure medical necessity and the appropriate level of... ...reviewing documentation, facilitating appeals, and validating claims. The ideal candidate will have an active RN license, at least 2 years of nursing experience...MedicalClaimsHourly pay- ...seeking a Registered Nurse for clinical review in Miami, Florida. This role involves ensuring medical necessity for claims, handling appeals, and validating medical records... ...clinical nursing, including experience in utilization review. Skills in coding and regulatory...MedicalClaims
- ...in Albany, NY, is seeking a clinical review specialist to ensure medical necessity and appropriate care levels... ...nursing experience and hold an active RN license. Responsibilities include reviewing medical claims, facilitating appeal processes, and resolving issues...MedicalClaimsWork at office
- Molina Healthcare in Des Moines seeks a qualified Registered Nurse (RN) for clinical review responsibilities that ensure medical necessity for claims and appeals processing. The ideal candidate will have a minimum of 2 years clinical experience and proficiency in ICD-10...MedicalClaims
$84.06k - $118.67k
...glance Location: Remote Facility:... ...Service Department: Utilization Management Schedule... ...Comprehensive health coverage: medical, dental, vision,... ...and utilization review. Review admissions... ...precertification, reimbursement and claim denials/appeals. Assess and...Remote workMedicalClaimsFull timeLocal area- ...a full-time Michigan Licensed Medical Review Nurse to manage the review of documentation in a remote capacity. This role involves ensuring... ...records, and overseeing claims for accurate reimbursement. The... ...experience and possess an active RN license in Michigan. Knowledge...Remote workMedicalClaimsFull time
- ...A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing...Remote workMedicalClaimsFull time
$67.7k
...A specialized consulting firm is seeking a Medical Claims Reviewer to conduct medical reviews and provide guidance on claims. This remote role requires an active RN license, a bachelor's degree in nursing, and at least five years of clinical experience. Ideal candidates...Remote workMedicalClaimsFull timeMonday to Friday- ...Health the Clinical Utilization Review Nurse II (URN) is an... ...education related to medical necessity,... ...with revenue cycle on claim issues and appeals. Analyze population... ...Current California RN License and Magnet ANCC... ...role requirements. Remote Work Disclosure...Remote workMedicalClaimsDaily paidWork at officeLocal areaShift work
- ...seeking a highly skilled Appeals Processor III (APP... ...dedicated team in a remote capacity. The Appeals... ...) is responsible for reviewing, analyzing, and processing... ...: Healthcare appeals Medical claims / utilization review Insurance or... ...roles may require RN) Responsibilities Duties...Remote workMedicalClaimsContract work
- ...Carolina is looking for a qualified applicant to perform medical reviews and support medical claims processing. The role involves reviewing complex claims... ...established clinical guidelines. Applicants must hold an active RN license and have at least two years of clinical...Remote workMedicalClaimsFull time
- ...Job Title: Utilization Review Nurse Duration : 6 +Months contract... ...) Location: 100% Remote (Illinois, Texas, Montana... ...member benefits, evaluate medical necessity and promote... ...Current unrestricted RN license. Multi-State... .../ICD-10), and overall claims process a plus Knowledge...Remote workMedicalClaimsContract workWork at officeLocal areaFlexible hoursShift work
$90k - $99k
...It takes great medical minds to create powerful solutions... ...for a DRG Nurse Reviewer Appeals and Hearings to coordinate... ...CEUs to maintain RN license and/or coding... ...perform reviews of multiple claim types to provide a... ...should expect in this role Remote (Work from Home) Up to...Remote workMedicalClaimsFull timeWork from homeRelocation packageFlexible hours- ...benefits, including medical, dental, vision,... ...-life balance. ~ Remote/hybrid setting (once... ...This individual will utilize clinical knowledge... ...to a second level reviewer. This individual interfaces... ..., benefit and claim concerns, and... ...is not limited to RN, LMSW, LMHC. # Must...Remote workMedicalClaimsTemporary workWork at officeWork from homeMonday to FridayFlexible hours
- ...Utilization Management Nurse (RN/LPN) – Managed Care / Appeals & Authorization (Remote) Overview We are seeking an experienced... ...to support clinical review operations within a... ...responsible for conducting medical necessity reviews,... ...Analyze pharmacy claims, encounter data, and...Remote workMedicalClaims
$30.64 - $45.8 per hour
...The Utilization Review Nurse gathers demographic and clinical... ...treatment, certifies the medical necessity and assigns... ...of CorVel. This is a remote position. ESSENTIAL FUNCTIONS... ...to the appropriate claims staff/customer... ...of operation required; RN is required unless local...Remote workMedicalClaimsHourly payMinimum wageFull timeWork at officeLocal areaFlexible hours- ...Rising Medical Solutions has an opening for a Utilization Review Nurse , and we want to hear from you! We're a bill review... ...reducing the cost of healthcare claims through bill review, case management... ...Hold an active and unencumbered RN license in one or more states...Remote workMedicalClaimsFull timeTemporary workFlexible hours
- ...in Phoenix, Arizona, to oversee medical review processes ensuring appropriateness... ...Applicants should possess an active RN license and have at least 2 years... ...detailed evaluations of medical claims and provide clinical resources for utilization management. A background in...MedicalClaims
- ...Position Summary The Utilization Review Nurse works as is responsible... ...high quality, cost efficient medical outcomes for those enrollees... ...authorization requests as well as claims disputes. The... ...clinical nursing experience as an RN, preferably in a hospital setting...Remote workMedicalClaimsWork at office
$29.05 - $67.97 per hour
...Arizona is seeking a Registered Nurse to utilize clinical expertise for medical documentation reviews. Responsibilities include validating medical claims, facilitating medical reviews, and... ...years of clinical experience, an active RN license, and strong knowledge of...MedicalClaimsHourly pay$29.05 - $67.97 per hour
...Description Job Summary Utilizing clinical knowledge... ..., responsible for review of documentation to ensure medical necessity and... ...medical record and claim submitted support correct... ...review of appeals for denied prior authorizations... ...• Registered Nurse (RN). License must be...MedicalClaimsHourly payWork experience placementWork at office$29.05 - $67.97 per hour
...Description Job Summary Utilizing clinical knowledge... ..., responsible for review of documentation to ensure medical necessity and appropriate... ...medical record and claim submitted support... ...review of appeals for denied prior authorizations... ...- Registered Nurse (RN). License must be...MedicalClaimsHourly payWork experience placementWork at office
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