Remote Medicare Medical Review Nurse
Peraton
New York, NY
- Remote job
Peraton is seeking a Medical Review Nurse- Medicare to perform medical record reviews and apply clinical judgment to determine payment decisions. The role supports fraud detection and may involve research on regulations and potential referrals to law enforcement. Telework is available from anywhere in the United States. A nursing license is required, with strong investigative, communication, and organizational skills to ensure accurate reviews and documentation for Medicare payments. #J-18808-Ljbffr Peraton
Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the Remote Medicare Medical Review Nurse in New York, NY vacancy
- WPS Health Solutions seeks an Appeals Nurse (RN) to review medical records for first-level appeal cases... ...and determine medical necessity under Medicare guidelines. The role collaborates... ...clinical experience are required, with remote work options available in designated...Remote jobMedical
- ...Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level... ...to determine medical necessity under Medicare guidelines. The role collaborates with... ...clinical experience are required, with remote work options available in approved states...Remote jobMedical
- ...Health Solutions is seeking an Appeals Nurse (RN) to review medical records for first-level appeal cases... ...determine medical necessity under Medicare guidelines. You will collaborate with... ...communication and regulatory knowledge. Remote work is available in approved states,...Remote jobMedical
- WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level appeal determinations under Medicare guidelines. The RN collaborates with... ...license, with 1+ year clinical experience. Remote work is allowed in several states with requirements...Remote jobMedical
- WPS—A health solutions company is seeking an Appeals Nurse to review medical records and claims for first-level appeal cases to determine medical necessity and adherence to Medicare coverage guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations...Remote jobMedical
- ...Health Solutions is seeking an Appeals Nurse (RN) to review medical records and claims for first-level... ...cases, determining medical necessity and Medicare coverage compliance. The RN... ...timely manner. This position supports remote work in approved states, including Ohio...Remote jobMedical
- ...Health Solutions is seeking an Appeals Nurse to review medical records for first-level appeals to determine medical necessity under Medicare guidelines. The RN collaborates with Appeals... ...year clinical experience are required. Remote work options are available in specified...Remote jobMedical
- WPS—A health solutions company is seeking an Appeals Nurse (RN) to review medical records and claims for first-level appeal cases to determine medical necessity under Medicare guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations. In...Remote jobMedical
- WPS is seeking an Appeals Nurse (RN) to review medical records and denial information for first-level Medicare appeals, ensuring services meet medical necessity and CMS guidelines... ...1+ year of clinical experience, and offers remote work options in approved states, including...Remote jobMedical
- WPS Health Solutions is hiring an Appeals Nurse RN to review medical records and claims for first-level appeal cases to determine medical necessity according to Medicare guidelines. This remote-friendly role supports timely redeterminations and collaborates with Appeals...Remote jobMedical
- Peraton seeks a Nurse Reviewer for SafeGuard Services to conduct medical record reviews and make informed payment decisions. You will support fraud investigations... ...issues, and refer cases for administrative action. Remote work is available from anywhere in the United...Remote workMedical
- WPS Health Solutions in Columbus, OH, is seeking an Appeals Nurse to review medical records and Medicare claims for first-level appeals to determine medical necessity and coverage alignment. The role collaborates with Appeals Examiners to prepare timely redeterminations...Remote jobMedical
- ...States is seeking a clinically focused claims reviewer with an active California RN license to evaluate complex medical claims and post-service appeals. You will interpret... ...to ensure accurate determinations. This remote role offers a base hourly wage, annual bonus program...Remote jobMedicalHourly pay
- ...States is seeking a qualified Clinical Reviewer to provide expert review of medical claims and post-service appeals... .... You will audit complex Medicare claims, apply CMS guidelines, and... ...supporting SCAN’s mission and goals. This remote role offers a comprehensive benefits...Remote jobMedical
- ePATHUSA, Inc. is seeking a Registered Nurse for a fully remote, Medicare-focused medical record review role. You will evaluate Part A and B claims, ensure coding accuracy, and determine compliance with national and local coverage determinations. The position supports...Remote jobMedicalLocal area
- Peraton, a leader in national security solutions, seeks a Medical Review Nurse for Medicare fraud detection and medical claim evaluation. You will... ...violations, with the opportunity to support investigations remotely from anywhere in the United States. The role requires a...Remote jobMedical
$80.31k - $116.19k
...adults. Our work spans Medicare Advantage, fully... ...care, care for the most medically and socially complex populations... ...Provide clinical review of medical claims and post... ...Quality of Care (QOC) Nurse, Medical Management... ...to $55.86 per hour Remote position An annual employee...Remote workMedicalHourly payFull timeFor contractorsLocal area- Seeking Registered Nurse for fully remote role to perform complex medical record and claim reviews for various services and equipment (Medicare Part A and Part B) to make coverage determinations based on applicable Medicare coverage policies and payment rules, coding guidelines...Remote workMedicalContract workWork at officeLocal area
- ...and detail-oriented Registered Nurse (RN) to join a specialized... ...you will be responsible for reviewing and evaluating critical incidents... ...with each participant's medical and functional needs. You will... ...utilizing technology to support remote and hybrid work functions....Remote workMedicalWork from home
- ...Review NurseThis is a contract assignment that will start right away and end on April 30th 2024Summary Description:The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS)...Remote workMedicalContract workImmediate start
$61.05k - $98.33k
...Itemization Review NurseThe Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. This is a remote position.Essential Functions & Responsibilities:Collects...Remote workMedicalFull timeWork at officeFlexible hours$34 - $47 per hour
...UM Review NurseAstrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position... ...approve or deny outpatient medical services for patients based... ...various Health Plans. This is a remote position for CA-licensed...Remote workMedicalHourly payLive inWork at officeMonday to FridayShift work- Quantum Health, Inc. is seeking a Pre-Certification Review Nurse - Pharmacy to assess coverage determinations and utilization management requests for provider-administered specialty medications. You will use clinical judgment and pharmacy knowledge to make timely, well-...Remote jobMedical
- ...seeking an experienced Clinical Appeals Registered Nurse (RN) to support the Medicare appeals team for a leading healthcare insurance client. This fully remote opportunity focuses on reviewing clinical appeals, evaluating medical necessity, and ensuring timely determinations...Remote jobMedical
- ...Services Corporation is seeking a Nursing professional for a 6-month remote role focused on concurrent reviews and utilization management.... ...levels, and collaborate with Medical Affairs to support quality of... ...should be familiar with Medicare/Medicaid regulations and be prepared...Remote jobMedical
$66k - $68k
WPS is seeking an Appeals Nurse (RN) to evaluate medical records and claims for first-level Medicare appeals, ensuring medical necessity and compliance with guidelines.... ...finalize redeterminations promptly. The role supports remote work in approved US states, offers a salary of...Remote jobMedical- HealthHelp, a WNS company, seeks a Clinical Review Nurse for a fully remote role in the United States. You will perform prospective reviews for medical necessity on prior authorization requests across multiple specialty programs and refer non-qualifying cases to Physician...Remote jobMedical
- ...solutions company, is hiring an Appeals Nurse to review medical records and claims for first-level... ...ensuring medical necessity and adherence to Medicare guidelines. The role collaborates with... ...and compliance with CMS requirements. Remote work is available from select states...Remote jobMedical
$61.05k - $98.33k
...Description Job Description The Itemization Review Nurse provides a summary and analysis of items by... ...all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES...Remote workMedicalMinimum wageFull timeWork at officeLocal areaFlexible hours- ...Medical Reviewer This isn't just a job; it's an opportunity to build something that truly matters and directly shape the future of at-home... ...equipment (DME) order is fully compliant with Centers for Medicare & Medicaid Services (CMS) regulations, including Local Coverage...Remote workMedicalLocal areaFlexible hours
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Medicare Medical Review Nurse. Be the first to apply!
Related searches
- graphic design remote New York, NY
- remote scrum master New York, NY
- remote document review New York, NY
- remote recruiter New York, NY
- remote infrastructure engineer New York, NY
- genetic counselor remote New York, NY
- remote appointment scheduler New York, NY
- junior angular developer remote New York, NY
- remote video game New York, NY
- global remote customer service jobs New York, NY

