Remote RN Medical Reviewer for Medicare Claims & Compliance
Broadway Ventures LLC
- Remote job
Broadway Ventures is seeking a Medical Reviewer (1099 contract) on a remote basis for the United States. The role involves reviewing PCR packages for Medicare coverage and coding, documenting outcomes with clinical rationale, and engaging with providers as needed. Start date December 2026. A strong focus on accuracy and QA is required. Minimum RN licensure and 2+ years in clinical work, including home health or utilization review, are essential; ICD coding proficiency is a plus. #J-18808-Ljbffr Broadway Ventures LLC
- ...Broadway Ventures is seeking a dedicated Registered Nurse (RN) to join our Medical Review team in a remote role. You will conduct pre- and post-payment medical reviews to ensure criteria compliance, assess medical necessity and reimbursement eligibility, and document...Remote workClaims
- ...Registered Nurse: Review and EvaluationAre you a registered... ...integrity through compliance management. Here, you'... ...nursing judgment to analyze medical records, documentation,... ...Registered Nurse (RN) licenseStrong clinical... ...improvement, compliance, or claims review is a plus—but...Remote workClaimsWork from home
- ...seasonal project, the part-time hourly Medical Reviewer, Coder will perform automated and complex reviews of Medicare Fee-for-Service claims, ensuring compliance with Medicare policies and documenting findings accurately in a remote environment. Key responsibilities...Remote workClaimsHourly payPart timeWork experience placementSeasonal work
- ...Summary Performs medical reviews using clinical/medical information... ...support and review of medical claims and utilization practices.... ...Location: This is a full-time remote (40-hours/week) working an 8... ...License and Certificate: Active RN licensure in state hired OR...Remote workClaimsFull timeFor contractorsWork experience placementWork at officeLocal areaWork from homeMonday to FridayShift work
- ...Certified Coder performs coding-focused medical review of Medicare Part A/B and DMEPOS claims for the program. Certified coders... ...or underpayments, and confirm compliance with Medicare policy. ~3+ years... ...and productively in a remote, technology-driven, queue-based claims...Remote workClaimsContract workLocal area
$78k - $85k
Overview Medicaid Medical Review RN (Medical Reviewer III) - REMOTE The Medicaid Medical Review RN (Medical Reviewer... ...In addition, this position applies Medicare and Medicaid guidelines in making... ...information contained in Standard Claims Processing System files (e.g., claims...Remote workClaimsFor contractorsH2bH1bWork at officeLocal areaHome office- Gainwell Technologies is seeking a Medical Reviewer (Radiologist) to provide physician-... ...You will review radiology-related claims, TARs, and medical records to ensure medical necessity and program compliance. The role is fully remote in California with a Monday-Friday...Remote jobClaimsMonday to FridayFlexible hours
$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. You will collaborate with... ...promptly. The role supports remote work in approved US states, offers a...Remote jobClaims- ...Solutions is seeking an Appeals Nurse (RN) to review medical records and claims for first-level appeal cases, determining medical necessity and Medicare coverage compliance. The RN collaborates with... ...manner. This position supports remote work in approved states, including...Remote jobClaims
- A leading medical service provider in Washington, DC is seeking a DME Medical Reviewer to ensure compliance with nursing standards and provide comprehensive... ...must hold an active RN license and have at least two... ...audits. The role emphasizes remote work capabilities and adherence...Remote job
$42 per hour
...Management Department (Fully Remote) Provides health care... ...planning and utilization review. Reviews admissions and... ...concurrent and retrospective medical necessity and/or compliance with reimbursement policy... ..., reimbursement and claim denials/appeals. Assesses...Remote jobClaims- ...Quality Assurance / Compliance Registered Nurse (QI/QA/Compliance RN) is responsible for... ..., Federal Tort Claims Act (FTCA) standards... ...rural, frontier, and remote healthcare environments... ..., patient‑centered medical home (PCMH), and... ...in peer review and clinical case review...Remote workClaimsWork at office
- ...insurer and DoD contractor, seeks a Claims Examiner III LPN to safeguard... ...with data analysis to assess medical necessity, detect unusual... ...compliant benefits administration. Remote work options are available... ...position requires U.S. citizenship, RN or LPN licensure, and 3+ years...Remote jobClaimsFor contractors
- ...North America seeks a Telephonic Nurse Case Manager (Remote) with a Florida RN license to lead medical claim management and facilitate cost-effective return-to... ...services while maintaining privacy and regulatory compliance. The role requires independent decision-making, 3+...Remote jobClaims
- ...program integrity through compliance management. Here, you... ...bedside setting to review and audit claims, supportprogram... ...judgment to analyze medical records, documentation... ...unrestricted Registered Nurse (RN) license Strong... ...populations Remote work - enjoy the convenience...Remote workClaimsFull timeTemporary workWork at office
- ...Description The utilization review and management (UM)... ...facilities are medically necessary, clinically... ...supporting regulatory compliance and organizational risk... ...and documentation of claims along the process chain... ...This is an in-office, no remote work capability position...Remote workClaimsFull timeWork at office
- ...Brighterway builds AI-native claims software and administration for... ...in workers' compensation medical-legal review, where our agentic document pipeline... .... What we look for Active RN license and 5+ years of... ...opportunity employer. Location: Remote (United States) Employment type...Remote workClaimsFull timeFlexible hours
- ...coordination or utilization review. It is clinical risk... ...at the intersection of claims, underwriting, and... ...claim notices and claimant medical records to identify... ...~ Active, unencumbered RN license; compact state... ...strongly preferred given the remote and multi-state nature...Remote workClaimsFull timeTemporary work
- ...a subject matter expert in medical coding and DRG validation, playing... ...coding accuracy, regulatory compliance, and appropriate... ...conduct detailed retrospective claims reviews, provide expert-level coding... ...who thrives in a fast-paced, remote environment and is passionate...Remote workClaimsFull timeWork at officeWork from homeHome office
$96k - $132k
...Specialist is responsible for reviewing inpatient medical records to ensure accurate,... ..., completeness, and compliance. • Maintain an accuracy rate... ...skills Work location: Remote-United States Travel: May... ...recruitment schemes that falsely claim to represent Solventum and...Remote workClaimsH1bWork at officeRelocation packageFlexible hours$30 - $40 per hour
...Certified Medical Coder The Certified Medical... ..., while ensuring compliance with state-... ...requirements. Performs review of all coding... ...reimbursement. *This is a remote role. We are only... ...required for WC claims. Support WC-... ...as Commercial and Medicare pain management coding...Remote workClaimsHourly payWork at office$150k - $180k
...Risk Control Specialist, RN About Alera Group... ...service strategies based on claims data, loss trends,... ...assessments and operational reviews to evaluate business... ...Knowledge of medical malpractice, healthcare... ...Arrangement This position is Remote ~ Remote: This role...Remote workClaimsFull timeWork at officeLocal area- ...Health, Inc. (Wellpoint Federal) is seeking a Clinical Review Nurse I to review medical determinations for claim benefits. This virtual-eligible role requires... ...1 year of clinical experience plus an unrestricted RN license. Residency in the US is required. #J-18808-...Remote jobClaimsWork at officeFlexible hours
- J29, Inc. is seeking a Medical Reviewer, Coder for a temporary seasonal role conducted remotely. The position involves reviewing Medicare FFS claims to determine proper payments and identify overpayments or underpayments, aligned with RAC guidance. Applicants should have...Remote jobClaimsTemporary workSeasonal work
- ...Corporation Jobs in United States Senior Compliance Corrections Specialist Privacy &... ...Clinical Operations - Behavioral Health UM Medicare Compliance Advisory Project Manager II Manager... ...Enterprise Engagement Officer Director, Claims Business Implementation Manager, Payment...Remote jobClaims
$70k - $120k
...Fully Remote: Clinical Documentation Specialist Facilitate the... ...concurrent and retrospective reviews of medical records to ensure accurate documentation... ...improvement. Ensure compliance with regulatory requirements... ...Registered Nurse (RN) with a current license from...Remote workLocal areaMonday to Friday- Optum is seeking a Clinical DRG RN auditor who will validate ICD-10-CM/PCS codes and DRG assignments for inpatient claims. You will write clear rationales and use proprietary tools... ...accurate reimbursements. The role supports remote work from anywhere in the U.S. and requires...Remote jobClaims
- UnitedHealth Group is seeking a Senior Inpatient Medical Coder for a fully remote role. You will encode inpatient hospital claims, ensure DRG accuracy, and maintain compliance with AHIMA/AAPC guidelines. Strong trauma center experience and ICD-10-CM/PCS expertise are required...Remote jobClaims
- ...assesses their current medical status, applies appropriate... ...injured person, the claim’s examiner, employers,... ..., unencumbered compact RN license required Bilingual... ...Wisconsin Contract Compliance Law (§16.765). Poster link... ...Law Poster #LI-Remote #J-18808-Ljbffr ParadigmRemote workClaimsFull timeContract workPart timeFor contractorsLive inLocal areaFlexible hoursShift workNight shiftWeekend workAfternoon shift
- ...Optum Waste and Error Claims Investigator Optum... ...the claim for further review in a production environment... ...facility) claims vs. medical records to determine... ...to state and federal compliance policies, reimbursement... ...knowledge of Medicaid/Medicare Reimbursement...Remote jobClaimsContract workWork at officeLocal areaMonday to Friday
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