Remote RN: Medical Claims Review Specialist
Broadway-Ventures
Broadway Ventures is looking for a dedicated Registered Nurse (RN) to join its Medical Review team. This remote role involves conducting pre‑ and post-payment medical reviews, ensuring compliance with clinical criteria. The ideal candidate should have an active RN license, an Associate Degree in Nursing, and at least two years of clinical experience. Responsibilities include reviewing complex claims and educating teams on processes. The company supports remote work and provides necessary equipment. #J-18808-Ljbffr
- ...established industry player is seeking a Medical Review Nurse to join their dynamic team in... ...involves reviewing and adjudicating medical claims, ensuring compliance with industry standards... ...enjoying the flexibility of a primarily remote work environment. If you are passionate...Remote workMedical
- A healthcare services firm based in the US is seeking a remote Medical Claim Review Nurse. In this role, you will conduct clinical reviews of medical... ...of experience in clinical appeals review and an active RN license. This full-time position offers a structured schedule...Remote workMedicalFull time
- ...Ventures is looking for a dedicated Registered Nurse (RN) to join its Medical Review team. This remote role involves conducting pre‑ and post-payment... ...experience. Responsibilities include reviewing complex claims and educating teams on processes. The company supports...Remote workMedical
- ...Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle... ...duties as assigned. Location & Status Remote USA; work from home office. Full time,... ...; organize information and access to medical documentation. Audit all aspects of...Remote workMedicalFull timeWork at officeWork from homeHome office
- ...A healthcare organization is seeking a Clinical Services Specialist RN to perform reviews of patient records for medical necessity compliance. This full-time role involves analyzing records according to policies and facilitating communication with various stakeholders....Remote workMedicalFull timeWork from home
$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX Agency: Mindlance Health... ...contact and will include 80% travel. Remote role. Will require a driver’s license.... ...partner with top-tier hospitals and medical institutions nationwide, helping you...Remote workMedicalHourly payFull timeContract workImmediate startShift work3 days per week- ...Institute is seeking a Concurrent Review Case Manager responsible for... ...and documentation of medical treatments, ensuring guidelines... ...higher and have an active Texas RN license, along with 5+ years of... ...concurrent review. The role allows for remote work flexibility across the U....Remote workMedical
- ...P3 Health Partners in Henderson, NV is seeking an RN Concurrent Review to ensure compliance with the Medical Management Program. The role may be hybrid or fully remote, with competitive hourly rates based on experience. The successful candidate will have at least two years...Remote workMedicalHourly pay
- ...A national healthcare organization is searching for Clinical Utilization Review Nurses (RN) based in Alabama. This full-time, remote position involves assessing the medical necessity and quality of healthcare services. Candidates must have a BA/BS in Nursing and an active...Remote workMedicalFull time
- ...Management Council, Inc is looking for a Remote RN to join their team. The role requires 2 years of RN experience and Utilization Review expertise, supporting various units in a... ...flexible scheduling with benefits that include medical, dental, and retirement contributions...Remote workMedicalWork from homeFlexible hours
$30.5 - $59.47 per hour
...Molina Healthcare is seeking a Clinical Reviewer to provide support for medical claim and internal appeals review activities in North Las Vegas, NV. This role... ...including utilization review, along with a valid RN license in Nevada. The position involves facilitating clinical...MedicalHourly pay- ...Providence is seeking an RN for a remote Utilization Review role. This per diem position involves conducting prospective, retrospective, and concurrent... ...experience. Responsibilities include daily clinical reviews and assessments of medical records. #J-18808-Ljbffr...Remote workMedicalDaily paid
$28.94 - $51.63 per hour
...Association Inc is seeking a Clinical Appeals RN to manage appeals and grievances... ...proficiency with Microsoft Office. You will review medical records, assess clinical eligibility for... ...with all regulations while working remotely from anywhere in the U.S. Attractive benefits...Remote workMedicalHourly payWork at office- ...Services is seeking a Clinical Review Nurse I for Medicare Part A, primarily... ...be responsible for reviewing claims and ensuring they meet members' benefits based on medical policy. Qualifications include... ...'s degree in nursing, an active RN license, and at least one year of...Remote workMedical
- ...A regional healthcare provider in Houston is seeking a Utilization Management Review Nurse. This role involves evaluating the appropriateness of medical services based on necessity and promoting quality care outcomes. The candidate must have a Bachelor's in Nursing and...Remote workMedicalFlexible hours
- ...COMAGINE HEALTH is seeking Clinical Utilization Review Nurses (RN) for a full-time remote position focused on assessing the medical necessity of healthcare services in Alabama. Candidates must hold an active RN license and possess a BA/BS in nursing, alongside a minimum...Remote workMedicalFull time
$84.06k - $118.67k
...seeks a Licensed Registered Nurse for a remote position in Utilization Management. The... ...admissions and discharge planning, conducting reviews for medical necessity, and assisting with coding and claims issues. Candidates must hold an RN license from the Texas Board of Nursing...Remote workMedical- ...A health organization is seeking a Registered Nurse (RN) to perform clinical review and QIDP work remotely. The ideal candidate will assess medical necessity according to Alabama Medicaid guidelines and possess a current RN license in Alabama, along with a BA/BS in Nursing...Remote workMedical
- ...Administration, Inc. is seeking an RN Clinician to provide utilization management services in a remote role from Virginia. The ideal... ...include prior authorization reviews, care coordination, and managing... ...denied. In addition to competitive medical benefits, the position offers...Remote workMedical
- ...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... ...review, and a valid RN license in Florida or Kentucky...Remote workMedicalFull time
$28.37 - $36 per hour
...Acentra Health, LLC is seeking a Clinical Reviewer - RN - PRN (Remote U.S.) to interpret patient records, ensuring medical necessity and appropriateness of care. Ideal candidates will possess an RN license and relevant clinical experience. This position offers flexible...Remote workMedicalReliefFlexible hours- ...qualified registered nurse to join their utilization review team. This remote position requires an active Georgia RN license and experience in a healthcare setting,... ...evaluating patients for admission, documenting medical conditions, and communicating clinical information...Remote workMedical
- ...Providence Health & Services is hiring a Utilization Review RN for a remote position focused on administering medical management programs, including prior authorization and review processes. Candidates must have a strong clinical nursing background with 5 years of experience...Remote workMedical
$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 findings, and communicating with claims examiners. Candidates must have a current RN license and at least four years of...Remote workMedical- ...nonprofit organization is seeking a Registered Nurse (RN) to perform Clinical Review work and QIDP reviews. This remote position requires an active RN license in Alabama... ...include applying Medicaid criteria to determine medical necessity, completing reviews within established...Remote workMedical
- ...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 workMedicalFull time
- ...company is seeking a Registered Nurse (RN) Intern to conduct clinical reviews and support healthcare initiatives. This... ...military spouses, providing key training in a remote work setting. Key responsibilities include performing medical necessity reviews, documentation, and...Remote workMedicalInternship
- ...A leading medical service provider in Washington, DC is seeking a DME Medical Reviewer to ensure compliance with nursing standards and provide... ...candidate must hold an active RN license and have at least two... ...audits. The role emphasizes remote work capabilities and...Remote workMedical
- ...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 workMedicalFull time
$80k
...Liberty Healthcare Corporation Career Center is looking for a full-time Clinical Reviewer to join their team. This remote-first role involves reviewing medical records, conducting analyses, and writing objective reports. In addition to a competitive annual salary of $...Remote workMedicalFull time
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