Remote RN Clinical Review Specialist
Texas Health Institute
- Remote job
Optum, a UnitedHealth Group company, seeks a Clinical Review Clinician to serve as a subject matter expert for itemized bill reviews and hospital facility bill analysis. You will document, research, and identify adjustments for payment as part of Forensic Reviews for clients. This telecommute-friendly role offers limited supervision within policy, HIPAA confidentiality, and opportunities to impact outcomes. You will join a diverse team with strong benefits and ongoing career development. #J-18808-Ljbffr Texas Health Institute
- ...WNS, part of Capgemini, is seeking a remote RN/LPN for utilization review in the United States. The role involves assessing medical necessity, resolving escalations, and maintaining HIPAA-compliant documentation with HealthHelp policies. Requires active nursing license...Remote workWork at office
- Santa Barbara Cottage Hospital is seeking a PRN Clinical Review Specialist to provide remote clinical review support. You will evaluate medical necessity,... ...inpatient and outpatient services. The role requires an active RN license (compact preferred), 3-5 years of clinical...Remote jobRelief
- UnitedHealth Group's Optum is seeking a Clinical Review Clinician to act as a subject matter expert in itemized bill reviews and hospital facility bills. You will document and research adjustments for Forensic Reviews for specific clients. This role offers telecommuting...Remote job
$50 per hour
...healthcare recruitment agency is seeking a Registered Nurse Clinical Reviewer for a remote to office-based position in Jericho, NY. This role involves... ...has a baccalaureate degree in Nursing and a current NY RN license with at least 3 years of related experience. Competitive...Remote jobWork at office- ...Director of Risk Capture, the Pre-Visit Clinical Review Specialist (CRS) facilitates the accurate and... ...enterprise· Maintains clinical licensure (e.g. RN, PA, NP) and/or coding credentials (e.... ...CONDITIONS: · Primarily a remote work model. Periodic on-site meetings...Remote workWork at office
- ...Working remotely, the Clinical Denials Specialist will review denied claims, analyze denial reasons, and collaborate with healthcare providers to gather documentation... ..., or a related field Clinical designated nurse or RN credentials (denials/CDI) Minimum of 2-3 years of...Remote work
- A health accreditation organization is seeking a Part-Time Clinical Review Specialist who will play a key role in supporting accreditation processes... ...and a background in quality assurance. This role is fully remote, allowing candidates from anywhere in the United States to...Remote workPart time
- ...of home healthcare services. We're seeking an experienced Clinical Review Specialist LPN to join our growing team and ensure every patient's care... ...compliance, and a compassionate touch. Position Details Location: Remote (Weekend only) On‑site Training: Orlando, FL Schedule:...Remote workPart timeWork at officeFlexible hoursWeekend work
- Medica, a nonprofit health plan, is seeking a remote Appeals & Grievances Clinical Specialist III to review and resolve appeals and grievances with clinical oversight... ...clinical staff. This position requires an active RN license and 5+ years of clinical experience, preferably...Remote job
- ...Quality Assurance Specialist, RN Wider Circle is a mission-driven healthcare organization... ...We do this by addressing the social and clinical barriers that get in the way of good care... ...— not a simple checklist job. You will review patient charts, design and run the QA...Remote workPermanent employmentLocal area
- ...healthcare accrediting organization is looking for a Full-time Clinical Review Specialist who will support the accreditation process for community... .... Strong communication skills and the ability to work remotely are essential. Traveling 15-20% will be required. #J-18808...Remote jobFull time
- ...Job Summary The Registered Nurse (RN) – Clinical Operations Specialist supports providers and clinical... ...appropriately based on clinical need. Review and route laboratory results,... ...Support Chronic Care Management, Remote Patient Monitoring, Transitional Care...Remote workWork at office
- ...currently recruiting a personable and detail-oriented Full-time Clinical Review Specialist to perform the associated duties which support and... ...Must be willing to travel (15-20%) This position is 100% remote and can be located anywhere nationwide. In order to be considered...Remote workFull timeWork at office
- AuraOne is seeking a Psychology Expert to remotely evaluate AI outputs that touch clinical review. You will review guidelines, grade reasoning, and flag patient-safety concerns, documenting corrected reasoning for model improvements. The role requires current clinical licensure...Remote jobFor contractors
- An established industry player is seeking a Clinical Editor/Proofer Registered Nurse for a remote role in New York. This unique position blends clinical expertise... ...dispute resolutions. You'll be responsible for reviewing case documents, making necessary edits, and...Remote job
- MES Solutions seeks a Clinical Quality Assurance Coordinator to review peer reports from a fully remote role based in Norwood, MA. You will ensure accuracy, regulatory compliance... ...clients. The ideal candidate has an active RN license, 2+ years clinical experience, and...Remote jobMonday to Friday
$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the Appeals and Grievances Clinical Specialist - RN, LPN... ...effectively with colleagues and prepare cases for review and appeals. Minimum Qualifications: RN, LPN, or...Remote jobFull timeMonday to FridayShift work- Myaegis is hiring an Oasis / Coding Review Specialist in Mesa, AZ. This full-time role involves reviewing clinical charts, supporting quality improvement initiatives, and coaching... ...candidate has a healthcare background (LPN, RN, PT, or PTA) and must possess strong...Remote jobFull time
- AuraOne seeks a Remote Recreational Therapist to review AI outputs for clinical review, grade reasoning and dosing, and flag safety issues. This is a contractor role focused on ensuring guideline adherence in regulated workflows. You will work asynchronously, applying a...Remote jobFor contractors
- Molina Healthcare is seeking a registered nurse with inpatient claim review experience to ensure diagnoses, procedures, revenue codes, and DRG assignments accurately reflect the documented care and billed charges. You will apply ICD-10, DRG and revenue code guidelines,...Remote job
- ...Registered Nurse (UMRN) to work entirely from home in a fully remote role. The nurse will review cases, educate patients on appropriate care, and manage... ...a Monday-Friday schedule of 8 hours per day, requiring an RN with a Bachelor's degree, state licensure, and CPUR/CCM...Remote jobWork from homeMonday to Friday
- A leading IT services company is seeking a candidate for a medical review role in Columbus, Ohio. The position involves reviewing Case Report Forms and managing various clinical studies, with a focus on adverse event reporting and medical communication. Candidates should...
- ...telephonic and e-Referral case review and authorization of services... ...provide quality care appropriate to clinical needs. Responsible for... ...position is full-time, fully remote (work from home) and requires... ...of Michigan clinical license (RN, LMSW, LP, LPC, or LLP) required...Remote workFull timeWork from homeShift workWeekend workAfternoon shift
- St. Luke's University Health Network is seeking a Clinical Triage Specialist (RN) to provide compassionate patient triage and clinical support in the... ...to triage calls and coordinate care per protocols. Remote work from home option available; requires PA/NJ nursing licensure...Remote jobWork from home
- ...NeighborHealth’s SCO RN UM Reviewer role is based in East Boston within the Senior Care Options team. You will review clinical appeals and service authorization needs to ensure medical necessity aligns with CMS standards and organizational determinations. The role requires...Remote work
- ...experienced nursing professionals to review medical records and ensure... ...Candidates must have a valid California RN license and at least two years of clinical experience or a Master's degree in... ...related field. The position offers remote work with emphasis on critical thinking...Remote work
- ...managing customer inquiries and ensuring compliance in the health insurance domain. Candidates must have a minimum of 2 years of clinical experience or related health care practice and hold a relevant license to practice in Arizona. This role involves analyzing customer...Remote job
- Concierge Home Care is seeking an experienced Utilization Review Specialist (RN) to join our remote home health team. This role emphasizes OASIS review, coding accuracy, QA, and remote documentation audits. The ideal candidate holds an active Florida RN license, OASIS certification...Remote job
$26.41 - $51.49 per hour
...Must reside in Florida Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that... ...of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice...Remote workHourly payWork experience placementWork at office$46.6 - $77.67 per hour
...Clinical Transition Educator With the nation's largest home infusion... ...Combination of in-person and remote patient education Job... ...increases, scheduling, performance reviews, discipline, etc.) Basic Education... ...Registered Nurse (RN) license required. Minimum...Remote workPart timeLocal areaFlexible hoursWeekend work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN Clinical Review Specialist. Be the first to apply!


