Remote RN Medical Review Specialist II
HCSC
- Remote job
Health Care Service Corporation seeks a Medical Reviewer II to perform accurate and timely medical review of claims suspended for medical necessity, contract interpretation, and pricing. You will initiate or respond to correspondence from providers or members regarding medical determinations, working within Texas and national accounts. The ideal candidate holds an active RN license, with 3 years of clinical experience, and demonstrates strong verbal and written communication along with #J-18808-Ljbffr Health Care Service Corporation
- An established industry player is seeking a Medical Review Nurse to join their dynamic team in Phoenix. This role involves reviewing and adjudicating... ...delivery while enjoying the flexibility of a primarily remote work environment. If you are passionate about making a...Remote job
- Broadway Ventures LLC is looking for a dedicated Registered Nurse (RN) to join its Medical Review team. This remote position involves conducting pre- and post-payment medical reviews and requires an active RN license and relevant clinical experience. Ideal candidates will...Remote jobWork at office
$61.05k - $98.33k
...Itemization Review Nurse II The 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 and...Remote workFull timeWork at officeFlexible hours$62.7k - $100.4k
Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services,... ...(A.S) Completion of an accredited registered nursing (RN) degree program required Three (3) years clinical experience...Remote workHourly payFull timeWork at office$69.3k - $78k
...payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical... .... The position requires an active RN license and a minimum of five years nursing... ...claims and documenting findings, all in a remote work environment. This role offers a...Remote job- Machinify is seeking a Medical Review Nurse II to perform medical claims audit reviews for Government and... ...Commercial Payers. This role requires an active RN license and at least 2 years of relevant experience. The position is remote, and you will be part of a dynamic, multi...Remote job
$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant, we’re focused on helping our clients... ...and Commercial Payers. You will work remotely in a fast paced and dynamic environment... ...Qualifications Active unrestricted RN license in good standing, is required....Remote workFor contractorsWork at officeWork from homeHome officeShift work$23 - $24 per hour
...Medical Billing Specialist II Fully Remote Allied Benefit Systems Overview Salary Range $23.00 - $24.00 Hourly Position Type Full Time Category... ...client invoicing, client setups/changes and rate sheet reviews to ensure timely invoice generation and adherence to key...Remote workHourly payFull time- ...A staffing agency is seeking a Remote Coding Specialist II to work in a fully remote setting. The ideal candidate is a graduate of an approved coding or Health Information Management (HIM) program and must have specific equipment: 2 monitors, a keyboard, and a mouse. Responsibilities...Remote workContract work
- ...Overview Medical Coding Specialist II - Inpatient role at UW Health SwedishAmerican. 100% FTE, day shift, Monday - Friday 7am - 3pm Central. You will work remote. Location: northern Illinois. Responsibilities Inpatient facility medical coding (specific duties...Remote workMonday to FridayDay shift
$65 per hour
...Fully Remote Position Job Title : RN - UTILIZATION REVIEW Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule Shift:... ...Hospital Highlights Type of Facility: Level II Trauma Center Total Staffed Beds: 571 total for...Remote workLocal areaImmediate startMonday to FridayShift workWeekend work- ...ECU Health is looking for a dedicated medical coder to review documentation and assign appropriate diagnosis and procedure codes. This remote position based in Greenville, NC, offers a flexible day shift schedule from Monday to Friday, 8:00 a.m. to 4:30 p.m. The ideal...Remote workMonday to FridayFlexible hoursDay shift
- ...Assurance (QA) and cargo preparation and deployment, to include medical controlled items stored in a secure location, operation of... ...units, AFMED, and NGB/SGX. The ANG SLEP Manager conducts monthly reviews, and provides monthly reports to the COR, of SLEP and DMLSS inventory...Remote workContract workTemporary workFor contractors
- ...Ambulatory Medical Practices MSO, Inc is seeking a Medical Biller Charge Review and Data Entry Specialist III in Valhalla, NY. This full-time position requires CPC certification and a minimum of 7 years of medical billing experience, with Epic EMR preferred. The role...Remote workFull time
- ...Medical Review Specialist We are seeking a detail-oriented Medical Review Specialist to join our remote Document Management Team. This role is ideal for individuals with strong organizational skills and a high level of accuracy in reviewing and handling sensitive medical...Remote work
- ...9 independent contractor. Candidates must hold a California license and have strong negotiation skills. The reviewer will evaluate health claims, provide medical interpretation, and ensure compliance with Concentra's policies and state regulations. This role requires maintaining...Remote jobFor contractorsFlexible hours
- CERIS is seeking an Itemization Review Nurse to analyze medical charges submitted by facilities for accuracy. This remote role requires RN licensure and at least five years of OR/ICU/ER experience. You will review data, document conclusions, and support billing decisions...Remote job
- ...allows customization of schedule and caseload. Candidates must hold a valid NJ license. Responsibilities include reviewing health claims, providing medical interpretations, and ensuring compliance with relevant regulations. The role demands board certification, post-graduate...Remote jobFor contractorsFlexible hours
- ...A healthcare intelligence organization in Florida is looking for a Medical Review Clinical Appeals Auditor (RN) to conduct Appeals reviews and analyze claims data. The ideal candidate must have an active RN license and relevant experience in provider or payer environments...Remote work
- Brighton Health Plan Solutions seeks a Casualty Bill Review Specialist who will ensure accurate and compliant medical bill review in the New York workers’ compensation environment. The role requires expertise in managing bill review processes and training staff on regulations...Remote job
- ...Health Treatment & Recovery in Portland, Oregon seeks a Billing Specialist II responsible for handling claims and authorizations efficiently... ...a coding certification. After 90 days, there is potential for remote work upon supervisor's approval. Solid organizational skills...Remote job
- Medlogix is seeking a full-time Medical Review Specialist to work remotely within the EST zone. The specialist will evaluate medical documentation, ensuring compliance with regulatory standards and supporting quality assurance initiatives. The ideal candidate will have...Remote jobFull time
$95 per hour
Long-Term Care Registered Nurse (VA Reviewer) - Remote (#25278) Location: Remote Employment Type: Contract... ...clinical oversight by reviewing medical cases to assess the quality, timeliness,... ...Licensure Must hold a current, non-restricted RN license in a U.S. state or territory....Remote jobHourly payPrice workContract workPrivate practiceWork at officeFlexible hours- TALENT Software Services is looking for a qualified RN to perform clinical reviews, ensure compliance with medical necessity, and communicate with providers. The role demands strong clinical and computer skills, as well as the ability to work independently. Ideal candidates...
- Empower AI is seeking a Medical Review Specialist III to perform Medicare comprehensive medical record and claims reviews. This casual role requires a Registered Nurse with at least four years of experience, focusing on payment determinations for Medicare PART A services...Casual work
- ...in Portland, Oregon is seeking a Billing Specialist II to join the Finance team. The ideal candidate... ...of 3 years billing experience in a medical field and a coding certification. The role also includes the potential for remote work after an initial period, providing flexibility...Remote work
$20.36 - $24.97 per hour
UNITE HERE HEALTH is looking for a Claims Adjudicator II in Oak Brook, IL, to efficiently manage medical claim processing. You will handle various types of... ...coding. The salary range is $20.36 to $24.97 hourly, with remote work options after initial training. #J-18808-Ljbffr...Remote jobHourly pay- ...position. This role offers flexibility to customize schedules and a per-case compensation model. The physicians will conduct health claim reviews and ensure compliance with Concentra's policies. Candidates must have a TX license, current board certification, and active...Remote job
$69.38k - $92.28k
...MVP Health Care seeks a Professional Concurrent Review RN to ensure members receive appropriate care while navigating the healthcare continuum. This hybrid role allows for independent work alongside collaboration with providers, focusing on enhancing health care delivery...Remote work- A leading medical school is seeking a Disability Reviewer II to lead disability assessments and manage a caseload of applicants. The role requires an RN or a licensed vocational counselor with relevant experience... ...offers the flexibility of remote work and the possibility of...Remote jobFull time
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