Remote RN: Clinical Claims Review & Compliance
UnitedHealth Group
The IRR Clinical Claim Review Nurse at UnitedHealth Group performs claim reviews to verify coding and charges, researching guidelines to determine claim viability. This role suits professionals with clinical experience and a solid understanding of the claim review process.
Based in Plymouth, MA with a full-time day shift, the position supports remote work anywhere in the U.S. while complying with HIPAA, state and federal regulations.
#J-18808-LjbffrVacancy posted 2 hours ago
Similar jobs that could be interesting for youBased on the Remote RN: Clinical Claims Review & Compliance in Massachusetts vacancy
$29 - $52 per hour
...Program Integrity Clinical Compliance Auditor Optum Insight... ...performing compliance reviews of medical and administrative... ...providers who submit claims for payment. This... .... This position is Remote in Massachusetts. You... ...~ Nurse licensure (RN or LPN) with a current...Remote jobClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work- ...CVS Health is seeking a Clinical Claims Review Nurse to interpret clinical documentation and apply decision... ...cases. The ideal candidate has RN licensure with 2–3 years of RN... ...hold a bachelor’s degree. This full-time, remote position is based in North Dakota. #J...Remote workClaimsFull time
CVS Health Corporation
North Dakota2 hours ago - UnitedHealth Group seeks a Clinical Review Clinician to act as a subject matter expert in itemized bill reviews... ...team preparing Forensic Reviews for clients. Remote work is available nationwide, with responsibilities spanning claim review, medical record evaluation, and...Remote jobClaims
- UnitedHealthcare, part of the UnitedHealth Group family, invites you to join as a SSBV Clinical Claims Review RN. This role is a multifaceted position with autonomy and responsibility, focusing on administrative reviews of inpatient hospital claims and documenting determinations...Remote jobClaimsWork at office
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims, document determinations, and maintain screening criteria. This multifaceted role offers telecommuting from anywhere in the U.S. and...Remote jobClaims
- ...Description The utilization review and management (UM)... ...medically necessary, clinically appropriate, evidence-... ...supporting regulatory compliance and organizational... ...and documentation of claims along the process chain... ...This is an in-office, no remote work capability...Remote workClaimsWork at office
MedTrust LLC
Oklahoma City, OK3 days ago $31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a... ...-quality care, regulatory compliance, and improved member outcomes... ...This is a 100% remote role, and requires robust... ...authorization data with post-service claims validation, we're creating...Remote workClaimsFull timeFlexible hoursShift workVenturefizz Product Management Community
United States12 hours ago$28.94 - $51.83 per hour
...Ssbv Clinical Claims Review Rn Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits...Remote jobClaimsHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal areaHome office$29 - $52 per hour
...Clinical Review Clinician Optum is a global organization that delivers... ...comprehensive understanding of the claim review process including... ...~ Active and unrestricted RN license OR LPN in the state of... ...with billing, charge master and compliance Experience working with...Remote jobClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal area- ...Optum Waste and Error Claims Investigator Optum is a global organization... ...of the claim for further review in a production environment.... ...Primary Responsibilities: Clinical Case Reviews - 75% Perform... ...to state and federal compliance policies, reimbursement policies...Remote jobClaimsContract workWork at officeLocal areaMonday to Friday
$93.35k - $132.43k
...First (Days) Overview: Sentara Health Plans is hiring a Clinical Claims Reviewer/ RN - Remote! Status: Full-time, permanent position (40 hours)... ...referrals to Medical Directors as appropriate. Ensures compliance with health plan policy and other regulatory agencies such...Remote workClaimsPermanent employmentFull timeTemporary workWork at officeShift work- ...is seeking a Nurse Reviewer to perform complex medical... ...Part A/B and DMEPOS claims. The role requires clinical judgment to assess... .... The position is remote, offering... ...medical standards. An RN license and 2-4 years... ...documentation skills and HIPAA compliance. #J-18808-Ljbffr...Remote jobClaims
- ...Inland Empire Health Plan is seeking a Claims Review Nurse, LVN to perform timely medical reviews of facility and professional claims.... ...identify improvements in the UM/Claims interface and support clinical determinations under supervision, helping IEHP meet quality goals...Remote workClaims
Inland-Empire-Health-Plan-
Rancho Cucamonga, CA2 hours ago - ...leading healthcare intelligence company. The Medical Review Nurse II audits home health claims, working remotely with a multi-location team to ensure compliance and high-quality documentation. The role emphasizes strong clinical judgment, coding accuracy, and regulatory...Remote jobClaimsWork from home
$69.3k - $78k
...integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and... ...The position requires an active RN license and a minimum of five years... ...documenting findings, all in a remote work environment. This role...Remote jobClaims$25 - $35 per hour
...Companies is seeking a Clinical Appeals Nurse to... ...for a contract remote opportunity... ...the appeals team, reviewing complex cases, ensuring regulatory compliance, and supporting accurate... ...necessary claim adjustments. • Identify... ...Registered Nurse (RN) license in the State...Remote workClaimsHourly payContract workPiper Companies
United States5 days ago$112.7k - $193.2k
...Associate Director of Clinical Operations is... ...Clinical Itemized Bill Review (IBR) operations supporting... ..., support accurate claim adjustments, and ensure compliance with CMS guidelines... ...flexibility to work remotely * from anywhere... ...unrestricted Registered Nurse (RN) license 5+ years...Remote jobClaimsMinimum wageFull timeWork experience placementLocal area$70k - $80k
...Companies is seeking a Clinical Appeals Nurse for a fully remote healthcare-based... ...focused on clinical review, appeal resolution, regulatory compliance, and member/provider... ...facilitating necessary claim corrections and adjustments... ...Registered Nurse (RN) license in the State...Remote workClaimsLong term contractZP Group
Raleigh, NC3 days ago$26.01 - $68.55 per hour
...About This Role The Clinical Claims Review Nurse at CVS Health is responsible... ...1 - $68.55/hour Location: Remote, ND Schedule: Full-time... ...internal workflows to ensure compliance. Requirements Education Nursing degree (RN) required Bachelor’s degree...Remote workClaimsFull timeCVS Health Corporation
North Dakota2 hours ago- ...Clinical Review Nurse - RemoteARC Group has multiple positions open for Clinical... ...! These positions are 100% remote. These are direct hire FTE... ...as to the validity of health claims and levels of payment in... ...unrestricted Registered Nurse (RN) licensePreferred Qualifications...Remote workClaimsPermanent employmentWork at officeLocal area
American Recruiting & Consulting Group
Jacksonville, FL3 days ago - MES Solutions is seeking a Clinical Quality Assurance Coordinator (RN/LPN) to review peer reports and ensure accuracy, compliance with client agreements, and regulatory standards. This 100% remote role aligns clinical expertise with quality control across cases. The position...Remote jobMonday to Friday
$2,300 per month
...The Clinical Review Nurse (RN) supports the organization’s care management function by conducting clinical... ...of medical services, and maintaining compliance with regulatory and plan-specific... ...outcomes for members. This is a remote role open to candidates residing in Utah...Remote workPart timeWork at officeMotivHealth
Utah9 hours ago- ...The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review... ...communication skills. Advanced Remote EMR access is essential as... ...Licenses/Certifications RN - Registered Nurse - State...Remote workClaimsFull timeWork at office
**Talteam Inc.
Baltimore, MD14 days ago - Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical... ...revenue cycle operations by reviewing denied claims for clinical accuracy and... ...reimbursement outcomes, and ensuring compliance with payer policies and...Remote workClaims
$40 per hour
...-30 hours week) - Remote Work Environment... ...Supports Medical Review Services. The Nurse... ...reviews for Medicaid claims. This involves... ...records to ensure compliance with established guidelines... ...regulations. The RN will work closely... ...0, CPT and HCPCS Clinical criteria (...Remote workClaimsContract workWork at officeLocal areaImmediate start- ...Registered Nurse: Review and EvaluationAre you a registered... ...integrity through compliance management. Here, you'... ...role, you'll use your clinical knowledge outside of the... ...setting to review and audit claims, support program... ...unrestricted Registered Nurse (RN) licenseStrong clinical...Remote workClaimsWork from home
The CKHobbie Group
Pittsburgh, PA3 days ago $69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant,... ...primarily performs medical claims audit reviews. As a... .... You will work remotely in a fast paced and dynamic... ...Active unrestricted RN license in good... ...contractor and subject to compliance with client...Remote workClaimsFor contractorsWork at officeWork from homeHome officeShift work- ...healthcare platform, the full-time Medical Review Nurse will ensure compliance with CMS regulations for durable... ...data security while working remotely. Key Responsibilities Review DMEPOS... ...utilization management reviews, or claim audits Proficiency with medical review...Remote workClaimsFull timeFlexible hours
Virtual Vocations Inc
United States3 days ago - ...evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex... ...responsibilities Perform clinical assessments and... ...treatment utilization, and compliance Collaborate with physicians, claims examiners, and other stakeholders...Remote workClaimsFull timeWork experience placement
Virtual Vocations Inc
United States2 days ago - ...healthcare staffing company is seeking a Clinical Review Nurse for Prior Authorization Review. This remote role demands conducting reviews,... ...collaborating with healthcare teams, and ensuring compliance. Candidates need an active RN license and 2–4 years experience in...Remote workContract work
SPECTRAFORCE
Washington DC14 hours ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN: Clinical Claims Review & Compliance. Be the first to apply!
Related searches