Remote RN - Clinical Claim Review & Compliance Auditor
Texas Health Institute
- Remote job
Optum Insight is seeking a Clinical Claim Review RN to perform compliance reviews of medical and administrative documentation to identify fraud or wasteful practices. The role involves site visits, desk audits, and collaboration with a team of auditors to document findings and input data into audit systems. The position is full-time (40 hours/week) with remote work options in Massachusetts and potential overtime. Training is provided and hours align with 8:00 am–5:00 pm local time. #J-18808-Ljbffr Texas Health Institute
- UnitedHealth Group seeks a Clinical Review Clinician to analyze itemized hospital bills and document adjustments... ...U.S. The role requires clinical experience, RN or LPN license, and bill review knowledge. You will support claims through research and QA until client-ready....Remote jobClaims
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims and document... ...U.S. while maintaining rigorous screening criteria and compliance with state/federal requirements. Qualified candidates will...Remote jobClaims
- ...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
$29 - $52 per hour
...Program Integrity Clinical Compliance Auditor Optum Insight is improving... ...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 workClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work- UnitedHealth Group seeks an experienced SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims. The role requires documenting determinations and maintaining screening criteria, contributing to efficient, compliant health...Remote jobClaims
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims and to document all determinations. The role emphasizes adherence to Federal, State and client requirements in a telecommuting setting...Remote jobClaimsHome office
- UnitedHealth Group is seeking a Clinical Review Clinician to serve as a subject matter expert for itemized bill reviews and hospital facility... ...Forensic Reviews for clients. Role involves understanding claim review processes, medical record review, and applicable billing...Remote jobClaims
- Optum is hiring a Clinical Review Clinician to act as a subject matter expert for itemized bill reviews and hospital facility bills. The role includes documenting, researching, and identifying adjustments needed for payment as part of a team preparing Forensic Reviews for...Remote jobClaims
- UnitedHealth Group seeks a Clinical Review Clinician to serve as a subject matter expert for itemized bill reviews and analysis of hospital... ...is supported from anywhere in the U.S. The position requires RN or LPN licensure, 2+ years clinical experience, and 1+ year bill...Remote jobClaims
- UnitedHealth Group seeks a Clinical Review Clinician to serve as the subject matter expert for itemized bill reviews and analysis of hospital... ...within a broad policy framework and must understand the claim review process, clinical review, medical record review, and billing...Remote jobClaims
- ...Registered Nurse to perform medical review of complex claims, pre-authorization requests,... ...referrals. You will apply clinical expertise and established guidelines... ...determinations. The role is remote and full-time, requiring an active RN license and at least two years...Remote jobClaimsFull time
- UnitedHealth Group is seeking a SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims, documenting determinations and maintaining screening criteria. The role supports telecommuting from anywhere in the U.S. and requires...Remote jobClaimsWork at office
- ...Medical Review Nurse - Home Health Auditor Machinify is a leading healthcare... ...performs medical claims audit reviews with a... .... You will work remotely in a fast-paced and... ...Cross train in all clinical departments/areas.... ...active/unrestricted RN license) is required...Remote workClaimsWork at 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 workClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal area- DaMar Staffing is seeking a Registered Nurse (RN) to review and evaluate medical necessity, appropriateness, quality, and compliance of services rendered by providers. The role covers claims analysis, provider audits, fraud detection, and regulatory enforcement to ensure...Remote jobClaims
$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 work- ...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
$92.4k - $133.67k
...Supervises a team of auditors that participate... ..., operational, compliance, or information technology... ...and subsequent reviews of Primary Care... ...safe and effective clinical services.... ...required. ~ California RN license in good standing... ...Mode: Partially Remote An annual...Remote workContract workLocal areaHome office- ...Optum Waste And Error Claims Investigator Optum... ...the claim for further review in a production environment... ...Responsibilities: Clinical Case Reviews - 75%... ...to state and federal compliance policies, reimbursement... ...Certified Outpatient Auditor (COC) Certified Professional...Remote jobClaimsContract workWork at officeLocal areaMonday to Friday
- ...training curricula for clinical audit nurses and audit... ...IPF and IRF claim review, documentation requirements... ...effective delivery in a remote environment.... ...including: the 60%/75% compliance rule and qualifying conditions... ...vs. SNF — and train auditors to apply those distinctions...Remote workClaimsFull timeWork at office
- ...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
$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- ...Job Title: Clinical Review Nurse - Concurrent Review Location: Remote -Anywhere in US Shift : Tuesday - Thursday 9:30 am... ...supplemental information to resolve denial claims Assists with issues and/or... ...Licensure Required: LPN or RN, active in any state Preferred...Remote workClaimsLocal areaShift work
$86.8k - $124k
...Summary The Clinical Policy Specialist – Itemized Bill Review is responsible for... ...facility billing, UB-04 claim processing, itemized... ...to ensure compliance and program alignment... ...Active, Unrestricted RN license from the United... ...role Location: Remote (U.S.-based) Travel...Remote workClaimsFull timeFlexible hours- ...Clinical Review Nurse - Remote ARC Group has multiple positions open for Clinical Review Nurses! These... ...determinations as to the validity of health claims and levels of payment in meeting... ...Valid unrestricted Registered Nurse (RN) license PREFERRED QUALIFICATIONS * Inpatient...Remote workClaimsPermanent employmentWork at officeLocal area
- NTT DATA, Inc. in Tampa, Florida seeks a BPO Clinical Review Specialist to perform clinical and medical necessity... ...for Medical Director review, ensuring compliance with NCQA standards and Medicaid guidance. This remote Florida role offers benefits including medical,...Remote job
$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- ...Insurance is seeking a Senior Analyst, SIU Clinical Investigator to detect and audit aberrant billing patterns in claims and clinical documentation. You will review medical records to ensure alignment... ...recovery or referrals. This is a remote role with NYC/Tempe office options....Remote jobClaimsWork at office
$59.3k - $80.9k
...Medical Coding Auditor The Medical Coding Auditor reviews medical claims submitted against medical records... ...documentation for clinical indicators to ensure specific... ...reviews to ensure compliance with coding guidelines... ...Work Style: Remote, work at home. While this...Remote workClaimsBi-weekly payContract workTemporary workWork at officeWork from homeHome officeMonday to Friday$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 workClaimsHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal areaHome office
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