Remote RN Claims Reviewer: Utilization & Post-Pay
Sentara Health
Sentara Health Plans is hiring a Clinical Claims Reviewer/RN for a remote role. This full-time position involves utilization management and post-payment review across various care settings, with RN licensure and coding credentials under consideration.
The role offers remote opportunities across multiple states, including NC, VA, and others, with standard hours from 8am to 5pm EST, M-F. A BSN and 3 years acute care experience are required.
#J-18808-Ljbffr- ...Sentara Health Plans is seeking a Clinical Claims Reviewer/RN for a remote, full-time position. Responsibilities include utilization management, pre/post payment claim reviews, and authorization assessments across inpatient and outpatient cases, with regulatory compliance...Remote workClaimsFull time
- ...Sentara Health Plans is seeking an RN Clinician for remote utilization management and claims review. You will perform pre/post payment reviews, authorizations, and post-payment inquiries in a compliant manner with NCQA, CMS, DMAS guidelines. Requires a BSN and 3 years...Remote workClaims
$68.64k - $72.8k
...Overview: The RN Reviewer position is a crucial... ...skills across remote teams Customer... ...understanding of utilization and case management... ...Experience in acute or post-acute settings... ...opportunity Pay & Perks:... ...with post-service claims validation, we’re...Remote workClaimsHourly payFull timeFlexible hoursShift workWeekend work$1,759.5 per week
...Travel RN - Case Management/Utilization Review American Traveler Austin, Texas, United... ...estimated advertised weekly pay) Description American... ...Management RN for a fully remote role requiring TX or... ...precertification, reimbursement, and claims denial/appeal issues...Remote workClaimsWeekly payLocal areaShift work- A recognized healthcare provider is seeking a Board Certified Orthopaedic Spine Surgeon to conduct utilization reviews. This telework position allows for a flexible schedule within a standard Monday - Friday work week. Responsibilities include reviewing medical records,...Remote workClaimsFor contractorsMonday to FridayFlexible hours
- ...Working remotely in a full-time capacity, the Florida RN Utilization Reviewer will conduct admission, concurrent, and retrospective reviews of medical records to ensure compliance with clinical performance standards and reimbursement guidelines while managing a caseload...Remote workFull time
$52 - $56 per hour
...both. We're hiring a contract RN for a New York health plan (Medicare... ...medical necessity judgment you built in utilization management. 100% remote (U.S.) | Contract | $52–$56/hr based... ...: intake, investigation, clinical review, decision and notification...Remote workContract workAfternoon shift$100k - $130k
...need it most. The Utilization Management (UM) team... .... As the Lead RN, Utilization... ...staff, oversee daily review operations, and monitor... ..., Care Management, Claims, Provider Relations... ...Additionally, we embrace a remote-first culture that... ...company. Final pay is based on several...Remote workClaimsFull timeWork experience placementWork at officeFlexible hours- ...seeking an experienced Utilization Management Nurse (RN) in California for a remote 6-month contract. The incumbent... ...inpatient utilization review, medical necessity... ..., and facility claims compliance, auditing DRG... ...performing concurrent or post-service inpatient reviews...Remote workClaimsContract work
$35 - $40 per hour
...Sagility LLC, a leader in healthcare transformation, seeks an RN Utilization Management Reviewer for a fully remote role. You will perform timely clinical decision reviews for services requiring prior authorization across various clinical areas, applying criteria like...Remote workHourly pay- ...Cook Children's Health Care System is seeking a Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer to coordinate the efficient utilization of health care resources for CCHP members and ensure timely, quality care throughout the continuum...Remote work
- ...Providing timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions, treatment planning... ...compliance Collaborate with physicians, claims examiners, and other stakeholders to...Remote workClaimsFull timeWork experience placement
- ...Sentara Health Plans is seeking a Clinical Claims Reviewer/RN for remote work. The role involves evaluating utilization management, reviewing pre/post payment claims, and ensuring adherence to policy across multiple states. A BSN and active RN license are required, with...Remote workClaims
- ...That's the power of the Cleveland Clinic Health System team, and The Power of Every One. Job Title Utilization Management RN Reviewer Location Cleveland Facility Remote Location Department Utilization And Quality Assur-Weston Hospital Job Code 000446 Shift Days Schedule...Remote workFull timeWork at officeShift workWeekend work
- ...Broadway Ventures is seeking a Medical Reviewer for a remote role handling various claims (Radiology, Ambulance, Physical... ...requirements include an active RN license in the U.S., an Associate’... ...and 2+ years in clinical work with utilization/medical review. #J-18808-LjbffrRemote workClaims
- ...CorVel is seeking a Utilization Review Case Manager to gather demographic and clinical data... ...Management department’s goals. This remote role requires RN licensure and 4+ years of clinical experience... ...emphasizes collaboration with claims staff, physicians, and clients,...Remote workClaims
- ...Sentara Health Plans is seeking a Clinical Claims Reviewer/RN for a remote role. This full-time, 40-hour position offers remote work across multiple... ...CPC certification within a year. The role focuses on utilization management, claim reviews, and compliance with CMS/NCQA/...Remote workClaimsFull time
- CorVel Corporation is seeking a Utilization Review Case Manager for a remote role. The ideal candidate holds an RN license and has 4+ years of clinical experience with utilization... ...on certification, and collaboration with claims staff and stakeholders. Applicants should be...Remote jobClaims
- ...to the LTSS department. RN will be responsible for... ...and concurrent review. Provides monthly telephonic... ...of treatment setting by utilizing the applicable medical... ...appropriateness of care and accurate claims payment. May also... ...Info: *possible remote opportunity after training...Remote workClaimsContract workMonday to FridayFlexible hours
- ...seeks an experienced Utilization Management Nurse (RN) for a remote opportunity... ...inpatient utilization review, medical necessity determinations... ..., and facility claims compliance. Duration... ...Possible Extension Pay Rate: $55/hour on W2... ...with concurrent or post-service inpatient reviews...Remote workClaimsContract workTemporary workWork at officeLocal area
$42 per hour
...Friday (08:30 - 17:00). Pay Rate: $42/hr. POSITION... ...acute admission utilization review across 13 acute care and... ...Skills/Experience: Licensed RN (multistate or TX RN),... ...insurers, Google Workspace, remote work experience Other... ..., reimbursement, and claim denials/appeals....Remote workClaimsWork experience placementMonday to Friday- ...Gainwell Technologies is seeking a Nurse Reviewer (RN) to perform clinical reviews determining medical necessity and documenting findings... ...The role is full-time, with day-one benefits, and offers a remote option for US-based employees. Travel is minimal, and opportunities...Remote workFull time
$83k - $99k
Overview Base pay range: $83,000.0... ...Responsibilities The Utilization Management... ...and claim patterns; and makes... ...provider/facility Reviews are conducted using... ...Active LPN/RN clinical license... ...accurate as of this posting date. HMA... ...reimbursement Remote work and continuing...Remote workClaimsFull timeWork at officeFlexible hours- ...Behavioral Health Utilization Management ReviewerAt Health... ...Utilization Management Reviewer, you'll play a vital role... ...this position is fully remote. Candidate must hold... ...PsychologistRegistered Nurse (RN) with behavioral health... ...minimum of the range. Pay ranges are listed as...Remote workHourly payFull time
- ...Requirements CDI Second Level Reviewer StartDate: 11/9/2026 Pay Rate: $48.00 - $60.00... .../ Pre-Bill Auditor (Remote - Part-time & Full... ...DRG assignment. Utilize Iodine software tools... ...documentation prior to claim submission. Escalate... .... Qualifications RN (preferred) or HIM (must...Remote workClaimsFull timeTemporary workPart time
- ...Description Job Description The utilization review and management (UM) component... ...logging and documentation of claims along the process chain. #... ...and Environment Must pay attention to detail-visual &... ...This is an in-office, no remote work capability position Travel...Remote workClaimsWork at office
- ...Gainwell Technologies LLC is seeking a Senior Nurse Reviewer to perform reviews of medical records, healthcare claims, itemized medical bills, and UB-04 forms to... ...itemized bill review experience, with potential utilization review responsibilities. Home-based position within...Remote workClaimsWork from homeFlexible hours
$219k - $286.9k
...Remote Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance... ...company events. #LI-Remote Pay Transparency The base pay... ...role is listed in the job postings under "Work Location". This...Remote workFull timeFor contractorsLocal areaWork from homeRelocationHome officeWeekend work$52.75k - $76k
...Utilization Reviewer At Enlyte, we combine innovative technology, clinical... ...plans, contributing to effective claims management and optimal... ...Experience: Registered Nurse (RN) or LVN with a valid license... ...geographic market. The expected base pay for this position ranges from...ClaimsFull timePart timeWork at officeLocal areaMonday to FridayFlexible hours$22 - $33 per hour
...innovation—shaping roads, utilities, and communities for... ...What You’ll Do Prepare, review, and quality-check... ...license Where You Fit This posting covers Utilities Document... ...levels 1–3, and the pay range shown reflects the... ...which may be in rural or remote locations with limited...Remote workDaily paidFull timeWork experience placementRelocationLong distance
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