Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

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
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote RN Claims Reviewer: Utilization & Post-Pay in United States vacancy
  •  ...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 work
    Claims
    Full time

    Sentara Health

    United States
    2 days ago
  •  ...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 work
    Claims

    Sentara Health Plans

    United States
    2 days ago
  • $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 work
    Claims
    Hourly pay
    Full time
    Flexible hours
    Shift work
    Weekend work

    Cohere Health

    Remote
    12 days ago
  • $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 work
    Claims
    Weekly pay
    Local area
    Shift work

    American Traveler

    Austin, TX
    3 days ago
  • 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 work
    Claims
    For contractors
    Monday to Friday
    Flexible hours

    Dane Street

    United States
    2 days ago
  •  ...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 work
    Full time

    Virtual Vocations Inc

    United States
    23 hours ago
  • $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 work
    Contract work
    Afternoon shift

    Phaxis

    United States
    4 days ago
  • $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 work
    Claims
    Full time
    Work experience placement
    Work at office
    Flexible hours

    Clover Health

    Remote
    6 days ago
  •  ...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 work
    Claims
    Contract work

    Amerit Consulting

    United States
    1 day ago
  • $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 work
    Hourly pay

    Sagility LLC

    United States
    3 days ago
  •  ...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

    Cook Children's Health Care System

    Fort Worth, TX
    1 day ago
  •  ...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 work
    Claims
    Full time
    Work experience placement

    Virtual Vocations Inc

    United States
    3 days ago
  •  ...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 work
    Claims

    Sentara Health

    United States
    2 days ago
  •  ...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 work
    Full time
    Work at office
    Shift work
    Weekend work

    CCF

    New York, NY
    2 days ago
  •  ...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-Ljbffr
    Remote work
    Claims

    BROADWAY VENTURES, LLC

    United States
    1 day ago
  •  ...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 work
    Claims

    CorVel Brand

    Folsom, CA
    23 hours ago
  •  ...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 work
    Claims
    Full time

    Sentara Health

    United States
    2 days ago
  • 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 job
    Claims

    CorVel Corporation

    Folsom, CA
    3 days ago
  •  ...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 work
    Claims
    Contract work
    Monday to Friday
    Flexible hours

    HealthCare Support

    New York, NY
    4 days ago
  •  ...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 work
    Claims
    Contract work
    Temporary work
    Work at office
    Local area

    Amerit Consulting

    Sacramento, CA
    1 day ago
  • $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 work
    Claims
    Work experience placement
    Monday to Friday

    Pacer Group

    Austin, TX
    3 days ago
  •  ...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 work
    Full time

    Gainwell Technologies LLC

    United States
    3 days ago
  • $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 work
    Claims
    Full time
    Work at office
    Flexible hours

    Healthcare Management Administrators

    Bellevue, WA
    4 days ago
  •  ...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 work
    Hourly pay
    Full time

    Baystate Health

    Springfield, MA
    4 days ago
  •  ...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 work
    Claims
    Full time
    Temporary work
    Part time

    AMN Healthcare

    Austin, TX
    2 days ago
  •  ...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 work
    Claims
    Work at office

    MedTrust LLC

    Oklahoma City, OK
    3 days ago
  •  ...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 work
    Claims
    Work from home
    Flexible hours

    Gainwell Technologies LLC

    Columbus, OH
    3 days ago
  • $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 work
    Full time
    For contractors
    Local area
    Work from home
    Relocation
    Home office
    Weekend work

    Oscar-Health-

    Arizona
    2 days ago
  • $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... 
    Claims
    Full time
    Part time
    Work at office
    Local area
    Monday to Friday
    Flexible hours

    Mitchell International, Inc.

    Wayne, PA
    3 days ago
  • $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 work
    Daily paid
    Full time
    Work experience placement
    Relocation
    Long distance

    ORC Corp

    Fort Worth, TX
    3 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote RN Claims Reviewer: Utilization & Post-Pay. Be the first to apply!