Remote RN Medical Reviewer II - Claims & Utilization
BlueCross and BlueShield of South Carolina
- Remote job
BlueCross and BlueShield of South Carolina seeks an RN Medical Reviewer II to join the Palmetto GBA Medical Review team. You will perform medical reviews using clinical information, apply guidelines, and help ensure accurate coverage and payment determinations. Ideal candidates have RN licensure, 2 years of clinical experience, strong communication, and the ability to educate internal/external staff while supporting quality goals. This is a work-from-home, full-time role with daytime hours. #J-18808-Ljbffr BlueCross and BlueShield of South Carolina
- ## RN Medical Reviewer II - Palmetto GBA-13Apply: Remote: ****@*****.*** South Carolina: Full time: Posted Yesterday: End Date: November 11, 2026 (3 days left to... ...guidelines. Provides support and review of medical claims and utilization practices.# **Description**Why should you join...Remote workClaimsFull timeFor contractorsWork experience placementWork at officeLocal areaWork from homeHome officeMonday to FridayShift work
- Broadway Ventures is seeking a Medical Reviewer for a remote role handling various claims (Radiology, Ambulance, Physical Therapy... ...requirements include an active RN license in the U.S., an... ...2+ years in clinical work with utilization/medical review. #J-18808-Ljbffr...Remote jobClaims
- ...Ventures LLC team is seeking a skilled Medical Reviewer to evaluate a variety of medical claims, including radiology and... .... Candidates must hold an active RN license in the United States and... ...BSN and additional clinical and utilization review experience, plus proficiency...Remote jobClaimsWork from home
- Palmetto GBA is seeking an RN Medical Reviewer II to join our Medical Review team. This remote, full-time role uses your clinical expertise to perform medical reviews, apply established guidelines, and assist with timely coverage determinations. You will educate staff and...Remote jobClaimsFull timeWork at officeMonday to Friday
- ...Summary Performs medical reviews using clinical/medical information... ...and review of medical claims and utilization practices. Description... ...Location: This is a full-time remote (40-hours/week) working an... ...License and Certificate: Active RN licensure in state hired...Remote workClaimsFull timeFor contractorsWork experience placementWork at officeLocal areaWork from homeMonday to FridayShift work
- Broadway Ventures is seeking a Medical Reviewer to evaluate radiology, ambulance, physical therapy, and surgical claims using established criteria and clinical guidelines. This remote role requires an active RN license in the U.S. and an associate degree in nursing. You...Remote jobClaims
$78k - $85k
Overview Medicaid Medical Review RN (Medical Reviewer III) - REMOTE The Medicaid Medical Review RN (... ...information contained in Standard Claims Processing System files (... ...payment policies Utilizes extensive knowledge of... ...CM, ICD-10-CM HCPCS Level II and CPT coding along with...Remote workClaimsFor contractorsH2bH1bWork at officeLocal areaHome office- ...Comprehensive Health Coverage – Medical, dental, and vision... ...The Appeal Specialist II reviews, analyzes, and... ...Appeal Process for denied claims. Follows and... ...years of experience in utilization review and/or case management... ...and Certifications RN - Registered Nurse -...Remote workClaimsFull timeContract workWork at office
- ...Title - Medical Coder II, Certified Shift - (Remote working after on-site training (2-4 weeks... ...position focused on review of documentation and coding... ...ensure accurate coding and claim submission and... ...specialties as assigned. Utilize available coding tools and...Remote workClaimsPermanent employmentFlexible hoursShift work
- Spectraforce Technologies, Inc. is seeking a Medical Reviewer I to perform medical reviews and utilization management in a remote-capable role based in Columbia, SC. The position... ...background, licensure options (LPN/LVN or RN, or social work background), and at least two...Remote jobClaims
$26 - $30 per hour
...Medical Coder IIMeduit is a national leader in healthcare... ...Coding Specialist II is responsible for correctly... ...coding healthcare claims and analyzing denials to... ...Medical Coder II Location: Remote Schedule: 8am – 5pm in... ...and State standards utilizing CCI edits, Medicare bulletins...Remote workClaimsHourly pay- The Inpatient Coder II is responsible for assigning ICD-1... ...based on documentation in the medical record and utilization of coding guidelines,... ...coders. Responsibilities Remote States: Candidates residing... ...intermediate coding edits and claim edits. Completes special...Remote workClaimsFull timeWork experience placement
$88.85k
...Utilization Management (UM) Claims Review Nurse RN IISalary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)L.... ...Management (UM) Claims Review Nurse RN II is responsible for conducting clinical review of medical claims to ensure services were medically...Claims- ...monitoring the utilization of physical health (PH) medical and healthcare services... ...Director for review. Refer to and... ...coding, researching claims to ensure... ...management. Level II (in addition to... ...and active NYS RN license required... ...opportunity for remote work may be possible...Remote workClaimsContract workWork at office
- Medical Records Coder II (20660517) job at CalOpps. San Francisco,... ...facility in San Mateo with remote options. The ideal... ...and submitting claims related to substance... ...inpatient medical records. Utilize technical coding... ...-CM/CPT procedures. Review narrative records of...Remote workClaimsWork at office
$62.7k - $100.4k
...Summary: The Clinical Care Reviewer II - Post-Acute is responsible for conducting medical necessity reviews to... ...to non-clinical utilization management staff as needed... ...accredited registered nursing (RN) degree program... ...opportunity count. Each claim, each phone call, each...ClaimsHourly payWork at officeWeekend work- ...position is responsible for reviewing medical records for... ...audits acute inpatient claims. Integrates medical chart... ...payment by independently utilizing DRG grouper, encoder,... ...management. Level II (in addition to Level... ...: The opportunity for remote work may be possible for...Remote workClaimsWork experience placement
- ...the LTSS department. RN will be responsible... ...of the use of Medical Services for Long-Term... ...authorization and concurrent review. Provides monthly... ...setting by utilizing the applicable medical... ...care and accurate claims payment. May... ...Info: *possible remote opportunity after training...Remote workClaimsContract workMonday to FridayFlexible hours
- Sedgwick is seeking a remote RN Utilization Review professional in Tennessee to provide timely utilization... ...patient care. You will assess medical conditions, coordinate with clinicians... ...accompany the position. #J-18808-Ljbffr Sedgwick Claims Management Services LtdRemote jobClaimsFlexible hours
- ...Denial Mitigation-Appeal Specialist II RN to support revenue cycle by reviewing clinical cases, preparing appeals,... ...coordinating with payers to defend denied claims. The role involves collaborating... ...ensure timely appeal submissions. Remote work may be possible after...Remote workClaimsTrial period
$42 per hour
...Ascension Texas Utilization Management Department (Fully Remote) Provides health care services... ...planning and utilization review. Reviews admissions and... ...concurrent and retrospective medical necessity and/or... ...precertification, reimbursement and claim denials/appeals....Remote jobClaims$63k - $73k
...limit to what you can achieve. Utilization Review Nurse (RN) As a nurse at Sedgwick,... ...the management of complex medical conditions, treatment planning... ...well-being of others in a remote work environment. Enjoy... ...effectively with physicians, claims examiners, clients, vendors...Remote workClaimsWork experience placementLocal areaFlexible hours$35 - $40 per hour
...solutions, payment integrity, claims cost containment, and analytics. Job Title RN Utilization Management Reviewer Responsibilities Conduct... ...procedures, Medicare Part B medications, LTSS, and Home Health.... ...weekends. Location: Fully remote work at home role. Secure,...Remote workClaimsHourly payTemporary workMonday to FridayFlexible hoursWeekend work- ...Broadway Ventures is seeking a dedicated Registered Nurse (RN) to join our Medical Review team in a remote role. You will conduct pre- and post-payment medical reviews to ensure criteria compliance, assess medical necessity and reimbursement eligibility, and document decisions...Remote workClaims
$35 - $40 per hour
...solutions, payment integrity, claims cost containment, and... ...across 5 countries. Job title: RN Utilization Management Reviewer Job Description: We are... ...authorization review for medical necessity and decision-making... ...weekends This is a fully remote work at home role. You...Remote workClaimsHourly payTemporary workCurrently hiringMonday to FridayFlexible hoursWeekend work$63k - $65k
...Financial Services & Insurance RN Utilization Review As a nurse at Sedgwick, you... ...the management of complex medical conditions, treatment... ...and well-being of others in a remote work environment. Enjoy flexibility... ...with physicians, claims examiners, clients, vendors,...Remote workClaimsFull timeWork experience placementLocal areaFlexible hours$75k - $100k
...Utilization Management RN (Registered Nurse) evaluates efficiency, appropriateness, and medical necessity for medical services, and procedures... ...judgment to review medical services... ...We are open to remote work in the following... ..., Member Services, Claims, Provider Contracting...Remote workClaimsFor contractorsWork at officeLocal areaImmediate start- ...Nurse Case Manager II Location: This role... ...Interfaces with Medical Directors and Physician... ...with providers, claims or service issues.... ...with development of utilization/care management... ...Current, unrestricted RN license in applicable... ...Ability to manage, review and respond to...Remote workClaimsFull timeWork at officeMonday to FridayAfternoon shift
- ...Nurse Case Manager II Location: Georgia Shift... .... Interfaces with Medical Directors and Physician... ...solving with providers, claims or service issues.... ...Assists with development of utilization/care management... ...Current, unrestricted RN license in applicable state...Remote workClaimsFull timeWork at officeShift workDay shift
- ...Brighterway builds AI-native claims software and... ...workers' compensation medical-legal review, where our agentic document... ...we look for Active RN license and 5+ years of... ...experience. Experience in utilization review, nurse case... ...opportunity employer. Location: Remote (United States)...Remote workClaimsFull timeFlexible hours
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