Remote RN Medical Reviewer & Claims Utilization
your Jared
- Remote job
Palmetto GBA is seeking an experienced RN for remote utilization review to evaluate medical claims using established criteria and guidelines. The role emphasizes timely decisions, documentation, and collaboration with internal teams. You will work from a home office and engage in ongoing education with staff regarding coverage determinations. The position requires active RN licensure and 2+ years of clinical experience, with strong communication and analytical skills. #J-18808-Ljbffr your Jared
- ...BlueShield South Carolina subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim reviews and determine medical... ...role documents decisions and supports utilization review across multiple services. The position is remote, full-time, with standard hours 8:00 AM...Remote jobClaimsFull time
- ...RN / Medical Reviewer / Remote Job Details Professional Discipline : Registered Nurse Specialty : Utilization Review Employment Type : Full Time City :... ...your clinical proficiency and claims knowledge. This is a REMOTE...Remote workClaimsFull timeContract workLocal areaShift work
- ...Carolina is seeking a Registered Nurse to perform medical reviews using clinical information and established guidelines... ...documenting decisions and supporting medical claims and utilization practices from a remote location in South Carolina, Georgia, North Carolina...Remote jobClaims
- BlueCross BlueShield of South Carolina is seeking a registered nurse to perform utilization review for medical claims in a home-office setting. The role includes evaluating complex services, preauthorizations, and appeals while ensuring accurate coding and reimbursement...ClaimsHome office
- ...Summary and Responsibilities As our Utilization Review RN, you will play a pivotal role in optimizing healthcare delivery by ensuring medical necessity and appropriate patient status... ...payer requirements, preventing claim denials, and upholding the high-quality...Remote workClaims
- Gainwell Technologies is seeking a Medical Reviewer (Registered Nurse) to support California healthcare programs.... ...to review medical records, healthcare services, claims, and authorization requests. You will work remotely within California with flexible hours, contributing...Remote jobClaimsFlexible hours
- ...seeks an experienced Registered Nurse to perform medical review of complex claims, pre-authorization requests, appeals, and fraud... ...support accurate payment determinations. The role is remote and full-time, requiring an active RN license and at least two years of clinical...Remote jobClaimsFull time
- J29, Inc. is seeking a Medical Reviewer, RN Coder for a remote, temporary assignment. The role is expected to last approximately 3-6 months and focuses on reviewing Medicare FFS claims via automated and manual processes to identify overpayments and ensure compliant, accurate...Remote jobClaimsTemporary work
- ...Medical Reviewer (Registered Nurse) - Remote CA It takes great medical minds to create powerful... ..., healthcare services, claims, and authorization... ...claim adjudication, drug utilization review, and other healthcare... ...unrestricted registered nurse (RN) license to practice in...Remote jobClaimsFull timeHome officeMonday to FridayFlexible hours
$70k - $85k
Description: Medical Reviewer, RN Location: Remote Salary: $70,000-85,000 annually, based on years of experience About J29 J29, Inc. (J29) has been supporting... ...providing processing, review, and analysis of medical claims, records, data, and audits between areas of compliance,...Remote workClaimsFor contractorsLocal area- A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and...Remote workClaimsFull time
- ..., and monitoring the utilization of behavioral health... ...appropriate cases to the Medical Director for review. Refer to and work... ...coding, researching claims to ensure accurate application... ...and active NYS RN license required.... ...may be opportunity for remote work within all jobs...Remote workClaimsContract workWork at office
- ...Utilizing clinical expertise, the full-time Licensed Medical Review Nurse (LVN/LPN) will conduct medical reviews of claims and documentation to ensure medical necessity and compliance with regulations while working remotely on a MST/PST schedule. Key responsibilities...Remote workClaimsFull time
$45 - $50 per hour
...for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical... ...nursing programs with an active New York RN license. #J-18808-Ljbffr kozmetickesluzby....Remote jobHourly pay- 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
- Kelsey-Seybold Clinic, part of the Optum family, is hiring a Utilization Review LVN nurse in Houston area. The role involves data entry, eligibility verification, and coordinating with insurers for pre-certification. Requirements include TX LVN license and UR experience...Remote jobClaimsHourly pay
- First Coast Service Options is seeking a Clinical Review Nurse to evaluate medical necessity, coverage, and payment levels for Medicare-related claims. The role applies clinical knowledge to determine the appropriateness of care in line with CMS policies and standards....Remote jobClaims
$71.1k - $97.8k
...Appeals (G&A) Nurse (Utilization Management Nurse 2... ...communication of medical services and/or... ...of cases prior to review by the Humana G&A... ...documentation, researching claims, benefits, as well... ...Registered Nurse (RN) with compact... .... This is a remote position. This...Remote workClaimsFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeFlexible hoursWeekend workWeekday work$30 - $40 per hour
...RN Clinical Review Nurse (Utilization Review Nurse)The Clinical Review Clinician for Appeals... ...appeals by examining medical records and clinical data.... ...denials and retrospective claim denials to determine medical... ...Workplace Type:This is a fully remote position.Application...Remote workClaimsContract workTemporary work$42 per hour
...population health, and utilization management.... ...Interdisciplinary Teams, Medical Directors, and provider networks to review service utilization... ...care and related claims are: Reasonable and... .... Current RN license Proven experience... ...: This is a fully remote role based in the United...Remote workClaimsContract work$30.64 - $45.8 per hour
...Utilization Review NurseThe Utilization Review Nurse gathers demographic... ..., certifies the medical necessity and assigns... ...of CorVel. This is a remote position.Essential... ...concern to the appropriate claims staff/customerCollects... ...operation required; RN is required unless local...Remote workClaimsFull timeWork at officeLocal areaFlexible hours- 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
$34 - $35 per hour
...Utilization Management - Clinical Nurse - Work... ...telephonic and concurrent review of... ...management principles, and medical necessity criteria... ...Qualifications ~ RN license in an eNLC... ...Authorization Remote Registered Nurse (... ...Manager Clinical Claims Nurse (Healthcare...Remote workClaimsFull timeWork at officeWork from homeNight shift$30 - $40 per hour
...Job Title: RN Clinical Review Nurse (Utilization Review Nurse) Job Description The Clinical... ...appeals by examining medical records and clinical data.... ...denials and retrospective claim denials to determine... ...Workplace Type This is a fully remote position. Application...Remote workClaimsContract workTemporary work- ...Utilization Review Nurse, LPNAcrisure is seeking a Utilization Review Nurse... ...requirements. This role reviews medical information submitted by... ...in the office and three days remote. Candidates must also have... ...physicians, healthcare providers, claims professionals, and internal...Remote workClaimsWork at officeImmediate startFlexible hours2 days per week
- Peraton’s SafeGuard Services seeks a Nurse Reviewer to conduct medical record reviews, applying clinical judgment to claim payments and supporting fraud investigations. Telework is available from any state. The ideal candidate will hold a US nursing license, have 5+ years...Remote jobClaims
$83k - $99k
...Responsibilities The Utilization Management Nurse... ...utilization and claim patterns; and makes... ...provider/facility Reviews are conducted using... ...ongoing chronic medical conditions Evaluates... ...Active LPN/RN clinical license required... ...reimbursement Remote work and continuing...Remote workClaimsFull timeWork at officeFlexible hours$62k - $65k
...partner in innovation. Registered nurse (RN) Medical Reviewer Location: Remote Type: Full-Time Rate: $62-$65K... ...perform medical review of complex claims, pre-authorization requests, appeals... ..., skilled nursing facility) Utilization or medical review Quality assurance...Remote workClaimsFull timeContract workTemporary workFor contractorsWork at office$29 - $52 per hour
...for performing compliance reviews of medical and administrative... ...care providers who submit claims for payment. This position will utilize information from claims... ...schedule.This position is Remote in Massachusetts. You will... ...licensure (RN or LPN) with a current,...Remote workClaimsHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work$20 - $36 per hour
...a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity... ...meaning behind Caring. Connecting. Growing together. The Utilization Review LVN nurse will perform documentation review for medical...Remote jobClaimsHourly payMinimum wageFull timeWork experience placementWork at officeLocal area
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