Remote RN Clinical Review Nurse — Claims & Policy Analysis
CareFirst, Inc.
- Remote job
CareFirst, Inc. is seeking a full-time RN Clinical Medical Review Nurse to work remotely from the greater Baltimore metropolitan area. This role involves managing the review of professional and institutional claims, analyzing medical information for enrollment eligibility, and supporting claims processing and adjudication. Applicants must have a Bachelor's degree in Nursing or equivalent work experience, current RN licensure in VA, DC, or MD, and a minimum of 3 years of acute clinical experience. #J-18808-Ljbffr CareFirst, Inc.
$28.76 - $62.3 per hour
...support for medical claim and internal appeals review activities - ensuring... ..., Molina policies and procedures, and... ...medically appropriate clinical guidelines. Contributes... ...least 4 years clinical nursing experience, including... ...Registered Nurse (RN). License must be active...Remote workPolicyClaimsHourly payWork experience placementWork at office$90k - $110k
...: Job Role The Clinical RN Chart Reviewer will perform clinical... ...to validate issues of claims coding accuracy,... ...clinical guidelines. Analysis of claims data to optimize... ...workflow diagrams, policies and procedures, and... ...Qualifications: ~ Registered Nurse required, preferable...Remote jobPolicyClaimsTemporary workCasual workWork at office$67.32k - $133.71k
...Purpose: The Clinical Appeals Nurse completes research, basic analysis, and evaluation... ...clinician to work remotely from within... ...corporate policies and decisions... ...for physician review by compiling clinical... ...policy and claims information along... ...Required: RN - Registered Nurse...Remote workPolicyClaimsWork experience placementWork at officeImmediate start- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical... ...as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical... ...unrestricted Registered Nurse (RN) license PREFERRED...Remote workPolicyClaimsPermanent employmentWork at officeLocal area
- ...Comagine Health is looking for a Clinical Utilization Review Nurse (RN) to perform remote assessments on the medical necessity of healthcare services. This full... ...reviews and ensuring compliance with clinical policies for quality care. Candidates should possess a BA...Remote workPolicyFull time
$50 per hour
...Medical Review RN IV – Commercial Appeals & Grievance Nurse Location: Remote – Candidate Must Reside in California... ..., grievances, and clinical determinations. This... ..., Quality, Pharmacy, Claims, and Customer Service... ...accuracy, and medical policy compliance while ensuring...Remote workPolicyClaimsContract workWork at officeLocal areaMonday to Friday- ...MedPOINT Management as a Medical Claims Clinical Review Nurse in Sherman Oaks, CA, where... ...to ensure compliance with policies and regulations.... ...Requirements: Registered Nurse (RN) license in California is required... ...the lives of patients every day. This is a remote position.Remote workPolicyClaimsFull time
$2,210 per week
...exclusive features. Nurses – are you... ...-life balance. Remote/hybrid setting... ...individual will utilize clinical knowledge and... ...a second level reviewer. This... ...guidelines, Hines policies and procedures,... ...status, benefit and claim concerns, and... ...not limited to RN, LMSW, LMHC....Remote workPolicyClaimsFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours- ...Medical Review Clinical Appeals Auditor (RN) In October 2025, Machinify... ...department quality policies and procedures, scoring... ...research, analyzes claims data, applies knowledge... ...independently in remote setting with minimum... ...standing and diversified nursing experience providing...Remote workPolicyClaimsFlexible hours
$64.96k - $90k
...services, and clinical expertise. Our... ...looking for an RN Chronology to join... ...essential analysis and organizational... ...customized for specific claims, ensuring... ...defendants by reviewing claim documents... ...all corporate policies including policies... ...’s degree in nursing preferred...Remote workPolicyClaimsContract workWork at officeLocal area- ...Utilization Review Nurse (Ur Nurse) Join our... ...responsible for reviewing clinical information to... ...organizational policies. This role involves... ...Review medical claims and pre-determinations... ..., unrestricted RN license (State license... ...and medical trend analysis. Work...Remote workPolicyClaimsFull timeTemporary workSummer workWork at officeFlexible hours
$45k - $70k
...Utilization Management Nurse Reviewer plays a crucial... ...requires strong clinical knowledge, critical... ...unrestricted LVN/RN license from an accredited... ...paid time off policy ensures you have... ...are provided for remote workspace.... ...200,000 insurance claims annually for leading...Remote workPolicyClaimsTemporary workWork at officeWork from homeMonday to FridayShift work$64k - $93k
...Job Summary The Clinical Auditor I... ...record audit review and analysis of the health... ...and ancillary claims to ensure that... ...regulations, internal policies and best... ...You Full‑time remote work Competitive... ...'s degree in nursing or an equivalent... ...years minimum RN experience in...Remote workPolicyClaimsFull timeContract workFlexible hours$30.58 - $55.09 per hour
...million members as a clinical professional on... ...Purpose Routinely reviews more challenging prior... ...Complies with all policies and standards.... ...Accredited School of Nursing or Bachelor’s... ...plan and requires NY RN Licensure. Pay... ...approach to work with remote, hybrid, field or...Remote workPolicyHourly payFull timePart timeWork at officeFlexible hours$30 - $38 per hour
...are seeking Utilization Review Nurse RN to join our team on a... ...necessity; and post claim or post service reviews... ...guidelines, internal medical policies, group specific... ...program) required. 1+ year clinical experience required.... ...perform in a remote healthcare environment...Remote workPolicyClaimsHourly payFull timePart timeWork at officeMonday to FridayWeekend work$35 per hour
...5.00/hr Medical Review Nurse Location: Phoenix, AZ 85034 (Remote) 3+ Months Day... ...Services (FES) 1500 claim forms. Some coordination... ...• Statistical analysis • Computer data retrieval... ...: • Active RN License in state of... ..., laws and agency policy pertaining to the...Remote workPolicyClaimsHourly payContract workTemporary workPart timeFor contractorsWork at officeShift workDay shift$64k - $80k
...Fraud and Abuse Review Nurse- Remote at Gainwell, you... ...Member Services, Claims) to collect relevant... .... Data analysis of claims and utilization... ...Active, unrestricted RN license in good... ...of five years of clinical nursing... ...flexible vacation policy, a 401(k) employer...Remote workPolicyClaimsFull timeLocal areaWork from homeFlexible hours- ...retrospective reviews of patient medical... ...standardized clinical guidelines such... ...with coverage policies. Facilitate communication... ...delays, and claim denials for... ...Degree in Nursing (ADN) required... ...Registered Nurse (RN) license. Certification... ...Necessity Analysis: This skill...PolicyClaimsPart time
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence... ...assigned Registered Nurse with active,... ...applications This is a 100% remote role, and requires... ...continuum–including policy, prior authorization... ...with post-service claims validation, we're...Remote workPolicyClaimsFull timeFlexible hoursShift work$88.85k
Clinical Policy Nurse RN II Job Category: Clinical Location: Los Angeles, CA,... ...accreditation requirements that impact claims, Utilization Management (UM... ...operations. Review and interpret clinical, utilization... ...and clinical research analysis based on the best available...PolicyClaimsFull timeLocal area$38.91 - $60.31 per hour
...offer a hybrid or remote option... ...care liaison and clinical resource. Conducts... ...frequent rounds to nursing units and... ...indicators, data analysis and system improvement... ...per policies and regulatory... ...Registered Nurse (RN). ~2 years of... ...living. Market reviews: All UCHealth positions...Remote workPolicyFull timeTemporary workLocal areaFlexible hoursShift workNight shift$79k - $99.75k
...comprehensive inpatient DRG reviews based on... ...evidence based clinical criteria plan, and policy exclusions.... ...on inpatient DRG claims as they compare... ...Will Bring: ~ RN or LVN required... ...conducting root cause analysis and identifying... ...a hybrid and remote friendly culture...Remote workPolicyClaimsFull timeWork at officeLocal areaVisa sponsorshipFlexible hours- ...Solutions, Inc RN Case Manager... ...Summary Provides nursing, clinical, casework services... ...for weekly review Tasks must be kept... ...on complex cases, claim barriers and on resolution... ...and ongoing analysis of the diagnosis as... ...Support - Follows policies and procedures;...Remote jobPolicyClaimsFull timePart timeReliefWork at officeImmediate startHome office
$36.49 - $41.49 per hour
...Responsibilities Review, research, and analyze professional... ...and institutional claims using clinical judgment and medical policies for accurate... ...medical policy meetings, nursing forums, and review sessions... ...HCPCS). Medical policy analysis and research. Risk assessment...PolicyClaimsWork at office$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... ...be required to adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors including but not...Remote jobPolicyClaimsHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal areaHome office- ...Medical Director for review and works closely... ...concurrent and post-service clinical reviews to... ...guidelines and medical policies and contractual... ...coding, researching claims to ensure accurate... ...degree and active NYS RN license required.... ...be opportunity for remote work within all...Remote workPolicyClaimsContract workWork at office
$29 - $52 per hour
...challenges. Primary Responsibilities Perform clinical coverage review services, which require interpretation... ...'s degree Current unrestricted RN license in the state of Massachusetts 3... ...adhere to UnitedHealth Group's Telecommuter Policy. Pay is based on several factors...Remote workPolicyClaimsHourly payMinimum wageFull timeWork experience placementLocal area$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant,... ...primarily performs medical claims audit reviews. As a... .... You will work remotely in a fast paced and dynamic... ...review guidelines, policies and rules. Document... ...Active unrestricted RN license in good standing...Remote workPolicyClaimsFor contractorsWork at officeWork from homeHome officeShift work$26 - $28 per hour
...Clinical Reviewer, RN/LPN (Remote - TN) Essential Duties and Responsibilities: Review requests for services... ...criteria, state and federal policy, and related requirements. Issue... ...external market and internal value analysis including seniority and merit systems...Remote jobPolicyMinimum wageContract workTemporary workWork experience placement- ...various aspects of the medical file review process. They will review the... .... Our generous paid time off policy ensures you have time to relax... ...stipend are provided for remote workspace. ABOUT DANE STREET:... ...process over 200,000 insurance claims annually for leading national...Remote workPolicyClaimsTemporary workWork from home
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN Clinical Review Nurse — Claims & Policy Analysis. Be the first to apply!


