Remote RN: Clinical Claims Reviewer
CVS Health
Sacramento, CA
- Remote job
CVS Health is seeking a licensed RN to exercise clinical judgment in processing post-service claims, reviewing clinical documentation and applying criteria. You will coordinate resolutions with clinicians, train staff, identify trends, and ensure HIPAA compliance while supporting customer service and claims teams. The role requires strong analytical skills with experience in medical claims and working from home with reliable internet access. #J-18808-Ljbffr CVS Health
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Remote RN: Clinical Claims Reviewer in Sacramento, CA vacancy
- ...CVS Health is seeking an experienced RN professional to review clinical documentation and determine appropriate post-service claim decisions. The role emphasizes clinical decision... ...and cross-training duties within a fully remote US-based environment. You will support...Remote workClaims
- ...Enterprise Engagement Officer Compliance Oversight Specialist (Non Clinical) Vice President, Clinical Operations - Behavioral Health UM... ...Officer Privacy & Security Enterprise Engagement Officer Director, Claims Business Implementation Manager, Payment Integrity - Financial...Remote jobClaims
- ...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....Remote workClaims
- ...Administrators LLC seeks a qualified RN reviewer to perform medical reviews based on clinical information and established... ...documents decisions and supports medical claims and utilization practices. The position is full-time and remote with a mandatory 8-hour shift,...Remote workClaimsFull timeMonday to FridayShift 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... ...have an active RN license in the U.S., two years of clinical experience, and proficiency with MS Office. #J-18808...Remote jobClaims
- J29, Inc. is seeking a Remote Medical Reviewer (RN) for a temporary assignment to audit Medicare FFS claims, including Part A/B, DMEPOS, and Home Health/Hospice as needed. You will apply CMS rules, document findings, and ensure accuracy in each review while maintaining...Remote jobClaimsTemporary workWork experience placement
- RN / Medical Reviewer / Remote Job Details Professional Discipline : Registered Nurse Specialty : Utilization... ...eligibility regarding benefits and clinical criteria and assess and monitor... ...using your clinical proficiency and claims knowledge. This is a REMOTE opportunity...Remote jobClaimsFull timeContract workLocal areaShift work
- ...Summary Performs medical reviews using clinical/medical information provided... ...support and review of medical claims and utilization practices.... ...Location: This is a full-time, remote (40-hours/week) working an... ...and Certificate: Active RN licensure in state hired,...Remote workClaimsFull timeFor contractorsWork experience placementWork at officeLocal areaWork from homeMonday to FridayShift work
- Optum is seeking a Clinical DRG RN auditor who will validate ICD-10-CM/PCS codes and DRG assignments for inpatient claims. You will write clear rationales and use proprietary tools to... ...accurate reimbursements. The role supports remote work from anywhere in the U.S. and...Remote jobClaims
$78k - $85k
Overview Medicaid Medical Review RN (Medical Reviewer III) - REMOTE The Medicaid Medical Review RN (Medical Reviewer... ...be responsible for conducting clinical reviews of medical records during the... ...information contained in Standard Claims Processing System files (e.g.,...Remote workClaimsFor contractorsH1bH2bWork at officeLocal areaHome office$83.2k - $93.6k
...months based on business needs. Medical Reviewer, RN Location: Remote Rate: $40-45 hourly About J29 J2... ..., review, and analysis of medical claims, records, data, and audits between areas of compliance, policy, and clinical expertise. Our team is experienced in...Remote workClaimsHourly payTemporary workFor contractorsSeasonal workLocal area$50 - $52 per hour
...Claims Clinical Documentation Reviewer Schedule: 5-10 hours per week. Resource can work any day of the week they are available and any time including weekends if they prefer. Remote position. Equipment is provided by facility. Base pay: $50.00/hr - $52.00/hr....Remote workClaimsPart timeWork at officeLong distance10 hours per week$68k - $71.03k
AHCCCS, Arizona’s Medicaid agency, is seeking a Claims Clinical Documentation Reviewer in the Division of Fee for Service (DFSM). This role reviews clinical... ...skills. It offers salary $68,000-$71,032 and a remote-work option within the State of Arizona. #J-18808-Ljbffr...Remote jobClaims- ...improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our... ...professionally. ### Position Overview We are seeking an RN to perform Clinical Review work and QIDP reviews work. Team member will serve as...Remote workContract work
$68k - $71.03k
...supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned... .... Come join our dynamic and dedicated team. Claims Clinical Documentation Reviewer Division of Fee for Service (DFSM) Job Location:...Remote workClaimsFull timePart timeInternshipWork at officeWork from homeLong distanceFlexible hours- 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
- ...full-time Tennessee Licensed RN Pharmacy will evaluate prescribed... ...medical conditions, and work remotely while advocating for effective... ...Key responsibilities Perform clinical assessments and evaluate... ...with clients, nursing staff, and claims examiners regarding pharmacy issues...Remote workClaimsFull timeWork experience placement
- Do you have a strong clinical background and a talent for turning complex... ...into clear, well-supported review decisions? Are you energized... ...care? Comagine Health is seeking remote Clinical Reviewers (Licensed... ...information through providers or the claim system, and communicate with...Remote workClaimsFull timeContract workPart timeReliefShift work
- ...Utilization Management Department (Fully Remote)Job Summary:• Provides health care services... ..., discharge planning and utilization review.Responsibilities:• Reviews admissions and... ...documentation, precertification, reimbursement and claim denials/appeals.• Assesses and...Remote workClaims
- ...and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical... ...Key responsibilities Perform clinical assessments and evaluate patient... ...Collaborate with physicians, claims examiners, and other stakeholders...Remote workClaimsFull timeWork experience placement
- ...Maximus is seeking a Clinical Reviewer in Tysons, VA to evaluate requests for services, ensure compliance with clinical and governmental requirements... ...providers and state personnel. Preferred candidates have remote-work experience, strong written and verbal communication...Remote workContract workWork experience placement
- ...appeals, ensuring medical policy alignment and appropriate determinations. The role emphasizes collaboration with physician advisers and educating non-clinical staff, leveraging experience in clinical care, coding, and claims review to drive outcomes. #J-18808-LjbffrRemote workClaimsWork from home
- ...CVS Health is seeking a licensed RN to join our remote team focused on post-service claims review and clinical decision-making. You will interpret clinical documentation, apply policies, and coordinate resolutions with clinicians as needed. The role requires 2–3 years...Remote workClaimsWork from homeHome office
- Comagine Health in Washington State is seeking an experienced Registered Nurse to join our remote Clinical Reviewer team. The role focuses on assessing medical necessity, appropriateness, and quality of care through prospective, concurrent, and retrospective reviews for...Remote jobContract workWork from home
$80k - $100k
...Clinical Reviewer – Registered Nurse (RN) Comagine Health | Washington State | Remote / Work From Home Department: Care Management Contract: Washington Labor & Industries (L&I) Location: Washington State – Remote Employment Type: Full-Time This is an...Remote workFull timeContract workLocal areaWork from homeHome office$26.14 - $56.64 per hour
...DESCRIPTION Job Summary Provides support for inpatient and outpatient clinical claim review activities. Verifies that coded diagnoses, procedures,... ...of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice...ClaimsHourly payWork experience placementWork at office- ...Clinical Quality Reviewer - BCBAOnos Health's mission is simple but ambitious: ensure every healthcare... ...review platformsExperience analyzing claims, utilization, or outcomes dataLocation... ...Francisco office (Financial District), remote-first cultureUnlimited vacation policyPaid...Remote workClaimsWork at officeHome officeFlexible hours2 days per week3 days per week
$100k - $110k
...Payment Integrity Manager (RN) Fully remote, open to candidates located... ...leadership role in ensuring claims accuracy, driving reimbursement... ...role, you'll partner with clinical, coding, and operational teams... .... Oversee audits and reviews focused on coding accuracy,...Remote workClaims- Medix is seeking an RN-Coder Clinical Validation Reviewer to support payment integrity and clinical validation workflows in a hybrid setup. The role emphasizes reviewing medical records against claims to determine support for billed services, with documentation of clear...Remote jobClaimsWork at office
- UnitedHealth Group is seeking a Clinical Grievances Nurse to review retrospective cases for appropriate care and... ...’ immediate needs. The role embraces remote PST hours with an on-site base in... ...requiring CA residency and an active CA RN license. You will assess care against...Remote jobImmediate start
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN: Clinical Claims Reviewer. Be the first to apply!
Related searches


