Remote Nurse Reviewer - Medical Necessity & Medicaid
Healthcare Quality Strategies, Inc. (HQSI)
- Remote job
Healthcare Quality Strategies, Inc. (HQSI) is seeking a Nurse Reviewer for remote work to support Medical Review Services. The position requires comprehensive medical necessity reviews for Medicaid claims and requires key responsibilities including conducting reviews and managing case processes. Candidates should have a BSN and active RN licensure, with 3-5 years of experience in medical review. Benefits include medical, dental, vision, and a 401k plan. #J-18808-Ljbffr Healthcare Quality Strategies, Inc. (HQSI)
- ...Quality Strategies, Inc. (HQSI) is looking for a Nurse Reviewer to support Medical Review Services. This remote position requires a BSN with active RN... ...Nurse Reviewer will conduct thorough medical necessity reviews for Medicaid claims and collaborate with a team of professionals...Remote workMedical
- ...Healthcare Quality Strategies, Inc. (HQSI) is seeking a Nurse Reviewer for a remote position supporting Medical Review Services. The role requires conducting comprehensive medical necessity reviews and ensuring compliance with established guidelines. The ideal candidate...Remote workMedical
$36.27 - $56.77 per hour
...Elevance Health is looking for a Nurse Reviewer I in Walnut Creek, CA, allowing for virtual work full-time with in-person training. Responsibilities include conducting reviews for diagnostic imaging services and collaborating with healthcare providers to ensure quality...Remote workMedicalFull time- ...A healthcare organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The role involves examining claims, maintaining... .... This position offers a chance to work in a remote setup with competitive hours. Benefits include...Remote workMedical
$40 per hour
...Nurse Reviewer PT (20‑30 hours week) – Remote Work Environment Non‑Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical... ...performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves...Remote workMedicalContract workWork at officeLocal areaImmediate start$5,833.33 - $6,666.67 per month
...Job Title: Nurse III – Nurse Reviewer Location: Austin, TX – 4601 W Guadalupe... ...ensure adherence to Texas Medicaid requirements and state and... ...hospital records to validate medical necessity, accurate diagnoses and... ...Microsoft software in a telework/remote environment. Minimum of...Remote workMedicalFull timeWork at officeShift workNight shift- ...healthcare quality organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The ideal candidate will have a BSN and... ...participating in ongoing training. This is a part-time remote position, offering a flexible work environment...Remote jobMedicalHourly payPart timeFlexible hours
- ...Elevance Health is seeking a Nurse Reviewer I to conduct medical necessity reviews for diagnostic imaging services. This role offers the flexibility of virtual full-time work, with part-time onsite requirements for training. The successful candidate should possess at least...Remote workMedicalFull timePart time
- A leading medical review company in Washington is seeking a Utilization Management Nurse Reviewer. The role involves assessing medical necessity, reviewing patient records, and collaborating with healthcare... ...a competitive salary range, remote work options, and a...Remote workMedical
$45k - $70k
A healthcare management firm is seeking a Utilization Management Nurse Reviewer to ensure efficient use of medical services. The role involves reviewing medical records, assessing treatment necessity, and collaborating with healthcare providers. Candidates should possess...Remote jobMedical- ...Rising Medical Solutions in Chicago seeks a Legal Nurse to evaluate medical necessity and appropriateness in various claims. Candidates should have an Associate or Bachelor's Degree in nursing and an active RN license. Responsibilities include assessing demand packages...Medical
- ...Harris Health System, Inc. is seeking a Utilization Management Review Nurse (UMRN) in Bellaire, TX. This position involves evaluating medical service necessity and efficiency, ensuring quality care based on clinical guidelines. The UMRN will work closely with various...Remote workMedicalFlexible hours
- ...services organization is seeking a Medical Director to ensure compliance with healthcare... ...standards and evaluate medical necessity for Medicare and Medicaid services. Required qualifications... ...clinical experience. The role supports remote work and requires participation in...Remote workMedical
- ...DOMA Technologies is seeking a Nurse Reviewer to support independent dispute resolutions at Federal... ...levels. This role involves analyzing medical records, providing quality assurance... ...direct patient care experience. This is a remote position that offers the flexibility of...Remote workMedicalWork from home
$45 - $55 per hour
...Commence is looking for a Nurse Reviewer to analyze medical records and support independent dispute resolutions at federal and state levels. The role... ...position offers a flexible work environment, including remote options. The salary ranges from $45 to $55 per hour, depending...Remote workMedicalHourly payPart timeFlexible hours- ...PWN Remote Care Services, P.A. (PWN) is a telehealth practice... ...state physician, registered nurse, and genetic counselor... ...physicians to support asynchronous medical necessity review following a completed... ...Enrollment in Kansas or Arkansas Medicaid preferred, or willingness...Remote workMedicalContract workFlexible hours
$90k - $99k
...It takes great medical minds to create powerful solutions that solve some of healthcare... ...seeking a talented individual for a DRG Nurse Reviewer Appeals and Hearings to coordinate and perform... .... What you should expect in this role Remote (Work from Home) Up to 25% Travel for...Remote workMedicalFull timeWork from homeRelocation packageFlexible hours$45k - $70k
...A healthcare services company is seeking a Utilization Management Nurse Reviewer to ensure medical services are used appropriately. The role involves reviewing medical records and coordinating care while adhering to guidelines. Candidates should possess an unrestricted...Remote workMedical$90k - $99k
...DRG Nurse Reviewer Appeals and Hearings- Remote Date: Jan 9, 2026 Location: Any city, FL, US, 99999 Work Mode: Virtual (Exception only) It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and...Remote workMedicalFull timeWork from homeFlexible hours$45k - $70k
...A leading healthcare company is looking for a Utilization Management Nurse Reviewer to ensure medical services are appropriately utilized. Responsibilities include conducting assessments, reviewing patient records, and collaborating with healthcare providers. A valid...Remote workMedical$45k - $70k
...A leading healthcare company in the United States is looking for a Utilization Management Nurse Reviewer to ensure the efficient use of medical services and provide clinical expertise. Applicants must have an active LVN/RN license, with a preference for candidates having...Remote workMedical$70k - $80k
...Gainwell Technologies is seeking a Nurse Reviewer, Associate, who will conduct clinical reviews to assess if medical records support the need for services based on defined criteria. In this home-based full-time role, you will review and interpret medical documentation,...Remote workMedicalFull timeWork from home- ...Medical Analyst We are seeking Medical Analysts with experience in preparing Medicare... ...Medical Cost Projections. This includes reviewing records, preparing the narrative and an... ...Degree, Associate Degree or Diploma in Nursing required • 3-5 years' experience in Nursing...Remote workMedicalFull time
- ...Downtown Boulder Partnership is seeking a Nurse Reviewer for Appeals and Hearings to coordinate... ...This position is a full-time, permanent remote role that complies with work-from-home policies... ...have at least 5 years of clinical or medical record coding experience, strong...Remote workMedicalPermanent employmentFull timeWork from homeFlexible hours
- ...Description Description: The Medical Nurse Reviewer applies clinical nursing... ...compliance with Medicare, Medicaid, and hospice-specific regulatory... ...This role performs medical necessity reviews, utilization audits... ...and Environment 100% Remote PHI/PII Requirement: Yes...Remote workMedicalFull timeWork at officeFlexible hours
- ...Nurse Reviewer At Commence, we're the start of a new age of data-centric transformation, elevating... ...levels. This role involves analyzing medical records, ensuring proper documentation,... ...functions. This is an office/remote position. While performing the duties of...Remote workMedicalFull timeWork at officeShift work
- ...EPG) are virtual, multi‑state medical practices facilitating... ...with Everlywell, a leading remote‑based healthcare company. Our... ...support asynchronous medical necessity review following a completed genetic... ...AR, GA, MS, TX, WI, LA, AL). Medicaid enrollment in multiple states...Remote workMedicalContract workFlexible hours
$125k - $201k
...Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization... ...of an accredited registered nursing (RN) degree program required... ...Review experience preferred Medicaid/Medicare/Commercial experience...Remote jobMedicalHourly payWork at office- ...American Specialty Health Incorporated is searching for a Clinical Review Support Specialist in the United States. This remote position involves supporting medical necessity reviews, making outreach calls, and collaborating on clinical policies. The ideal candidate will...Remote workMedicalWork from home
- ...Innovative Systems Group is seeking a Registered Nurse for remote positions in IL, TX, NM, MT, or OK. The role involves collaborating... ...healthcare providers to optimize member benefits and evaluate medical necessity, ensuring compliance with established guidelines....Remote workMedical
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