Remote RN: Clinical Claim Review & Coverage Specialist
$29 - $52 per hourCrains Cleveland
- Remote job
Crains Cleveland is seeking an experienced Registered Nurse (RN) for clinical coverage review services in Boston, MA. Ideal candidates will need a current RN license and experience in inpatient settings. This position allows for telecommuting, adhering to company policies. As part of this role, you will interpret various mandates and communicate benefit determinations with healthcare providers. The hourly pay ranges from $29 to $52, reflecting skills and local labor market conditions. #J-18808-Ljbffr Crains Cleveland
$29 - $52 per hour
UnitedHealth Group is seeking a qualified Registered Nurse in Massachusetts to perform clinical coverage review services. As part of this role, you will communicate benefit determinations and work closely with healthcare providers to explain coverage. We offer telecommuting...Remote jobClaimsHourly pay$29 - $52 per hour
UnitedHealth Group is looking for a Registered Nurse to perform clinical coverage reviews and communicate benefit determinations. This role requires an Associate's degree and an unrestricted RN license in Massachusetts with 3+ years of nursing experience. You will contribute...Remote jobClaimsHourly pay$29 - $52 per hour
The University of Minnesota School of Nursing is seeking a Clinical Review RN in Boston, Massachusetts. This role involves performing clinical coverage reviews, interpreting mandates, and communicating benefit determinations while ensuring compliance with telecommuter...Remote jobClaimsHourly pay$29 - $52 per hour
Stryker Corporation is seeking a Registered Nurse in Boston, Massachusetts for clinical coverage review services. The ideal candidate will have an Associate's degree, an active RN license, and at least 3 years of nursing experience. Responsibilities include interpreting...Remote jobClaimsHourly pay$29 - $52 per hour
...tough challenges. Primary Responsibilities Perform clinical coverage review services, which require interpretation of state and federal... ...Qualifications ~ Associate's degree ~ Current unrestricted RN license in the state of Massachusetts ~3+ years of...Remote workClaimsHourly payMinimum wageFull timeWork experience placementLocal area- IntelliResume is looking for a Clinical Claim Review RN to work full-time in Boston, MA. This role involves performing clinical coverage review services and interpreting mandates to communicate benefit determinations in a fast-paced environment. The ideal candidate will...ClaimsFull time
- ...Stryker Corporation is seeking a Clinical Claim Review Nurse to perform detailed reviews of claims against medical records. The position offers... ...Candidates should possess an Associate's degree and an active RN license. Responsibilities include ensuring compliance with guidelines...Remote workClaims
$80k - $90k
...Range: $80-90k The Medical Review Clinical Appeals Auditor (RN) is responsible for... ...conducts research, analyzes claims data, applies knowledge of... ...programs, particularly the coverage and payment rules and regulations... ...to work independently in remote setting with minimum...Remote workClaimsFor contractorsImmediate startWork from homeHome officeFlexible hoursShift work- ...Southcarolinablues is seeking a RN Medical Reviewer III (Remote in SC) to perform medical reviews using clinical information and established guidelines. This role involves reviewing complex medical claims and educating teammates on healthcare processes. The ideal candidate...Remote workClaimsWork from home
$36 - $48 per hour
...Santa Barbara Cottage Hospital is seeking a Medical Claims Clinical Review Nurse for a remote position. This role involves conducting clinical reviews of... ...compliance with regulations. The ideal candidate will have an RN license in California and a minimum of three years of...Remote workClaimsHourly pay$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... ...along with Short-term disability and Long-Term Disability coverage ~401(k) Savings Plan, Employee Stock Purchase Plan ~...Remote jobClaimsHourly payMinimum wageFull timeTemporary workWork experience placementWork at officeLocal areaHome office$50 - $53 per hour
...Job Title: Clinical Review RN (IDR/Appeals) Experience: Open to various clinical backgrounds... ...State RN license*** Location: Remote (can sit anywhere in the US as long as... ...RNs as the project expands. 4. Claims assessment and adjudication. 5....Remote workClaimsLocal areaImmediate startFlexible hours- Stryker Corporation is looking for a Clinical Claims Review RN to perform reviews of inpatient hospital claims. This role supports a high-volume environment and allows for telecommuting from anywhere in the U.S. The ideal candidate must have an RN license, a minimum of...Remote jobClaims
- Optum, part of the UnitedHealth Group, is looking for a Clinical Claims Review RN to conduct administrative reviews of short stay inpatient hospital claims. This position is open to telecommuting from anywhere in the U.S. and is situated in a high-volume, production-driven...Remote jobClaims
$28.94 - $51.83 per hour
Crains Cleveland is seeking a Clinical Claims Review RN to perform administrative reviews of short-stay inpatient hospital claims. This role supports a production-driven environment and allows telecommuting from anywhere in the U.S. The ideal candidate must have an associate...Remote jobClaimsHourly pay- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical... ...to the validity of health claims and levels of payment in meeting... ...clinical decisions on the coverage, medical necessity,... ...unrestricted Registered Nurse (RN) license PREFERRED QUALIFICATIONS...Remote workClaimsPermanent employmentWork at officeLocal area
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting... ...applications This is a 100% remote role, and requires robust internet... ...authorization data with post-service claims validation, we're creating a transparent...Remote workClaimsFull timeFlexible hoursShift work$28.94 - $51.83 per hour
...Growing together. The Clinical Review Clinician serves as a subject... ...comprehensive understanding of the claim review process including... ...and Long-Term Disability coverage 401(k) Savings Plan, Employee... ...) Active and unrestricted RN license OR LPN in the state of...Remote workClaimsHourly payMinimum wageFull timeTemporary workWork experience placementLocal area- ...Ternium Revenue Cycle Management is seeking a full-time Remote Clinical Review Nurse to analyze denied insurance claims, draft appeal letters, and collaborate with legal... ...interaction. The ideal candidate will have an RN License and over 5 years of acute hospital...Remote workClaimsFull time
- ...Join MedPOINT Management as a Medical Claims Clinical Review Nurse in Sherman Oaks, CA, where you'll... ...Requirements: Registered Nurse (RN) license in California is required.... ...makes a difference in the lives of patients every day. This is a remote position....Remote workClaims
- Texas Health Institute is seeking a Clinical DRG RN auditor who will leverage expertise in MS-DRG and APR-DRG coding to audit inpatient claims. This role entails validating ICD-10 codes and DRG assignments while working remotely from anywhere in the U.S. The ideal candidate...Remote jobClaimsRelocation package
$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... ...such as Medical Coverage Guidelines (MCG) or InterQual... ...Active unrestricted RN license in good...Remote workClaimsFor contractorsWork at officeWork from homeHome officeShift work$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... ...medical necessity, benefit coverage, coding accuracy, and...Remote workClaimsContract workWork at officeLocal areaMonday to Friday$45.29 - $84.11 per hour
...weekends and holiday coverage expected! Northwell... ...better. Hybrid/Remote Summary: The purpose... ...and accurate clinical information to all... ...obstacles and deny claims and escalating any... ...Responsibilities: # Review all inpatient... ...Required: Current RN License in Connecticut...Remote workClaimsHourly payDaily paidPart timeShift workNight shiftRotating shift- UnitedHealth Group is seeking a Medical Director who focuses on clinical coverage and medical claims reviews. This role involves collaboration with a... ...least 5 years of clinical experience. Flexibility to work remotely within the U.S. is offered along with a competitive compensation...Remote jobClaims
- ...Remote Rn – Medical Claims Reviewer At Broadway Ventures, we transform challenges into opportunities with... ...ensure compliance with established clinical criteria and guidelines. The ideal candidate... ..., and reasonableness for coverage and reimbursement. Provide clear,...Remote workClaimsFull timeFor contractorsWork at officeHome officeMonday to Friday
$248.5k - $373k
Texas Health Institute is seeking a Medical Director in Boston, MA, to support Enterprise Clinical Services. This role focuses on clinical coverage and medical claims reviews, ensuring cost-effective quality medical care for members. The Medical Director will collaborate...Remote jobClaims- ...Clinical Trial Billing Specialist Primary City/State: Phoenix, Arizona... ...Department Name: Charge Review-Rsrch Work Shift:... ...by reading payer coverage analyses, dividing patient... ...role is primarily remote scheduled Monday-... ...and correcting claims. 4. Researches missing...Remote workClaimsWork at officeWork from homeMonday to FridayShift work
$29 - $52 per hour
About This Role The Clinical Claim Review RN at UnitedHealth Group is responsible for performing clinical coverage review services, interpreting mandates, and communicating benefit determinations. This role is ideal for experienced RNs looking to make impactful decisions...ClaimsHourly payFull timeDay shift$28.94 - $51.83 per hour
Optum, part of the UnitedHealth Group, is seeking a Clinical Claims Review RN (SSBV) to perform administrative reviews of short‑stay inpatient hospital claims and document determinations. The role supports a high‑volume, production‑driven environment and is eligible for...Remote workClaimsHourly payFull timeTemporary workWork at officeHome office
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