Remote Nurse Reviewer - Medical Claims & Policy Reviews
Healthcare Quality Strategies, Inc. (HQSI)
Florida, NY
- Remote job
A 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 an active RN license, along with experience in medical record review. Responsibilities include evaluating claims against standards, documenting results, and participating in ongoing training. This is a part-time remote position, offering a flexible work environment with competitive hourly pay. #J-18808-Ljbffr Healthcare Quality Strategies, Inc. (HQSI)
Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the Remote Nurse Reviewer - Medical Claims & Policy Reviews in Florida, NY vacancy
- ...healthcare organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The role involves examining... ...knowledge of Medicaid policies, and managing the screening... ...a chance to work in a remote setup with competitive hours...Remote workPolicyMedicalClaims
Healthcare Quality Strategies
Florida, NY2 days ago $90k - $99k
...DRG Nurse Reviewer Appeals and Hearings- Remote Date: Jan 9, 2026 Location: Any city, FL... ...Exception only) It takes great medical minds to create powerful... ...knowledge of clinical policies, procedures, rules, and... ...reviews of multiple claim types to provide a flexible...Remote workPolicyMedicalClaimsFull timeWork from homeFlexible hoursGainwell Technologies
Florida, NY2 days ago$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 role in... ...medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination...Remote workPolicyMedicalClaimsContract workWork at officeLocal areaImmediate startHealthcare Quality Strategies
Florida, NY2 days ago$78k - $85k
...Nurse Reviewer - Itemized Bill Review It takes great medical minds to create powerful solutions that solve some of healthcare... ...of medical records, healthcare claims, itemized medical bills, and UB‑... ...charges in accordance with client policy and industry standards. Perform...Remote workPolicyMedicalClaimsFull timeWork from homeFlexible hoursGainwell Technologies
United States4 days ago$65k - $75k
...to receive an alert: Nurse Reviewer (Registered Nurse) - Remote in US Date: Jul 25, 20... ..., 99999 It takes great medical minds to create powerful... ...clinical criteria, coverage policies, and utilization and... ...perform reviews of multiple claim types to provide a flexible...Remote workPolicyMedicalClaimsPermanent employmentFull timeContract workTemporary workWork from homeMonday to FridayFlexible hoursGainwell Technologies
El Paso, TX2 days ago- ...Description Description: The Medical Nurse Reviewer applies clinical nursing expertise to review claims, medical records, and provider... ..., LCDs, Medicare Benefit Policy Manual guidance, and billing requirements... ...and Environment 100% Remote PHI/PII Requirement: Yes. The...Remote workPolicyMedicalClaimsFull timeWork at officeFlexible hours
- ...Commission (HHSC) is hiring a Nurse Reviewer (Nurse III) to work under... ...assessment of resident needs, medical necessity of care, and... ...colleagues; follow established policies, procedures, and guidance. Support... ...and Microsoft software in a remote/telework environment....Remote workPolicyMedicalFull timeWork at officeNight shift
Yourtexasbenefits
Austin, TX1 day ago $5,833.33 - $6,666.67 per month
...Job Title: Nurse III – Nurse Reviewer Location: Austin, TX – 4601 W Guadalupe St... ...hospital records to validate medical necessity, accurate... ...and OIG colleagues. Follow policies, procedures, guidance, and... ...Microsoft software in a telework/remote environment. Minimum of two...Remote workPolicyMedicalFull timeWork at officeShift workNight shiftTexas Health and Human Services
Austin, TX1 day ago$79.56k - $115.72k
...professionals, including doctors, nurses, business people, tech... ...drive groundbreaking medical discoveries and invite... ...The Senior Nurse Reviewer is responsible for the... ...with the MGB Charge Audit Policy and established... ...Working schedule: ~ Remote, M-F eastern standard business...Remote workPolicyMedicalShift workMass General Brigham
United States1 day ago- ...Nurse Reviewer At Commence, we're the start of a new age of data-centric... ...This role involves analyzing medical records, ensuring proper... ...be responsible for resolving claim disputes submitted by various... ...functions. This is an office/remote position. While performing the...Remote workMedicalClaimsFull timeWork at officeShift work
- ...Work Location: Remote Benefits for eligible... ...and utilization review. Review admissions... ...and retrospective medical necessity and/or compliance... ...with reimbursement policy criteria. Provide... ...reimbursement and claim denials/appeals.... ...~ Registered Nurse credentialed from the...Remote workPolicyMedicalClaims
UAB Medicine
Birmingham, AL2 days ago $23.56 per hour
...hire multiple Referral Management (Non-Nurse) Reviewers to support our contract with the... ...Management, Authorization/Denials, or Medical Claims Processing/Insurance Referral U.S. Citizenship... ...DHA IPM and NCR Medical Directorate policies, notifying ordering providers...PolicyMedicalClaimsHourly payContract workFor contractorsWork at office$59k - $75.05k
...Nurse Reviewer The Nurse Reviewer is primarily responsible for conducting post-service... ..., pre or post payment in-depth claim reviews based on accepted medical guidelines and clinical criteria, billing and coding rules, plan policy exclusions, and payment errors/overpayments...PolicyMedicalClaimsFull timeWork at officeLocal areaVisa sponsorshipFlexible hoursZelis
Atlanta, GA2 days ago- Description: Nurses – are you looking for... ...benefits, including medical, dental, vision,... ...life balance. ~ Remote setting ROLE... ...to a second level reviewer. This individual interfaces... ...guidelines, Hines policies and procedures,... ..., benefit and claim concerns, and validation...Remote workPolicyMedicalClaimsTemporary workWork at officeMonday to FridayFlexible hours
- ...full-time Utilization Review Coordinator will manage... ...inquiries while working remotely. Key responsibilities... ...and UR information into claims or clinical management... ...sources in accordance with policies and procedures Required... ...experience in the medical field preferred Knowledge...Remote workPolicyMedicalClaimsFull timeWork at office
Virtual Vocations Inc
United States1 day ago - ...flexibility to customize schedules and a per-case compensation model. The physicians will conduct health claim reviews and ensure compliance with Concentra's policies. Candidates must have a TX license, current board certification, and active practice experience. Strong...Remote jobPolicyMedicalClaims
$28.76 - $62.3 per hour
...Provides lead level support for medical claim and internal appeals review activities - ensuring alignment with... ...federal regulatory requirements, Molina policies and procedures, and medically... ...QUALIFICATIONS: At least 4 years clinical nursing experience, including broad...Remote workPolicyMedicalClaimsHourly payWork experience placementWork at officeMolina Healthcare
United States3 days ago- ...role. This position allows you to customize your schedule and will involve reviewing health claims to ensure compliance with policies and guidelines. Key responsibilities include making medical interpretations for claims, maintaining licensure, and working with healthcare...Remote jobPolicyMedicalClaims
$41 per hour
...Medical Review Nurse (RN) Remote position, however, candidates must reside in the State of TX or State of... ...accurate and timely medical review of claims suspended for medical necessity,... ...experience. Needs to be able to navigate MCG and medical policies with the reviews....Remote workPolicyMedicalClaimsContract workHireOps Staffing LLC
United States5 days ago$85k - $90k
...Outlier and Readmission reviews. Under the direction... ...reviews of inpatient claims for both coding accuracy... ...Comply with organization policy and procedures.... ...College level courses in medical terminology, anatomy, pathophysiology... ...tasks easily. Remote Work Requirements:...Remote workPolicyMedicalClaimsMed Review Inc
United States1 day ago- ...As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews... ...and prospective and retrospective claims. The Physician Reviewer will... ...in compliance with client-specific policies, nationally recognized evidence-based...Remote workPolicyMedicalClaimsExtra income
Dane Street
United States5 days ago - ...contractor role. The position allows physicians to customize their schedules and involves reviewing health claims to provide medical interpretations while ensuring compliance with policies and state regulations. This role is crucial for health claims management and requires...Remote jobPolicyMedicalClaimsFor contractors
- ...accomplished Board Certified physician to join their medical reviewstream division. This telecommute position... ...a Monday-Friday work week. The role involves reviewing health claims, ensuring compliance with policies and regulations, and provides opportunity for independent...Remote jobPolicyMedicalClaimsMonday to Friday
- ...Candidates must hold a California license and have strong negotiation skills. The reviewer will evaluate health claims, provide medical interpretation, and ensure compliance with Concentra's policies and state regulations. This role requires maintaining credentialing and...Remote jobPolicyMedicalClaimsFor contractorsFlexible hours
- ...State Government is seeking a Claims Clinical Documentation Reviewer to manage pre-payment claim reviews... ...with healthcare laws and policies. The position offers a remote work option within Arizona and... ...reviewing clinical documents for medical and behavioral health services...Remote jobPolicyMedicalClaims
$63k - $65k
...management of complex medical conditions,... ...being of others in a remote work environment.... ...with physicians, claims examiners, clients... ...with the client, nursing staff and claims examiners... ...management reviews. Maintain client’s... ...expectations Metrics, policies, processes are...Remote workPolicyMedicalClaimsWork experience placementFlexible hoursSedgwick
Nashville, TN2 days ago$50 per hour
...Medical Review RN IV – Commercial Appeals & Grievance Nurse Location: Remote – Candidate Must Reside in California Duration: 6+ Months... ...teams, Quality, Pharmacy, Claims, and Customer Service departments... ...coding accuracy, and medical policy compliance while ensuring...Remote workPolicyMedicalClaimsContract workWork at officeLocal areaMonday to FridayPacer Group
United States2 days ago- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical... ...responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical...Remote workPolicyMedicalClaimsPermanent employmentWork at officeLocal area
American Recruiting and Consulting Group
United States3 days ago - ...Medicine physicians to conduct Independent Medical Exams (IME) and Peer Reviews. This opportunity allows you to... ...expertise, and reviews disability claims by providing an interpretation of the... ...based guidelines, client-specifics, policies, procedures, performance standards,...Remote workPolicyMedicalClaimsFor contractorsMonday to Friday
Dane Street
United States8 days ago $69.38k - $92.28k
...Professional Concurrent Review RN, you'll have... ...to apply your nursing knowledge in a meaningful... ..., healthcare policy interpretation,... ...Reviews inpatient medical records against established... ...Review individual claims requiring clinical... ...be: Location: Remote Pay...Remote workPolicyMedicalClaimsContract workMVP Health Care
United States15 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Nurse Reviewer - Medical Claims & Policy Reviews. Be the first to apply!
Related searches
- program coordinator remote Florida, NY
- automation engineer remote Florida, NY
- remote customer service advisor Florida, NY
- it manager remote Florida, NY
- remote financial planning Florida, NY
- remote banking Florida, NY
- remote 3d animation Florida, NY
- tableau developer remote Florida, NY
- python developer remote Florida, NY
- system engineer remote Florida, NY