Remote Nurse Reviewer - Medical Claims & Policy Reviews
Healthcare Quality Strategies, Inc. (HQSI)
- 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)
- ...Description Provide timely review and determination of medical claims, including prior... ...Coverage Determination (NCD) policies, and other federal regulations... ...license as a Registered Nurse (RN),as required by... ...for this position Remote but need to be local to 1...Remote workPolicyMedicalClaimsContract workFor contractorsWork experience placementWork at officeLocal area
$90k - $99k
DRG Nurse Reviewer Appeals and Hearings- Remote Date: Jan 9, 2026 Location: Any city, FL, US,... ...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 jobPolicyMedicalClaimsFull timeWork from homeFlexible hours$40 per hour
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 supporting the... ...medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination...Remote workPolicyMedicalClaimsContract workWork at officeLocal areaImmediate start$78k - $88k
...It takes great medical minds to create powerful solutions... ...individual for a Nurse Reviewer (RN) who will be responsible... ...criteria, coverage policies, and utilization and... ...to review multiple claim types to maintain workforce... ...work schedule. Remote position; employees must...Remote workPolicyMedicalClaimsPermanent employmentFull timeContract workTemporary workMonday to FridayFlexible hours- ...Providing support for inpatient and outpatient clinical claim review activities, the full-time Remote Registered Nurse Clinical Reviewer will verify coded diagnoses,... ...with billing guidelines while assessing medical records for clinical integrity. Key responsibilities...Remote workMedicalClaimsFull time
- ...Nurse Reviewer 1 Nurse Reviewer 1 Location: This role enables associates to work virtually... .... Please note that per our policy on virtual work, candidates not within a... ...are routine having limited or no previous medical review experience requiring guidance by...Remote workPolicyMedicalFull timeWork experience placementWork at officeLocal areaMonday to FridayWeekend work
- ...care.? Requirements: The Nurse Reviewer plays a crucial role in the... ...healthcare industry by evaluating medical records, treatment plans,... ...on healthcare regulations, policies, and guidelines, and ensure... ...functions. This is remote position. While performing the...Remote workPolicyMedicalWork at office
- ...Working remotely, the Clinical Denials Specialist will review denied claims, analyze denial reasons, and collaborate with... ...discrepancies Analyze medical records and payer policies to prepare effective appeal... ...healthcare administration, nursing, health information management...Remote workPolicyMedicalClaims
$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 hours- ...-quality at-home care, the full-time remote Medical Review Nurse will ensure compliance with CMS regulations... ...Interpret and operationalize LCD policies for surgical dressings and establish... ...process for surgical dressing claims, ensuring clinical completeness and billing...Remote workPolicyMedicalClaimsFull time
- ...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
$31 - $35 per hour
...Overview: The Clinical Review & Correspondence RN... ...by conducting medical necessity reviews,... ...need: Registered Nurse with active, unencumbered... ...: This is a 100% remote role, and requires... ...-including policy, prior authorization... ...with post-service claims validation, we’re creating...Remote workPolicyMedicalClaimsFull timeFlexible hoursShift work- ...Performing clinical claim reviews, the part-time Massachusetts Licensed... ...guidelines while working remotely. Key responsibilities: Conduct... ...reviews of claims against medical records to assess support for... ...and adhering to compliance policies Assist in resolving claims...Remote workPolicyMedicalClaimsPart timeWork at office
$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 work$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 Friday$57.24k - $62.18k
...Nurses - are you looking for a change? Want... ...Experience in both medical and behavioral... ...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- ...Medlogix, LLC delivers innovative medical claims solutions through a seamless... ...comprehensive Medical Review Services, Medical Case Management... ...per week) Non-Exempt Remote- EST time zone POSITION SUMMARY... ...to guidelines and RW policies and procedures. Determines...Remote workPolicyMedicalClaimsFull timeWork at office
- ...Working at HHS webpage. Functional Title: Nurse Reviewer Job Title: Nurse II Agency: Health &... ...statewide UR program and to ensure UR policies and procedures are applied consistently... ...laws, rules, standards, and regulations, medical diagnoses and procedures, community...Remote workPolicyMedicalFull timeTemporary workPart timeWork at officeLocal areaWork from homeShift work
- ...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
$50 - $52 per hour
...Claims Clinical Documentation Reviewer Schedule: 5-10 hours per week. Resource can work... ...weekends if they prefer. Remote position. Equipment is... ...providers for Medicaid services (medical, behavioral health, NEMT,... ...Statute, Rules, and Policies applicable to AHCCCS...Remote workPolicyMedicalClaimsPart timeWork at officeLong distance10 hours per week$7.25 per hour
...down healthcare costs. The Medical Review Nurse - CMS / RAC (Government... ...primarily performs medical claims audit reviews for government... ...Government Payers. You will work remotely in a fast paced and dynamic... ...medical review guidelines, policies and rules. Document all findings...Remote workPolicyMedicalClaimsHourly payFull timeFor contractorsWork at officeShift work$7.25 per hour
...drive down healthcare costs. The Medical Review Nurse II primarily performs medical claims audit reviews with a focus on... ...Payers. You will work remotely in a fast-paced and dynamic environment... ...appropriate medical review guidelines, policies and rules. Document all...Remote workPolicyMedicalClaimsHourly payFull timeWork at officeShift work$95k - $120.65k
...DRG Quality Assurance reviews in an effort to... ...reviews on inpatient DRG claims as they compare with medical records utilizing... ...client specific coverage policies. What you'll do:... ...~ Registered Nurse licensure preferred... ...foster a hybrid and remote friendly culture, and...Remote workPolicyMedicalClaimsFull timeWork at officeLocal areaVisa sponsorshipFlexible hours- ...The utilization review and management (UM... ...contracted facilities are medically necessary,... ...documentation of claims along the process... ...with organizational policies and regulatory requirements... ...· Register nurse with active, unincumbered... ...an in-office, no remote work capability...Remote workPolicyMedicalClaimsFull timeWork at office
$68k - $70k
Description Our Medical Review Nurse Analyst is responsible for conducting... ...Review Nurse Analyst reviews claims and delivers provider... ...experience. We are open to remote work in the following approved... ...CMS guidelines, and company policies. Enjoy staying current on...Remote workPolicyMedicalClaimsContract workFor contractorsLocal areaImmediate start- ...Position: Case Review Specialist – Phone Intake & Documentation Location: Remote Remote Status: Remote Job Id: 1678 #... ..., ensuring alignment with policies, procedures, and regulatory... ...Management, Customer Support, Medical Directors, Appeals, Claims, Operations) to ensure...Remote workPolicyMedicalClaimsWork at officeLocal areaMonday to FridayShift work
$30 - $38 per hour
...are seeking Utilization Review Nurse RN to join our team on... ...and review for the medical necessity of treatment... ...medical necessity; and post claim or post service... ...guidelines, internal medical policies, group specific... ...successfully perform in a remote healthcare environment...Remote workPolicyMedicalClaimsHourly payFull timePart timeWork at officeMonday to FridayWeekend work$35 per hour
...pay range $35.00/hr - $35.00/hr Medical Review Nurse Location: Phoenix, AZ 85034 (Remote) 3+ Months Day Shift Position Description... ...Emergency Services (FES) 1500 claim forms. Some coordination will be... ...of rules, laws and agency policy pertaining to the AHCCCS program...Remote workPolicyMedicalClaimsHourly payContract workTemporary workPart timeFor contractorsWork at officeShift workDay shift- ...Avosys is seeking a Registered Nurse - Medical Review Specialist to provide... ...Specialist LOCATION: Remote work from home. HOURS... ...Medicare Part A and Part B claims for Medical Review, Redeterminations... ...the applicable Medicare policies (i.e., Local Coverage...Remote workPolicyMedicalClaimsFull timeFor contractorsWork at officeLocal areaImmediate startMonday to FridayShift work
$80k - $90k
...Range: $80-90k The Medical Review Clinical Appeals... ...with department quality policies and procedures, scoring... ...conducts research, analyzes claims data, applies... ...work independently in remote setting with minimum supervision... ...and diversified nursing experience providing direct...Remote workPolicyMedicalClaimsFor contractorsImmediate startWork from homeHome officeFlexible hoursShift work
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