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 3 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 jobPolicyMedicalClaims
- WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level Medicare redeterminations to determine medical necessity... ...documentation is prepared for CMS and internal policies. The role requires an RN license, ASN/BSN, and 1+ year...Remote jobPolicyMedicalClaims
$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- ...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
Virtual Vocations Inc
United States5 days ago $78k - $85k
...It takes great medical minds to create powerful solutions that solve... ...a talented individual for a Nurse Reviewer- Itemized Bill Review role... ...medical records, healthcare claims, itemized medical bills, and... ...charges in accordance with client policy and industry standards....PolicyMedicalClaimsFull timeWork from homeFlexible hoursGainwell Technologies LLC
Texasmore than 2 months ago- Responsibilities Provide timely review and determination of medical claims, including prior authorization, appeals... ...Coverage Determination (NCD) policies, and other federal regulations Apply... ...unrestricted State license as a Registered Nurse (RN) as required by contract(s) 1+...PolicyMedicalClaimsContract workFor contractorsWork at officeLocal area
- ...Elevance Health’s Wellpoint Federal division seeks a Clinical Review Nurse I to assess pre-claim reviews and claims for medical necessity and eligibility. This remote role emphasizes accuracy, policy knowledge, and timely decision-making. The position requires an AS in...Remote workPolicyMedicalClaims
Elevance Health
Chicago, IL4 days ago $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
Plano, TX1 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
- ...within a Monday to Friday workweek. The role includes reviewing health claims and providing recommendations on medical necessity and appropriateness of care. Candidates... ...in ensuring compliance with medical review policies while maintaining a work-life balance. #J-18808-...Remote jobPolicyMedicalClaimsMonday to FridayFlexible hours
- UnitedHealth Group seeks a Clinical Review Clinician to serve as the subject matter expert for... ...enjoy limited supervision within a broad policy framework and must understand the claim review process, clinical review, medical record review, and billing guidelines. #J-...Remote jobPolicyMedicalClaims
- ...Medical Review SpecialistMedlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology, our highly skilled... ...documentation according to guidelines and RW policies and procedures.Determines if treatment is related...Remote workPolicyMedicalClaimsWork at office
Medlogix
Southfield, MI3 days ago - ...Certified Orthopedic Surgeon to join our medical review stream as a flexible, telecommute... ...independent contractor. You will review health claims, render medical interpretations and... ...appropriateness of services within Concentra policies, with a Monday-Friday schedule during...Remote jobPolicyMedicalClaimsFor contractorsMonday to FridayFlexible hours
- ...Certified Orthopedic Surgeon for a telecommute medical review role. This is a 1099 independent contractor position reviewing health claims, providing medical interpretation, and... ...in line with Concentra Physician Review policies and URAAC guidelines. The ideal candidate...Remote jobPolicyMedicalClaimsContract workFor contractorsMonday to Friday
- ...Quality Assurance Reviewer: Remote Position Grapefruit Health is... ...: Complete monthly claim review using clinical judgment and established policies and procedures by deadlines... ...a healthcare background: nursing, pharmacy, social work, medical assisting, dietitians,...Remote workPolicyMedicalClaimsImmediate start10 hours per week
Grapefruit Health
United States2 days ago - ...Rehabilitation physician for a telecommute medical review role in Los Angeles. The position is a 1099... ...hours. The role focuses on reviewing health claims, determining medical necessity, and ensuring compliance with UR policies and state regulations. A CA license and...Remote jobPolicyMedicalClaimsContract workFor contractorsMonday to FridayFlexible hours
$248.5k - $373k
...00 - $373,000/yearJob Area: Medical & Clinical OperationsCompany... ...clinical coverage and medical claims reviews. Our role is to empower... ...enjoy the flexibility to work remotely * from anywhere within the U... ...proprietary coverage review policies, render coverage determinationsDocument...Remote workPolicyMedicalClaimsMinimum wageFull timeWork experience placementLocal area- ...Coast Service Options is seeking a Clinical Review Nurse to evaluate medical necessity, coverage, and payment levels for Medicare-related claims. The role applies clinical knowledge to... ...of care in line with CMS policies and standards. The incumbent will review...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,... ...be able to navigate MCG and medical policies with the reviews. HireOps Staffing...Remote jobPolicyMedicalClaimsContract 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
American Recruiting and Consulting Group
United States2 days ago - ...Medical Review Nurse - Home Health Auditor Machinify is a leading healthcare... ...primarily performs medical claims audit reviews with a focus... ...Commercial Payers. You will work remotely in a fast-paced and dynamic... ...medical review guidelines, policies and rules. Document all...Remote workPolicyMedicalClaimsWork at office
Machinify, Inc.
United States3 days ago - ...experience, Associates and 7 years of experience At least 3 years of experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity. Current/Active Nursing or Physical Therapy...Remote workMedicalClaimsNight shift
$85k - $90k
...Outlier, and Readmission Reviews. Under the direction... ...reviews of inpatient claims to ensure coding accuracy... .... This is a fully remote position. Candidates must... ...with organization policy and procedures. Qualifications... ...level courses in medical terminology, anatomy,...Remote workPolicyMedicalClaimsFull timeMedReview
New York, NYa month ago- Itemized Bill and Medical Record Reviewer job at Alaffia Health. New York, NY. About... ...have experience reviewing claim forms and auditing provider... ...Flexible, paid vacation policy Work in a flat organizational... ...direct access to Leadership LI-REMOTE #J-18808-Ljbffr Alaffia...Remote workPolicyMedicalClaimsFlexible hours
$112.7k - $193.2k
...Payment Integrity's Professional Claim Review products. These are... ...fairly, reducing unnecessary medical spend across the full claim lifecycle... ...the flexibility to work remotely * from anywhere within the U.... ...coding validation, reimbursement policy, provider billing, or...Remote workPolicyMedicalClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaShift work- ...Description Physician Peer Reviewer – Multiple Specialties... ...accredited Independent Medical Review Organization (... ...independent review claims and appeals in any of the... ...regulations, and applicable policy guides Completes and... ...Job Type Contract Work Location Remote...Remote workPolicyMedicalClaimsContract workWork experience placementWork at office
Federal Hearings And Appeals
Wilkes Barre, PA9 days ago - ...of benefits including medical, dental, and vision coverage... ...generous paid time off policy ensures you have time... ...are provided for remote workspace. About Dane... ...over 200,000 insurance claims annually for leading national... ...Medical Exams and Peer Review programs that assist...Remote workPolicyMedicalClaimsFull timeTemporary workWork from home
- ...The utilization review and management (UM... ...contracted facilities are medically necessary,... ...documentation of claims along the process... ...with organizational policies and regulatory requirements... ...~ Registered nurse with active,... ...an in-office, no remote work capability position...Remote workPolicyMedicalClaimsWork at office
MedTrust LLC
Oklahoma City, OK2 days ago - ...Emergency Medicine Telecommute Medical Review Stream Physician Location... ...background, reviews health claims providing medical interpretation... ...Concentra Physician Review policies, procedures, and performance... ...agencies, carriers, employers, nurses and health care professionals...Remote workPolicyMedicalClaimsContract workTemporary workFor contractorsLocal areaMonday to FridayFlexible hours
Concentra
United States4 days ago $110k - $140k
...Clinical Quality Reviewer - BCBA Onos Health's mission... ...clinical documentation for medical necessity and clinical... ...Experience analyzing claims, utilization, or outcomes... ...office (Financial District), remote-first culture Unlimited vacation policy Paid parental leave...Remote workPolicyMedicalClaimsWork at officeHome officeFlexible hours2 days per week3 days per weekOnos Health
San Francisco, CA3 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
- senior devops engineer remote Florida, NY
- medical coding remote Florida, NY
- remote medical coding supervisor Florida, NY
- remote virtual Florida, NY
- remote contract attorney Florida, NY
- clinical data manager remote Florida, NY
- administrative assistant remote Florida, NY
- online remote Florida, NY
- remote junior web developer Florida, NY
- remote work no experience Florida, NY