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)
$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 hours- ...Medical Analyst We are seeking Medical Analysts... ...Projections. This includes reviewing records, preparing the... ...knowledge of CMS policies related to preparing MSAs... ...plans • Uses ISO Claims Partners proprietary information... ...Degree or Diploma in Nursing required • 3-5 years...Remote workPolicyMedicalClaimsFull time
$80k - $99.2k
...Nurse Reviewer Appeals and Hearings- Remote It takes great medical minds to create powerful solutions that solve some of healthcare... ...working knowledge of clinical policies, procedures, rules, and... ...to perform reviews of multiple claim types to provide a flexible workforce...Remote workPolicyMedicalClaimsFull timeFlexible hours- ...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
$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 supporting... ...medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous...Remote workPolicyMedicalClaimsContract workWork at officeLocal areaImmediate start$41.72 - $50.99 per hour
...Massachusetts, Inc. is hiring a Clinical Appeals Nurse Reviewer in Hingham. This role involves... ...certification and extensive experience analyzing claims and clinical documentation. This full-... ...benefits including paid time off and medical/dental/vision insurance. #J-18808-...PolicyMedicalClaimsHourly payFull time$23.56 per hour
...Referral Management Reviewer Zimmerman Associates, Inc. (ZAI)... ...multiple Referral Management (Non-Nurse) Reviewers to support our... ..., Authorization/Denials, or Medical Claims Processing/Insurance... ...and NCR Medical Directorate policies, notifying ordering providers...PolicyMedicalClaimsHourly payContract workFor contractorsWork at office$5,833.33 - $6,666.67 per month
...webpage. Functional Title: Nurse Reviewer Job Title: Nurse III... ...hospital records to validate medical necessity, accurate diagnoses... ...rules, regulations, written policies, and procedures; and identifies... ...software in a telework/remote environment. Minimum...Remote workPolicyMedicalFull timeTemporary workPart timeWork at officeShift workNight shiftDay shift$78k - $85k
It takes great medical minds to create powerful solutions that solve... ...a talented individual for a Nurse Reviewer- Itemized Bill Review role to... ...medical records, healthcare claims, itemized medical bills, and... ...charges in accordance with client policy and industry standards....PolicyMedicalClaimsFull timeWork from homeFlexible hours$30 - $34 per hour
...Complex Medicare Claims Review Complex Medicare claims/prior authorization... ...require the review of medical record documentation to determine... ...are required to use Registered Nurses ("RNs"). Clinical decisions will be based on CMS policies/procedures defined in the CMS...Remote workPolicyMedicalClaimsHourly payContract work- ...planning and utilization review. Review... ...concurrent and retrospective medical necessity and/or compliance... ...with reimbursement policy criteria. Provide case... ...precertification, reimbursement and claim denials/appeals.... ...: ~ Registered Nurse credentialed from the Alabama...Remote workPolicyMedicalClaims
- ...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
- ...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
- National Government Services is seeking a Clinical Review Nurse I for Medicare Part A, primarily working... ...training. You will be responsible for reviewing claims and ensuring they meet members' benefits based on medical policy. Qualifications include an Associate's degree...Remote jobPolicyMedicalClaims
- ...Surgeon or Neurosurgeon for a telecommute role to review health claims, ensuring compliance with policies and guidelines. This position offers flexibility in... ...environment and requires candidates to have a current NJ medical license. Key responsibilities include reviewing...Remote jobPolicyMedicalClaims
- ...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
- ...flexible telecommute position. In this role, you will review health claims and provide medical decisions regarding the appropriateness of provided services... ...and maintain high standards in compliance with state regulations and company policies. #J-18808-Ljbffr ConcentraRemote jobPolicyMedicalClaimsFor contractorsFlexible hours
- ...mandated turnaround times. Our reviewers are compensated on a per-case... ...and retrospective claims. The physician reviewer will... ...provide an interpretation of the medical necessity of services provided... ...compliance with client-specific policies, nationally recognized evidence...Remote workPolicyMedicalClaimsFor contractors
$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$88.85k
...Utilization Management Nurse Specialist RN II facilitates... ..., and approves medically necessary referrals that... ...admission and concurrent review, and collaborates with... ...service and retrospective claims medical review.... ...most current department policy. Facilitate/review requests...PolicyMedicalClaims- ...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
$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... ...staff. Working schedule: Remote, M-F eastern standard business...Remote workPolicyMedicalFull timeShift work- ...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
- 100% remote position in any state except, NY, CA, HI,... ...Care Coordination And Review Activities For Determining... ...And Quality Of Medical/Surgical Services And Serving... ...Review Criteria, Medical Policy guidelines and... ...extended care benefits and claims processing procedures)....Remote workPolicyMedicalClaimsContract work
- ...Job Title: Utilization Review Nurse Location: Remote in IL, TX, NM, MT or OK Duration... ...member benefits, evaluate medical necessity and promote... ...in compliance with medical policy, member eligibility, benefits... ...HCPCS/ICD-10), and overall claims process a plus • Knowledge...Remote workPolicyMedicalClaimsContract workLocal area
- ...Job Title: Utilization Review Nurse Location: Remote in IL, TX, NM, MT or OK Duration... ...member benefits, evaluate medical necessity and promote... ...in compliance with medical policy, member eligibility, benefits... ...HCPCS/ICD-10), and overall claims process a plus • Knowledge...Remote workPolicyMedicalClaimsContract workLocal area
- ...Description Job Description This is a remote position. Seeking Registered Nurse for fully remote role to perform complex medical record and claim reviews (Standard or Program Integrity) to... ...on applicable Medicare coverage policies and payment rules, coding...Remote workPolicyMedicalClaimsContract workTemporary workFor contractorsWork at officeLocal area
- ...BPO Clinical Review Specialist NTT DATA... ...appeals by reviewing medical records and... ...in accordance with policies, guidelines, and National... .... Review claim appeal for reconsideration... ...~ RN - Registered Nurse - State required... ...positions offer remote or hybrid work...Remote workPolicyMedicalClaimsWork at officeFlexible hoursShift work
- ...Description Job Description CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple... ...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 standards...Remote jobPolicyMedicalClaimsPermanent employmentWork at officeLocal area
$68.04k - $118.8k
...Position Perform clinical reviews within the Medical Management Operations... ..., execution of clinical policy and timely access to appropriate... ...of benefits and/or claim adjudication. Research... ...degree or bachelor's degree in nursing. Valid RN License without...Remote workPolicyMedicalClaimsWork experience placement
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