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Blue Cross Rn Remote Jobs in Franklin, TN (NOW HIRING)

PharmD Live

Spanish Speaking LPN - Tennessee

Nashville, TN · Remote

$26.25 - $35.75/hr

Fully Remote Schedule: Flexible - create your own hours Requirement: Must hold an active Tennessee RN or LPN license Position Overview: We are looking for a bilingual Care Coordinator (RN/LPN) fluent ...

PharmD Live

Spanish Speaking LPN - Tennessee

Nashville, TN · Remote

$24.75 - $33.75/hr

Fully Remote Schedule: Flexible - create your own hours Requirement: Must hold an active Tennessee RN or LPN license Position Overview: We are looking for a bilingual Care Coordinator (RN/LPN) fluent ...

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All JobsBlue Cross Rn JobsBlue Cross Rn Remote JobsBlue Cross Rn Remote Jobs in Franklin, TN

Blue Cross Rn Remote information

What is a Blue Cross RN remote?

A Blue Cross RN Remote is a registered nurse who works remotely for Blue Cross Blue Shield, typically supporting members through telehealth, case management, care coordination, and health coaching. These nurses use phone, video calls, and digital platforms to assess patient needs, develop care plans, and provide education and support. Their role helps ensure that members receive high-quality care and guidance without needing in-person visits, making healthcare more accessible and convenient. Blue Cross RNs working remotely may also assist with pre-authorization, utilization management, or disease management programs.

How does a Blue Cross RN remote typically communicate and coordinate care with interdisciplinary team members?

As a remote Blue Cross RN, effective communication with physicians, case managers, social workers, and other healthcare professionals is essential. Most coordination occurs via secure digital platforms, video calls, and phone conferences, allowing for timely updates on patient progress and care plans. Regular virtual meetings and documentation in shared electronic health records ensure seamless teamwork and continuity of care. Building strong digital communication skills and being proactive about follow-ups are key to success in this remote setting.

What are the key skills and qualifications needed to thrive as a Blue Cross RN remote, and why are they important?

To excel as a Blue Cross RN Remote, you need an active RN license, clinical nursing experience (often in case management or utilization review), and strong assessment abilities. Familiarity with electronic medical record (EMR) systems, telehealth platforms, and case management software is typically required, along with certifications like CCM (Certified Case Manager) being advantageous. Exceptional communication, self-motivation, and organizational skills help nurses effectively support members and collaborate virtually with healthcare teams. These competencies ensure quality patient care, regulatory compliance, and efficient service delivery in a remote environment.

What is the difference between Blue Cross Rn Remote vs Blue Cross Lpn Remote?

AspectBlue Cross Rn RemoteBlue Cross Lpn Remote
Required CredentialsRegistered Nurse (RN) licenseLicensed Practical Nurse (LPN) license
Work EnvironmentRemote healthcare support, patient assessmentsRemote patient care, basic clinical tasks
Employer & Industry UsageHealth insurance companies, healthcare providersHealth insurance companies, healthcare providers
Common Search & ComparisonYesYes

Blue Cross Rn Remote and Blue Cross Lpn Remote roles both serve in remote healthcare settings within insurance companies and healthcare providers. The main difference lies in the required credentials: RNs need a registered nurse license, while LPNs require a practical nurse license. RNs typically handle more complex patient assessments, whereas LPNs focus on basic patient care tasks. Both roles are essential in remote healthcare support, but they differ in scope and qualification requirements.

What are popular job titles related to Blue Cross Rn Remote jobs in Franklin, TN?

For Blue Cross Rn Remote jobs in Franklin, TN, the most frequently searched job titles are:

What job categories do people searching Blue Cross Rn Remote jobs in Franklin, TN look for?

The top searched job categories for Blue Cross Rn Remote jobs in Franklin, TN are:

What cities near Franklin, TN are hiring for Blue Cross Rn Remote jobs?

Cities near Franklin, TN with the most Blue Cross Rn Remote job openings:

Blue Cross Rn Remote jobs near you
Infographic showing various Blue Cross Rn Remote job openings in Franklin, TN as of August 2026, with employment types broken down into 78% Full Time, 11% Part Time, 9% Contract, and 2% Nights. Highlights an 100% Remote job distribution.

DRG Coder, Registered Nurse

Pivotal Placement Services

Brentwood, TN • Remote

$95K - $105K/yr

Full-time

Posted 2 days ago

New

Key responsibilities

  • Perform in-depth DRG quality audits of inpatient medical records and validate DRG assignments against clinical documentation and coding guidelines.

  • Evaluate physician documentation to ensure clinical indicators support assigned diagnoses and procedures, and assess severity of illness, risk of mortality, and DRG impact.

  • Ensure compliance with Medicare, CMS, and payer-specific documentation and coding requirements, and document audit findings clearly and professionally.

Job description

DRG Coder, Registered Nurse

Remote | Full-Time | Healthcare | Clinical Documentation & Coding

About the Role

We are seeking an experienced DRG Coder / Clinical Auditor (RN) to conduct comprehensive DRG quality and validation audits of inpatient medical records. This role is critical in ensuring accurate DRG assignment, strong clinical documentation support, and compliance with Medicare and CMS regulations. The ideal candidate is highly analytical, clinically strong, and comfortable working independently in a production-driven audit environment.

You will play a key role in improving coding accuracy, reimbursement integrity, and regulatory compliance while providing clear, defensible audit findings.

Key Responsibilities DRG Validation & Chart Review
  • Perform in-depth DRG quality audits of inpatient medical records.
  • Validate DRG assignments against clinical documentation and coding guidelines.
  • Identify missed opportunities, discrepancies, and documentation gaps impacting reimbursement.
Clinical Documentation Review
  • Evaluate physician documentation to ensure clinical indicators appropriately support assigned diagnoses and procedures.
  • Apply strong clinical judgment to assess severity of illness, risk of mortality, and DRG impact.
Audit & Compliance
  • Ensure compliance with Medicare, CMS, and payer-specific documentation and coding requirements.
  • Identify trends, risks, and improvement opportunities related to DRG accuracy and quality.
  • Support organizational initiatives focused on audit accuracy, compliance, and revenue integrity.
Coding Expertise
  • Apply extensive hands-on knowledge of ICD-10-CM and ICD-10-PCS, Coding Clinic guidance, and Official Coding Guidelines.
  • Utilize MS-DRG and APR-DRG methodologies when reviewing and validating records.
Communication & Reporting
  • Document audit findings clearly, concisely, and professionally.
  • Communicate results and rationale effectively to internal stakeholders as required.
Additional Duties
  • Support other documentation, coding, and audit-related activities as assigned.
Required Qualifications Licensure
  • Active Registered Nurse (RN) license required
    (Non-RN candidates will not be considered)
Experience
  • Minimum of 2 years of recent DRG quality auditing experience in a hospital or health plan setting.
  • Extensive hands-on inpatient ICD-10-CM and ICD-10-PCS coding experience required.
Certifications
  • National coding certification required (AHIMA or AAPC).
  • CCS, CIC, or equivalent strongly preferred.
Technical Knowledge
  • Proficiency in Medicare and CMS documentation and coding guidelines.
  • Strong understanding of MS-DRG and APR-DRG methodologies.
  • Advanced familiarity with Coding Clinic citations and Official Coding Guidelines.
Soft Skills
  • Exceptional attention to detail and analytical accuracy.
  • Strong critical thinking and problem-solving skills.
  • Clear, professional written and verbal communication.
  • Ability to work independently in a fast-paced, production-driven environment.
Tools
  • Proficient in Microsoft Office Suite (Excel, Word, Outlook).
Compensation

Pay Range: $90,000 – $104,841

Compensation is based on location, experience, qualifications, and internal equity. Final compensation may vary following the interview and assessment process.

Who We Are

Headquartered in Central Florida, Pivotal Placement Services is a full-service national workforce solutions firm specializing in healthcare talent—from frontline staff to executive leadership—in both clinical and non-clinical roles. We deliver customer-focused staffing solutions through Direct Placement and MSP/VMS partnerships nationwide.