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Blue Cross Rn Remote Jobs in Prairieville, LA (NOW HIRING)

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Blue Cross Rn Remote information

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 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 remote Blue Cross RN 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.
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What job categories do people searching Blue Cross Rn Remote jobs in Prairieville, LA look for? The top searched job categories for Blue Cross Rn Remote jobs in Prairieville, LA are:
What cities near Prairieville, LA are hiring for Blue Cross Rn Remote jobs? Cities near Prairieville, LA 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 Prairieville, LA as of July 2026, with employment types broken down into 2% As Needed, 72% Full Time, 14% Part Time, 11% Contract, and 1% Nights. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution.

RN, DRG Coder / Clinical Auditor

Pivotal Placement Services

Baton Rouge, LA • Remote

$95K - $105K/yr

Full-time

Posted 9 days ago

Job description

RN, DRG Coder / Clinical Auditor
Must be a Registered Nurse with experience

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

About the Role

We’re seeking a detail-oriented DRG Coder/Clinical Auditor to perform DRG validation reviews of medical records and documentation. This role ensures accurate coding and clinical support for DRG assignments, helping improve billing accuracy, reimbursement, and compliance. You’ll work independently to review records, validate coding, and communicate findings clearly and professionally.

Key Responsibilities

  • Chart Review & Validation
    Review medical records to validate DRG assignments and ensure clinical documentation supports coding decisions.

  • Physician Documentation Review
    Confirm that physician notes and clinical indicators support assigned DRGs.

  • Audit & Compliance
    Conduct audits to verify coding accuracy, enhance reimbursement, and identify cost-saving opportunities.

  • Coding Expertise
    Apply ICD-10-CM and PCS coding guidelines, payer rules, and regulatory standards (Medicare, Medicaid, CMS).

  • Communication & Reporting
    Clearly document findings and communicate results in a professional and concise manner.

  • Other Duties
    Support additional documentation and coding-related tasks as assigned.

Qualifications
  • Licensure: RN
  • Experience:
    • Minimum 1 year of recent DRG auditing experience in a hospital or health plan setting.
    • Inpatient ICD-10 coding experience required.
    • CDI candidates are encouraged to apply.
  • Certifications:
    • National coding certification through AHIMA (preferred) or AAPC.
    • CCS or CIC strongly preferred.
  • Technical Skills:
    • Proficient in MS and APR DRG methodology.
    • Familiarity with Coding Clinic citations and Official Coding Guidelines.
    • Strong understanding of Medicare/CMS documentation requirements.
  • Soft Skills:
    • Exceptional attention to detail.
    • Strong problem-solving and critical thinking abilities.
    • Effective verbal and written communication.
    • Ability to work independently in a fast-paced, production-driven environment.
  • Tools:
    • Proficient in Microsoft Office Suite.
Compensation

💵 Pay Range: $90,000 – $104,841
Salary is based on location, experience, qualifications, and internal equity. Final compensation may vary depending on assessment during the interview process.

Who We Are

Headquartered in Central Florida, Pivotal Placement Services is a full-service national workforce solutions firm that specializes in placing healthcare professionals—from staff to leadership—with both clinical and non-clinical employers. Our comprehensive and customer-focused workforce solutions include Direct Placement and Managed Service Provider (MSP) / Vendor Managed Services (VMS) engagements nationwide.