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Blue Cross Rn Remote Jobs in Sacramento, CA (NOW HIRING)

Star Nursing, Inc.

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Case Manager - RN / Clinical Liaison

Sacramento, CA · Remote

$38 - $40/hr

Case Manager - RN / Clinical Liaison Hours: 9 am to 530pm Start date: ASAP Pay rate: $38/hr - $40 ... Remote - Home Base Clinical Liaison / Case Manager Position: * Work closely with the Director of ...

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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 Sacramento, CA?

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

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

The top searched job categories for Blue Cross Rn Remote jobs in Sacramento, CA are:

What cities near Sacramento, CA are hiring for Blue Cross Rn Remote jobs?

Cities near Sacramento, CA 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 Sacramento, CA as of August 2026, with employment types broken down into 87% Full Time, and 13% Part Time. Highlights an 100% Remote job distribution.

Medical Reviewer (Registered Nurse) - Remote CA

Gainwell Technologies LLC

West Sacramento, CA • Remote

$70K - $100K/yr

Full-time

Medical, Life, Retirement, PTO

Posted 12 days ago

Gainwell Technologies rating

7.8

Company rating: 7.8 out of 10

Based on 83 frontline employees who took The Breakroom Quiz

138th of 247 rated software companies

Job description

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

Gainwell Technologies is seeking a Medical Reviewer (Registered Nurse) to support Medical Review Services for California healthcare programs. In this role, you will use your professional nursing experience and clinical judgment to review medical records, healthcare services, claims, and authorization requests.

Your role in our mission
  • Review and interpret medical records and clinical documentation to determine medical necessity and appropriateness of healthcare services.
  • Provide clinical review support for Treatment Authorization Requests (TARs) and other authorization activities.
  • Support medical review activities related to medical policy, claim adjudication, drug utilization review, and other healthcare program requirements as assigned.
  • Apply professional nursing principles, clinical judgment, medical policies, and established utilization guidelines when completing reviews.
  • Review medical documentation to determine whether requested services, procedures, supplies, and equipment meet applicable coverage and clinical requirements.
  • Document review findings, decisions, and supporting clinical rationale accurately and timely.
  • Determine approvals within established guidelines or refer cases to physicians or other appropriate clinical professionals when additional review is required.
  • Apply knowledge of hospital routines, medical services, medical supplies, and their appropriate clinical uses when conducting reviews.
  • Collaborate with physicians, pharmacists, nurses, and other healthcare professionals to support accurate medical review determinations.
  • Maintain current knowledge of applicable clinical criteria, medical policies, procedures, and regulatory requirements.
  • Meet established quality, accuracy, and productivity standards.
What we're looking for
  • Active and unrestricted Registered Nurse (RN) license to practice in the State of California, in good standing.
  • Minimum of two (2) years of professional nursing experience.
  • Possession of a Master’s Degree in Nursing may substitute for one (1) year of the required professional nursing experience.
  • Knowledge of professional nursing principles and techniques, hospital routines, and medical supplies and their uses.
  • Training and/or certification in wound and ostomy care preferred.
  • Strong clinical judgment and ability to interpret medical records and supporting clinical documentation.
  • Experience with medical review, utilization review, medical necessity review, prior authorization, Treatment Authorization Requests (TARs), or claims review preferred.
  • Strong written and verbal communication skills.
What you should expect in this role
  • Full-time position.
  • Remote work environment.
  • Monday through Friday work schedule.
  • Work primarily from your home office while supporting Medical Review Services for California healthcare programs.
  • Spend the majority of your day reviewing medical, clinical, claim, authorization, and/or supporting documentation relevant to your area of expertise.
  • Work independently while collaborating with physicians, pharmacists, nurses, other clinical specialists, operations teams, and business partners.
  • Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations.
  • Maintain all professional licenses, certifications, and credentials required for the position in active, unrestricted, and good-standing status, as applicable.
  • Maintain knowledge of applicable medical policies, coverage requirements, clinical standards, and regulatory guidelines.
  • Meet established quality, accuracy, productivity, and turnaround-time expectations.
  • Receive ongoing training and support related to program requirements, systems, policies, and medical review processes.

This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis.

#LI-REMOTE

#LI-MA1

The pay range for this position is $70,000 - $100,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

What Gainwell Technologies employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Gainwell Technologies logo

About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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