$29.10 - $62.32/hr
Clinical Claims Review Nurse This role requires the nurse to exercise clinical judgment and perform the following duties: Review and interpret clinical documentation obtained from medical records or ...
New
$29.10 - $62.32/hr
Clinical Claims Review Nurse This role requires the nurse to exercise clinical judgment and perform the following duties: Review and interpret clinical documentation obtained from medical records or ...
New
$29.10 - $62.32/hr
Clinical Claims Review Nurse We're building a world of health around every individual -- shaping a more connected, convenient and compassionate health experience. At CVS Health ® , you'll be ...
New
$29.10 - $62.32/hr
Clinical Claims Review Nurse We're building a world of health around every individual -- shaping a more connected, convenient and compassionate health experience. At CVS Health ® , you'll be ...
New
Baltimore, MD · On-site
$36.49 - $41.49/hr
Pay Range: $36.49hr - $41.49hr Responsibilities Review, research, and analyze professional and institutional claims using clinical judgment and medical policies for accurate adjudication. Conduct ...
Baltimore, MD · On-site
$36.49 - $41.49/hr
Pay Range: $36.49hr - $41.49hr Responsibilities Review, research, and analyze professional and institutional claims using clinical judgment and medical policies for accurate adjudication. Conduct ...
... claims review, utilization management, or other healthcare/health insurance environments involving assessment of medical necessity, appropriateness of care, and clinical decision-making. * 3+ years ...
... claims review, utilization management, or other healthcare/health insurance environments involving assessment of medical necessity, appropriateness of care, and clinical decision-making. * 3+ years ...
... claims review, utilization management, or other healthcare/health insurance environments involving assessment of medical necessity, appropriateness of care, and clinical decision-making. * 3+ years ...
... claims review, utilization management, or other healthcare/health insurance environments involving assessment of medical necessity, appropriateness of care, and clinical decision-making. * 3+ years ...
... claims review, utilization management, or other healthcare/health insurance environments involving assessment of medical necessity, appropriateness of care, and clinical decision-making. * 3+ years ...
... claims review, utilization management, or other healthcare/health insurance environments involving assessment of medical necessity, appropriateness of care, and clinical decision-making. * 3+ years ...
... claims review, utilization management, or other healthcare/health insurance environments involving assessment of medical necessity, appropriateness of care, and clinical decision-making. * 3+ years ...
... claims review, utilization management, or other healthcare/health insurance environments involving assessment of medical necessity, appropriateness of care, and clinical decision-making. * 3+ years ...
... claims review, utilization management, or other healthcare/health insurance environments involving assessment of medical necessity, appropriateness of care, and clinical decision-making. * 3+ years ...
... claims review, utilization management, or other healthcare/health insurance environments involving assessment of medical necessity, appropriateness of care, and clinical decision-making. * 3+ years ...
... claims review, utilization management, or other healthcare/health insurance environments involving assessment of medical necessity, appropriateness of care, and clinical decision-making. * 3+ years ...
... claims review, utilization management, or other healthcare/health insurance environments involving assessment of medical necessity, appropriateness of care, and clinical decision-making. * 3+ years ...
$28.94 - $51.83/hr
Ssbv Clinical Claims Review Rn Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ...
$28.94 - $51.83/hr
Ssbv Clinical Claims Review Rn Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ...
$28.94 - $51.83/hr
Ssbv Clinical Claims Review Rn Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ...
$28.94 - $51.83/hr
Ssbv Clinical Claims Review Rn Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ...
Jackson, MS · On-site
$85K - $100K/yr
Manage clinical claims review and processing activities, including medical necessity reviews, audits, reconsiderations, utilization management support, and resolution of complex DRG and OPPS claim ...
Jackson, MS · On-site
$85K - $100K/yr
Manage clinical claims review and processing activities, including medical necessity reviews, audits, reconsiderations, utilization management support, and resolution of complex DRG and OPPS claim ...
Jackson, MS · On-site
$85K - $100K/yr
Manage clinical claims review and processing activities, including medical necessity reviews, audits, reconsiderations, utilization management support, and resolution of complex DRG and OPPS claim ...
Jackson, MS · On-site
$85K - $100K/yr
Manage clinical claims review and processing activities, including medical necessity reviews, audits, reconsiderations, utilization management support, and resolution of complex DRG and OPPS claim ...
$75/hr
The Claims Review Position will play a crucial role in the Florida Statewide Health Plan Claim ... Prepare documents for the clinical reviewer assigned and provide instruction as needed.
$75/hr
The Claims Review Position will play a crucial role in the Florida Statewide Health Plan Claim ... Prepare documents for the clinical reviewer assigned and provide instruction as needed.
Review claims by requesting medical records and other documents to evaluate for clinical appropriateness, coding compliance and validity of charges. Document ineligible charges and provide ...
Review claims by requesting medical records and other documents to evaluate for clinical appropriateness, coding compliance and validity of charges. Document ineligible charges and provide ...
Somerville, MA · On-site +1
... clinical guidelines. The ideal candidate brings hands-on experience with SCO and One Care claims ... • Review and research assigned claims by navigating multiple systems and platforms, then ...
Somerville, MA · On-site +1
... clinical guidelines. The ideal candidate brings hands-on experience with SCO and One Care claims ... • Review and research assigned claims by navigating multiple systems and platforms, then ...
... clinical guidelines. The ideal candidate brings handson experience with SCO and One Care claims ... Review and research assigned claims by navigating multiple systems and platforms, then accurately ...
... clinical guidelines. The ideal candidate brings handson experience with SCO and One Care claims ... Review and research assigned claims by navigating multiple systems and platforms, then accurately ...
Virginia, IL · On-site
$75/hr
The Claims ReviewPositionwill play a crucial role in the Florida Statewide Health Plan Claim ... Prepare documents for the clinical reviewer assigned and provide instruction as needed.
Virginia, IL · On-site
$75/hr
The Claims ReviewPositionwill play a crucial role in the Florida Statewide Health Plan Claim ... Prepare documents for the clinical reviewer assigned and provide instruction as needed.
Los Angeles, CA · On-site
$88K - $142K/yr
Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type ... The UM Claims Review Nurse RN II collaborates closely with internal teams to ensure accurate ...
Los Angeles, CA · On-site
$88K - $142K/yr
Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type ... The UM Claims Review Nurse RN II collaborates closely with internal teams to ensure accurate ...
Los Angeles, CA · On-site
$115K - $142K/yr
Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type ... The UM Claims Review Nurse RN II collaborates closely with internal teams to ensure accurate ...
Los Angeles, CA · On-site
$115K - $142K/yr
Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type ... The UM Claims Review Nurse RN II collaborates closely with internal teams to ensure accurate ...
$11.54 - $14.31
4% of jobs
$14.31 - $17.09
14% of jobs
$18.17 is the 25th percentile. Wages below this are outliers.
$17.09 - $19.86
19% of jobs
The median wage is $21.67 / hr.
$19.86 - $22.64
21% of jobs
$22.64 - $25.42
14% of jobs
$26.53 is the 75th percentile. Wages above this are outliers.
$25.42 - $28.19
10% of jobs
$28.19 - $30.97
4% of jobs
$30.97 - $33.74
5% of jobs
$33.74 - $36.52
3% of jobs
$36.52 - $39.29
3% of jobs
$39.29 - $42.07
3% of jobs
$11
$24
$42
| Aspect | Clinical Claims Review | Medical Claims Processing |
|---|---|---|
| Credentials | Certifications like CPC, CCS, or RHIT often preferred | Certifications like CPC or CPC-H common |
| Work Environment | Healthcare settings, insurance companies, third-party administrators | Insurance companies, healthcare providers, billing departments |
| Job Focus | Evaluating medical necessity, accuracy, and compliance of claims | Data entry, coding, and processing of claims for payment |
Clinical Claims Review involves assessing the medical necessity and accuracy of claims, often requiring clinical knowledge and certifications. Medical Claims Processing focuses on data entry and coding to facilitate claim payments. While both roles work within the insurance and healthcare industry, Clinical Claims Review emphasizes clinical evaluation, whereas Medical Claims Processing centers on administrative processing.
Cities with the most Clinical Claims Review job openings:
States with the most job openings for Clinical Claims Review jobs include:
For Clinical Claims Review jobs, the most frequently searched job titles are:
Remote
$29.10 - $62.32/hr
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 3 days ago
New
5.8
Based on 4,372 frontline employees who took The Breakroom Quiz
We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.
Clinical Claims Review Nurse
This role requires the nurse to exercise clinical judgment and perform the following duties:
Review and interpret clinical documentation obtained from medical records or systems.
Apply clinical decision-making to utilize appropriate clinical criteria and policies for post-service claims.
Coordinate clinical resolutions independently with clinician/MD support as required.
Act as a resource for customer service and claims processing teams.
Train new staff and provide cross-training to existing team members.
Identify trends and provide feedback to leadership if discrepancies or potential fraudulent activities are identified.
Remain current with applicable laws, regulations, and internal workflows to ensure compliance with organizational and state-specific requirements.
Required Qualifications
Preferred Qualifications
Education
Anticipated Weekly Hours
40
Pay Range
The typical pay range for this role is
$29.10 - 62.32
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$29.10 - $62.32This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Get the full story on Breakroom
Sourced by ZipRecruiter
Health care and social assistance and retail
10,000+ Employees
Woonsocket, RI, US
