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Clinical Review Nurse Remote Jobs (NOW HIRING)

Centene

Clinical Review Nurse - Concurrent Review

$27.02 - $48.55/hr

This position is fully remote/work from home; applicants must reside in the state of Missouri and ... Nursing and 2 - 4 years of related experience. 2+ years of acute care experience required. Clinical ...

Centene

Clinical Review Nurse - Concurrent Review

$27.02 - $48.55/hr

The position is remote/work from home; applicants must hold an IL RN licensure. The position is ... Clinical knowledge and ability to determine overall health of member including treatment needs and ...

Corrohealth

PRN Clinical Review Nurse (RN)

The PRN Clinical Review Specialist provides clinical review support on an as-needed basis to assist ... This is a remote position. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and ...

Centene

Clinical Review Nurse - Prior Authorization

$27.02 - $48.55/hr

This isa remote positionrequiringexperience with InterQual, utilization management, and Medicaid. Candidatesshould be comfortableworking in ametric-driven environment andbe technologically savvy ...

HealthHelp

Nurse - Clinical Review

$65K - $75K/yr

Nurse - Clinical Review Performs utilization review of cases to determine if the request meets ... Remote Compensation Disclosure The base salary for this position is $65,000 [LVN/LPN], $75,000 [RN] ...

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

... policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly ... For positions that are available as remote work, Sentara Health employs associates in the following ...

TEEMA Group

Clinical Quality Review Nurse

Phoenix, AZ · Remote

$41 - $44/hr

USA- Remote in approved states Overview: TEEMA is partnering with a leading organization supporting a large-scale federal healthcare program to identify a Clinical Quality Reviewer. This role focuses ...

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How much do clinical review nurse remote jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for clinical review nurse remote in the United States is $44.13, according to ZipRecruiter salary data. Most workers in this role earn between $36.30 and $52.40 per hour, depending on experience, location, and employer.

What is a clinical review nurse remote?

Clinical Review Nurses working remotely are registered nurses who assess and review medical records, treatment plans, or insurance claims from a virtual location. Their primary responsibility is to ensure that patient care meets established guidelines and that services are medically necessary and appropriately documented. They often collaborate with healthcare providers, insurance companies, or government programs to provide clinical expertise and support decision-making processes. Remote positions allow these nurses to perform their duties from home or another offsite location, using secure digital platforms. This role typically requires strong analytical skills, attention to detail, and up-to-date nursing credentials.

How does a clinical review nurse remote typically collaborate with physicians and other healthcare professionals?

As a remote Clinical Review Nurse, collaboration with physicians and other healthcare professionals is primarily conducted through secure digital platforms, phone calls, and video conferencing. Nurses in this role review patient records, assess medical necessity, and communicate their findings or recommendations directly to providers, case managers, and insurance representatives. Building strong virtual communication skills is essential, as much of the teamwork relies on clear, concise documentation and timely follow-ups to ensure quality patient care and compliance with medical guidelines.

What are the key skills and qualifications needed to thrive as a clinical review nurse remote?

A Clinical Review Nurse Remote needs a current RN license, strong clinical expertise, and experience in case review or utilization management. Familiarity with electronic medical records (EMRs), review platforms, and payer-specific guidelines, often supported by certifications like CCM or URAC, is essential. Excellent analytical skills, attention to detail, and strong written communication set outstanding candidates apart in this role. These skills ensure accurate clinical evaluations, effective remote collaboration, and compliance with regulatory standards in healthcare delivery.

What is the difference between Clinical Review Nurse Remote vs Clinical Case Manager?

AspectClinical Review Nurse RemoteClinical Case Manager
CredentialsRN license, clinical review certification (e.g., CCRC)RN license, case management certification (e.g., CCM)
Work EnvironmentRemote, healthcare or insurance companiesRemote or in-office, healthcare or insurance settings
Industry UsageInsurance, healthcare, utilization reviewHealthcare, insurance, patient advocacy
Job FocusReview medical records for appropriateness of careCoordinate patient care and services

Both roles require nursing credentials and often involve remote work within healthcare or insurance industries. Clinical Review Nurses focus on evaluating medical records for care appropriateness, while Clinical Case Managers coordinate patient services and care plans. The roles are similar in environment and industry but differ in daily responsibilities.

How to become a clinical review nurse remote?

To become a remote clinical review nurse, candidates typically need a registered nurse (RN) license, relevant clinical experience, and knowledge of medical coding and documentation. Many roles require familiarity with electronic health records (EHR) systems and certification in case management or utilization review. Strong communication skills and the ability to work independently are also important for remote positions.

What does a remote clinical review nurse do?

A remote clinical review nurse evaluates patient records, medical histories, and treatment plans to determine appropriate care and insurance coverage. They analyze clinical data, ensure compliance with healthcare regulations, and communicate findings to healthcare providers or insurance companies, often using electronic health record systems. Strong clinical knowledge, attention to detail, and remote communication skills are essential for this role.
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Clinical Review Nurse Remote jobs near you
Infographic showing various Clinical Review Nurse Remote job openings in the United States as of August 2026, with employment types broken down into 3% As Needed, 74% Full Time, 15% Part Time, and 8% Contract. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution, with an average salary of $91,797 per year, or $44.1 per hour.

Clinical Review Nurse - Remote

ARC Group

Jacksonville, FL • Remote

Full-time

Re-posted 22 days ago

Job description

CLINICAL REVIEW NURSE - REMOTE
ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to join a dynamic and well-respected organization offering tremendous career growth potential.
At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply.
100% REMOTE!
Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering).
SUMMARY STATEMENT
The Clinical Review Nurse is responsible 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 of care. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prior authorization, complex pre-payment medical review or post-payment medical review.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
90% of time will be spent on one or more of the following activities depending on assignments:
Review and analyze pre and post pay complex health care claims from a medical perspective, inclusive of prior authorization:
  • Perform clinical review work as assigned; may provide guidance to other team members and accurately interpret and apply broad CMS guidelines to specific and highly variable situations.
  • Conduct review of claim data and medical records to make clinical decisions on the coverage, medical necessity, utilization and appropriateness of care per national and local policies, as well as accepted medical standards of care.
  • Review provider practices and identify issues of concern, overpayment and need for corrective action as necessary; includes surfacing potential fraud and abuse or practice concerns.
  • May develop recommendations for further corrective action based on medical review findings.
  • May refer for review, or implement, corrective action related to medical review activities.
  • May process claims and complete project work in the appropriate computer system(s).

The remaining 10% of time will be spent on the following activities depending on assignments:
Identify providers needing education and individually educate providers who are subject to medical
review processes:
  • Initiate or participate in provider teaching activities, creating written teaching material, providing one on one education or education to a group as a result of a medical review (e.g., probe, progressive corrective action, consent, etc.) or appeal.
  • This may involve discussion with CMS leaders and leaders in the provider community.
  • Participate in special projects as assigned.

REQUIRED QUALIFICATIONS
* Valid nursing degree
* 2 years' clinical experience
* Excellent written and oral communication skills
* Demonstrated experience with evaluating medical and health care delivery issues (e.g., Inpatient Rehab Facility)
* Strong computer skills to include Microsoft Office proficiency
* Valid unrestricted Registered Nurse (RN) license
PREFERRED QUALIFICATIONS
* Inpatient Rehabilitation Facility Experience
* Bachelor of Science in Nursing (BSN)
* Insurance industry experience
* Certified Coder
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position is offered with no fee to candidate.