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Contract Remote Nurse Reviewer Jobs (NOW HIRING)

Peraton

Nurse Reviewer - Medicaid

$66K - $106K/yr

... as a Registered Nurse or other clinician, and/or experience in review of medical claims for ... and contract considerations. Depending on the position, employees may be eligible for overtime ...

New

Broadway Ventures

Medical Claims Reviewer (RN)

Remote (U.S. - Work from home) Remote Work Requirements : High-speed internet (non-satellite) and a ... For positions covered by the Service Contract Act, pay is also governed by the applicable ...

Comagine

Clinical Reviewer RN - Alabama

We go beyond merely providing a remote work option; we support and embrace it. We offer ... Must maintain licensure eligibility for assigned state contract Comagine Health is an equal ...

Comagine Health

Clinical Reviewer

We go beyond merely providing a remote work option; we support and embrace it. We offer ... Current, active, unrestricted RN license * Must meet New Mexico state and contract-specific ...

MAXIMUS

Clinical Reviewer, RN/LPN (Remote - TN)

General information Job Posting Title Clinical Reviewer, RN/LPN (Remote - TN) Date Monday, July 6, ... contract. Areas will include but are not limited to PASRR Level 1 and Katie Beckett. In this role ...

Comagine

Clinical Reviewer

We go beyond merely providing a remote work option; we support and embrace it. We offer ... Current, active, unrestricted RN license * Must meet New Mexico state and contract-specific ...

BreatheSuite Inc

Remote Nurse Practitioner

Denver, CO · On-site +1

Remote Nurse Practitioner Classification: 1099 Independent Contractor Work Structure: Fully Remote ... review * Develop and manage individualized care plans for patients with chronic lung conditions

BreatheSuite

Remote Nurse Practitioner

Denver, CO · Remote

Remote Nurse Practitioner Classification: 1099 Independent Contractor Work Structure: Fully Remote ... review * Develop and manage individualized care plans for patients with chronic lung conditions

BreatheSuite Inc

Remote Nurse Practitioner

Denver, CO · Remote

Job Title:Remote Nurse Practitioner Classification: 1099 Independent Contractor Work Structure ... review * Develop and manage individualized care plans for patients with chronic lung conditions

BreatheSuite

Remote Nurse Practitioner

Denver, CO · Remote

Job Title:Remote Nurse Practitioner Classification: 1099 Independent Contractor Work Structure ... review * Develop and manage individualized care plans for patients with chronic lung conditions

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Contract Remote Nurse Reviewer information

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$28

$37

$42

How much do contract remote nurse reviewer jobs pay per hour?

As of Jul 30, 2026, the average hourly pay for contract remote nurse reviewer in the United States is $37.04, according to ZipRecruiter salary data. Most workers in this role earn between $34.13 and $41.35 per hour, depending on experience, location, and employer.

What is the difference between Contract Remote Nurse Reviewer vs Contract Remote Nurse Auditor?

AspectContract Remote Nurse ReviewerContract Remote Nurse Auditor
CertificationsRN license, clinical experienceRN license, clinical experience, auditing certifications (if any)
Work EnvironmentRemote, reviewing medical records and claimsRemote, auditing healthcare claims and documentation
Employer & Industry UsageHealthcare providers, insurance companiesInsurance companies, third-party administrators

Both roles require RN licensure and clinical experience, with the main difference being that Contract Remote Nurse Reviewers focus on evaluating medical records for appropriateness, while Contract Remote Nurse Auditors analyze claims and billing for accuracy. They often work in similar remote healthcare environments and are used by insurance companies and healthcare organizations. The roles are closely related but differ in their specific focus within healthcare compliance and review processes.

What are the key skills and qualifications needed to thrive as a Contract Remote Nurse Reviewer, and why are they important?

To thrive as a Contract Remote Nurse Reviewer, you need a valid RN license, solid clinical experience, and strong analytical skills in medical record review. Familiarity with utilization management software, electronic health records (EHR), and knowledge of regulatory guidelines like CMS or NCQA is essential. Excellent written communication, attention to detail, and the ability to work independently are standout soft skills for this role. These competencies are crucial for delivering accurate, timely reviews that support quality patient care and regulatory compliance in a remote setting.

What are some common challenges faced by Contract Remote Nurse Reviewers, and how can they be managed effectively?

Contract Remote Nurse Reviewers often encounter challenges such as adapting to varying client documentation systems, managing tight deadlines, and maintaining effective communication with healthcare teams while working remotely. To manage these effectively, it's helpful to become proficient in multiple electronic health record (EHR) platforms, establish a structured daily routine, and use collaboration tools like secure messaging or video conferencing. Staying organized and proactively reaching out to colleagues or supervisors for clarification can also ensure accuracy and efficiency in case reviews.

What is a Contract Remote Nurse Reviewer?

A Contract Remote Nurse Reviewer is a licensed nurse who works remotely, usually on a contract basis, to review medical records, claims, and healthcare documentation. Their main role is to assess the medical necessity, appropriateness, and quality of patient care, often for insurance companies, healthcare organizations, or legal purposes. They ensure that treatments and services provided meet established guidelines and help prevent fraud or unnecessary procedures. This position allows nurses to use their clinical expertise in a non-clinical, flexible work-from-home setting. Contract roles typically mean assignments may be temporary or project-based.
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Contract Remote Nurse Reviewer jobs near you

Nurse Reviewer - Allentown, PA

Healthcare Quality Strategies, Inc.

Allentown, PA • Remote

$40/hr

Part-time

Medical, Dental, Vision, Life, Retirement

Re-posted 17 days ago

Job description

Nurse Reviewer
PT (20-30 hours week) – Remote Work Environment
Non-Exempt: $40.00 hour
Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely.
Essential Duties and Responsibilities:
  • Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies
  • Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines
  • Document evidence-based criteria applicable to specific contract requirements
  • Record and report screening results, including relevant referral questions, into a centralized database
  • Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity
  • Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations
  • Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards
Knowledge, Experience, Skills and Education:
  • Medical terminology, ICD-10, CPT and HCPCS
  • Clinical criteria (InterQual and MCG)
  • Utilization/Medical record review and chart abstraction
  • Current standards of medical practice
  • Comply with HIPAA/HITECH laws and regulations
Experience in:
  • At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred)
  • Experience performing medical record review, audit for federal or state contracts
  • Knowledge and experience of Medicare and Medicaid policy
  • Proficiency with Microsoft Office (Word, Excel, and Outlook)
  • Proficiency with Adobe PDF files and features
  • Generating accurate, timely, and understandable correspondence
  • Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG)
Skills Requirements include:
  • Professional interpersonal skills; ability to interact with providers, physicians and peers
  • Solid analytical, assessment and documentation skills
  • Effective written and verbal communication, both internally and externally
  • Strong attention to detail
  • Strong attention to deadlines
  • Organizational skills including effective time management, priority setting and process improvement
  • Ability to work independently and as a member of a team
  • Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations
Educational Background:
  • BSN with active RN licensure in good standing
Physical Demands:
Remote Work, Prolonged Sitting, Screen Exposure
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
Healthcare Quality Strategies, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD amp;D, voluntary life/AD amp;D, 401k
For immediate consideration, please apply via the HQSI Careers Page at: www.hqsi.org gt; Careers gt; Current Employment Opportunities
EOE: Minorities/Females/Disabled/Veterans
Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace
Healthcare Quality Strategies, Inc. is an E-Verify Employer

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