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Freelance Insurance Nurse Reviewer Jobs (NOW HIRING)

Blue Cross Blue Shield of Wyoming

Nurse Reviewer, RN

We are Blue Cross Blue Shield Wyoming: a not-for-profit health insurer with offices throughout the ... As a Nurse Reviewer at BCBSWY, you will be part of an amazing team of knowledgeable professionals ...

Unum Group

Insurance Nurse Specialist

As an Insurance Nurse Specialist, you'll use your nursing knowledge and professional judgement to ... You will review and interpret medical evidence, identify functional restrictions, recovery ...

HMSA

Nurse Reviewer - Clinical Review Unit

Kapolei, HI · On-site

Assists on inquiries from external parties such as the State Insurance Commissioner and from the ... The Nurse Reviewer must follow each line of business' requirements and each accrediting body's (CMS ...

New

Zimmerman Associates, Inc.

$24.13/hr

Referral Management (Non-Nurse) Reviewers will facilitate centralized product line and specialty ... Processing/Insurance Referral * U.S. Citizenship required, with the ability to obtain a Public ...

Astiva Health

UM Nurse Reviewer

Orange, CA · On-site

The Utilization Management Authorization Review Nurse is responsible for managing inpatient ... Dental Insurance * Health Insurance * Life Insurance * Vision Insurance * Paid Time Off ...

Astiva Health

UM Nurse Reviewer

Orange, CA

$75K - $95K/yr

The Utilization Management Authorization Review Nurse is responsible for managing inpatient ... Dental Insurance * Health Insurance * Life Insurance * Vision Insurance * Paid Time Off ...

Zimmerman Associates, Inc.

$23.56/hr

Referral Management (Non-Nurse) Reviewers will facilitate centralized product line and specialty ... Processing/Insurance Referral * U.S. Citizenship required, with the ability to obtain a Public ...

Cohere Health

Lead RN Reviewer

$35 - $37/hr

Lead RN Reviewer Cohere's Service Operations team is responsible for ensuring that our healthcare ... Other duties as assigned What you'll need: * 5+ years in healthcare, managed care, or insurance ...

Dane Street

PRN Utilization Review Nurse Reviewer

Utilization Management Nurse Reviewers collaborate with healthcare providers, insurance companies, and patients to optimize healthcare delivery, control costs, and maintain quality care. Their ...

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How much do freelance insurance nurse reviewer jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for freelance insurance 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 Freelance Insurance Nurse Reviewer vs Insurance Claims Nurse?

AspectFreelance Insurance Nurse ReviewerInsurance Claims Nurse
CredentialsRegistered Nurse (RN) with insurance knowledgeRegistered Nurse (RN) with insurance or claims experience
Work EnvironmentRemote, freelance basisTypically in insurance company offices or remote
Employer/IndustryInsurance companies, third-party administrators, or as independent contractorsInsurance companies, healthcare providers, or claims departments

Both roles require RN licensure and insurance knowledge, but Freelance Insurance Nurse Reviewers work independently on review projects, while Insurance Claims Nurses handle claims processing and assessment within organizations. The freelance role offers more flexibility, whereas Claims Nurses often work in structured environments.

What cities are hiring for Freelance Insurance Nurse Reviewer jobs?

Cities with the most Freelance Insurance Nurse Reviewer job openings:

What are the most commonly searched types of Insurance Nurse Reviewer jobs?

The most popular types of Insurance Nurse Reviewer jobs are:

What states have the most Freelance Insurance Nurse Reviewer jobs?

States with the most job openings for Freelance Insurance Nurse Reviewer jobs include:

Freelance Insurance Nurse Reviewer jobs near you

Nurse Reviewer - Clinical Review Unit

Hawaii Medical Service Association

Kapolei, HI • On-site

Full-time

Posted 3 days ago

New

Job description

  1. Utilize medical necessity criteria from established medical policies and clinical practice guidelines to render precertification determinations as described in the Medical Management UM work plan. This detailed clinical judgment includes evaluating whether the requested service is a covered benefit under the member's health plan, is medically appropriate for the member's clinical condition or whether the request requires referral to a Medical Director for potential denial of the request. The Nurse Reviewer must follow each line of business' requirements and each accrediting body's (CMS, NCQA, HSAG) requirements for each request. Assists on inquiries from external parties such as the State Insurance Commissioner and from the Legal Department. Responsibilities include, but are not limited to:
  2. Demonstrate understanding and application of over 250 Guide to Benefits, Evidence of Coverage, Plan Brochure, and Member Handbook. HMSA annually updated medical and drug policies, medical protocols, National Comprehensive Cancer Network, Milliman Care Guidelines, Drugdex, etc. to determine the medical necessity of urgent and non-urgent precertification requests. Urgent requests must be completed within 72 hours and non-urgent requests within 15 calendar days.
  3. Use clinical judgment, medical necessity guidelines and plan benefits to determine approval, potential denial or alternative treatment of each urgent or non-urgent precertification request. Settings include inpatient, outpatient, in-state, out-of state and out-of country.
  4. Document clinical case summary and review outcome of each review appropriately to meet regulatory and program requirements.
  5. Review various types of services, including but not limited to:
    • Transplants
    • Air Ambulance
    • Chemotherapy
    • Clinical trials
    • Genetic testing
    • Cancer treatments/radiation therapy
    • Experimental/Investigational Services/Devices
    • New Technology
  6. Utilize medical necessity criteria from established medical policies and clinical practice guidelines to render precertification determinations as described in the Medical Management UM work plan. This detailed clinical judgment includes evaluating whether the requested service is a covered benefit under the member's health plan, is medically appropriate for the member's clinical condition or whether the request requires referral to a Medical Director for potential denial of the request. The Nurse Reviewer must follow each line of business' requirements and each accrediting body's (CMS, NCQA, HSAG) requirements for each request. Assists on inquiries from external parties such as the State Insurance Commissioner and from the Legal Department. Responsibilities include, but are not limited to:
    • Call providers when additional clinical information is required to clarify or complete a complex precertification determination.
    • Approve precertification requests based on clinical judgment using criteria, medical record documentation and other information received from the provider.
    • Consult with Medical Directors on requests which do not meet clinical criteria and offer alternative covered health care options as appropriate.
    • Consult Medical Directors on potential quality issues identified during review of medical records. Refer cases to Integrated Health Management, Pharmacy Department or Benefits Integrity Department depending on the concern.
  7. Evaluate suspended claims against medical records to determine the medical necessity and appropriateness of medical services, identify irregularities such as over or under-utilization of services, potential up-coding, over billing, etc.
  8. Communicate timely, accurate information either verbally, electronically or in writing using clinical judgment, knowledge of medical/reimbursement policies and plan benefits to providers, members as well as internal MM staff and other internal departments (Claims Administration, Customer Relations, Provider Contracting, etc.). For denied services, ensure the denial, benefit and appeal language are accurate and consistent with department procedures, accreditation and regulatory guidelines.
  9. Identify and refer members with specific medical and/or behavioral health needs or complex case management and collaborate with medical and behavioral case management staff. Identify and refer quality of care issues and suspected fraud, waste or abuse to the appropriate departments.
  10. Perform pre-screening assessment of incoming pre-certification requests to ensure appropriateness of review. Advises non-clinical staff on clinical and coding questions to ensure correct system processes and entries.

  1. Associates Degree in Nursing
  2. Current, unrestricted Nursing License in the state of Hawaii as an RN or LPN
  3. Two years clinical, case management or utilization management related experience
  4. Knowledge of current standards of care to be followed for a given diagnosis and the normative values of medical tests and procedures.
  5. Strong organizational skills
  6. Good communication skills both verbally and written
  7. Multi-tasking skills
  8. Critical thinking skills
  9. Analytical skills
  10. Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, and Outlook.
  11. Currently licensed in Hawaii as an RN or LPN
    (if applicable upon hire, proof of licensure to be provided by employee or confirmed by Human Resources)

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