S. - Work from home) Remote Work Requirements : High-speed internet (non-satellite) and a private ... Review medically complex claims , pre-authorization requests, appeals, and fraud/abuse referrals.
S. - Work from home) Remote Work Requirements : High-speed internet (non-satellite) and a private ... Review medically complex claims , pre-authorization requests, appeals, and fraud/abuse referrals.
S. - Work from home) Remote Work Requirements : High-speed internet (non-satellite) and a private ... Review medically complex claims , pre-authorization requests, appeals, and fraud/abuse referrals.
S. - Work from home) Remote Work Requirements : High-speed internet (non-satellite) and a private ... Review medically complex claims , pre-authorization requests, appeals, and fraud/abuse referrals.
S. - Work from home) Remote Work Requirements : High-speed internet (non-satellite) and a private ... About the Role We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team
S. - Work from home) Remote Work Requirements : High-speed internet (non-satellite) and a private ... About the Role We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team
Remote Triage Nurse
Eugene, OR · Remote
The Triage Nurse is a remote Registered Nurse who provides telephone and electronic triage support ... Manage inbound clinical issues from firsthand staff and patients via phone; triage appropriately ...
Remote Triage Nurse
Eugene, OR · Remote
The Triage Nurse is a remote Registered Nurse who provides telephone and electronic triage support ... Manage inbound clinical issues from firsthand staff and patients via phone; triage appropriately ...
RN Supervisor, Appeals, Managed Care, UM
OR · On-site +1
$75K - $135K/yr
REMOTE RN candidates may reside in any state but a current and active RN license from the state of California is strongly preferred Position Purpose: Supervises Prior Authorization, Concurrent Review ...
RN Supervisor, Appeals, Managed Care, UM
OR · On-site +1
$75K - $135K/yr
REMOTE RN candidates may reside in any state but a current and active RN license from the state of California is strongly preferred Position Purpose: Supervises Prior Authorization, Concurrent Review ...
Remote Triage Nurse
Eugene, OR · On-site +1
$80K/yr
The Triage Nurse is a remote Registered Nurse who provides telephone and electronic triage support ... Manage inbound clinical issues from firsthand staff and patients via phone; triage appropriately ...
Remote Triage Nurse
Eugene, OR · On-site +1
$80K/yr
The Triage Nurse is a remote Registered Nurse who provides telephone and electronic triage support ... Manage inbound clinical issues from firsthand staff and patients via phone; triage appropriately ...
... Registered Dietitians (RDs) and Certified Nutrition Specialists (CNSs) licensed in any state to ... remote sessions to clients who fit your areas of specialty. * Work from anywhere in the U.S. and ...
... Registered Dietitians (RDs) and Certified Nutrition Specialists (CNSs) licensed in any state to ... remote sessions to clients who fit your areas of specialty. * Work from anywhere in the U.S. and ...
... Registered Dietitians (RDs) and Certified Nutrition Specialists (CNSs) licensed in any state to ... remote sessions to clients who fit your areas of specialty. * Work from anywhere in the U.S. and ...
... Registered Dietitians (RDs) and Certified Nutrition Specialists (CNSs) licensed in any state to ... remote sessions to clients who fit your areas of specialty. * Work from anywhere in the U.S. and ...
... Registered Dietitians (RDs) and Certified Nutrition Specialists (CNSs) licensed in any state to ... remote sessions to clients who fit your areas of specialty. * Work from anywhere in the U.S. and ...
... Registered Dietitians (RDs) and Certified Nutrition Specialists (CNSs) licensed in any state to ... remote sessions to clients who fit your areas of specialty. * Work from anywhere in the U.S. and ...
Remote Employment Type: Contract (Case-based) Hourly Rate: Per Case Compensation (See details below ... We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to ...
Remote Employment Type: Contract (Case-based) Hourly Rate: Per Case Compensation (See details below ... We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to ...
Remote Care Management Nurse
Portland, OR · Remote
$34.20 - $55.70/hr
Remote Care Management Nurse (Future Opportunities) Work from home within Oregon, Washington, Idaho ... Are you a Registered Nurse looking to transition out of bedside care and into a role that still ...
Remote Care Management Nurse
Portland, OR · Remote
$34.20 - $55.70/hr
Remote Care Management Nurse (Future Opportunities) Work from home within Oregon, Washington, Idaho ... Are you a Registered Nurse looking to transition out of bedside care and into a role that still ...
Remote Care Management Nurse
Salem, OR · Remote
$34.20 - $55.70/hr
Remote Care Management Nurse (Future Opportunities) Work from home within Oregon, Washington, Idaho ... Are you a Registered Nurse looking to transition out of bedside care and into a role that still ...
Remote Care Management Nurse
Salem, OR · Remote
$34.20 - $55.70/hr
Remote Care Management Nurse (Future Opportunities) Work from home within Oregon, Washington, Idaho ... Are you a Registered Nurse looking to transition out of bedside care and into a role that still ...
Remote Care Management Nurse
Medford, OR · Remote
$34.20 - $55.70/hr
Remote Care Management Nurse (Future Opportunities) Work from home within Oregon, Washington, Idaho ... Are you a Registered Nurse looking to transition out of bedside care and into a role that still ...
Remote Care Management Nurse
Medford, OR · Remote
$34.20 - $55.70/hr
Remote Care Management Nurse (Future Opportunities) Work from home within Oregon, Washington, Idaho ... Are you a Registered Nurse looking to transition out of bedside care and into a role that still ...
Remote Care Management Nurse
Bend, OR · Remote
$34.20 - $55.70/hr
Remote Care Management Nurse (Future Opportunities) Work from home within Oregon, Washington, Idaho ... Are you a Registered Nurse looking to transition out of bedside care and into a role that still ...
Remote Care Management Nurse
Bend, OR · Remote
$34.20 - $55.70/hr
Remote Care Management Nurse (Future Opportunities) Work from home within Oregon, Washington, Idaho ... Are you a Registered Nurse looking to transition out of bedside care and into a role that still ...
Pharmacy Technician
Irving, TX · Remote
$16.75 - $20.25/hr
... chart review and outreach. This is a short-term contact position. WORK LOCATION: FULLY REMOTE PAY ... Must be a registered Pharmacy Technician in TX * 6+ months in pharmacy, call center, or customer ...
Pharmacy Technician
Irving, TX · Remote
$16.75 - $20.25/hr
... chart review and outreach. This is a short-term contact position. WORK LOCATION: FULLY REMOTE PAY ... Must be a registered Pharmacy Technician in TX * 6+ months in pharmacy, call center, or customer ...
$17.50 - $21.25/hr
... chart review and outreach. This is a short-term contact position. WORK LOCATION: FULLY REMOTE PAY ... Must be a registered Pharmacy Technician in TX * 6+ months in pharmacy, call center, or customer ...
$17.50 - $21.25/hr
... chart review and outreach. This is a short-term contact position. WORK LOCATION: FULLY REMOTE PAY ... Must be a registered Pharmacy Technician in TX * 6+ months in pharmacy, call center, or customer ...
Utilization Review Nurse
Roseburg, OR · On-site +1
$85K - $105K/yr
UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state * Graduation from an ...
Utilization Review Nurse
Roseburg, OR · On-site +1
$85K - $105K/yr
UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state * Graduation from an ...
Medical Review Auditor (Fraud Waste and Abuse)
$70K - $91K/yr
Licensed Practical Nurse (LPN) * Registered Nurse (RN) * Required Credential: * Certified ... This is a work-at-home position (US only). * Remaining in a stationary position, often standing or ...
Medical Review Auditor (Fraud Waste and Abuse)
$70K - $91K/yr
Licensed Practical Nurse (LPN) * Registered Nurse (RN) * Required Credential: * Certified ... This is a work-at-home position (US only). * Remaining in a stationary position, often standing or ...
Inside Sales Representative - Remote
Portland, OR · On-site +1
What if you could have an impactful sales career working from home without the pressure of knocking door-to-door or visiting client businesses? As an Inside Sales Representative (remote) with Precoa ...
Inside Sales Representative - Remote
Portland, OR · On-site +1
What if you could have an impactful sales career working from home without the pressure of knocking door-to-door or visiting client businesses? As an Inside Sales Representative (remote) with Precoa ...
Home Infusion Registered Nurse - Accredo Specialty Pharmacy Join Accredo Specialty Pharmacy, part ... If you will be working at home occasionally or permanently, the internet connection must be ...
Home Infusion Registered Nurse - Accredo Specialty Pharmacy Join Accredo Specialty Pharmacy, part ... If you will be working at home occasionally or permanently, the internet connection must be ...
From Home Remote Rn Chart Review information
What is the difference between From Home Remote Rn Chart Review vs From Home Remote LPN Chart Review?
| Aspect | From Home Remote Rn Chart Review | From Home Remote LPN Chart Review |
|---|---|---|
| Required Credentials | Registered Nurse (RN) license | Licensed Practical Nurse (LPN) license |
| Work Environment | Remote, home-based | Remote, home-based |
| Job Responsibilities | Comprehensive chart review, clinical decision support | Basic chart review, data entry |
| Industry Usage | Hospitals, insurance companies, healthcare providers |
While both roles involve remote chart review, Rn Chart Review requires an RN license and involves more complex clinical assessments, whereas LPN Chart Review requires an LPN license with more routine data review tasks. The RN role typically offers higher responsibility and pay, reflecting the advanced clinical skills needed.

Other
Re-posted 4 hours ago
Job description
Job Type: Full-time (40 hours/week)
Schedule: Monday-Friday, 8:00 AM - 5:00 PM
Max Salary: W-2 ($60,000-$63,000)
Location: Remote (U.S. - Work from home)
Remote Work Requirements: High-speed internet (non-satellite) and a private, lockable home office
Equipment: You will be provided with all necessary equipment to perform your job effectively, including but not limited to a desktop computer, dual monitors, a headset, an ethernet cable, and additional accessories as needed.
We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to assess medical necessity, appropriateness, and reimbursement eligibility while documenting decisions in accordance with regulatory and organizational requirements.
Key Responsibilities- Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
- Assess payment determinations using clinical information and established guidelines.
- Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
- Provide clear, well-documented rationales for service approvals or denials.
- Educate internal and external teams on medical review processes, coverage determinations, and coding requirements.
- Support quality control activities to meet corporate and team objectives.
- Provide guidance to LPN team members and support non-clinical staff through training and discussions.
- Assist with special projects and additional responsibilities as assigned.
- Active, unrestricted RN license in the U.S. and in the state of hire
OR - Active compact multistate RN license (as defined by the Nurse Licensure Compact).
- Associate Degree in Nursing
OR - Graduate of an accredited School of Nursing.
- Two years of clinical experience plus at least two years in one of the following:
- Home Health (meets for both clinical and HH requirement for a total of 2 years)
- Utilization/Medical Review
- Quality Assurance
- Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical settings.
- Ability to interpret and apply medical review criteria and clinical guidelines.
- Proficiency in Microsoft Office and word processing software.
- Strong analytical, organizational, and decision-making skills.
- Ability to work independently while managing priorities effectively.
- Excellent customer service, communication, and critical thinking skills.
- Ability to handle confidential information with discretion.
- Three years of clinical nursing experience in Home Health, Utilization Review, Medical Review, or Quality Assurance (strongly preferred).
- Proficiency in using multiple screens and software programs simultaneously.
If you are a detail-oriented RN with a passion for medical review, we encourage you to apply!
About BROADWAY VENTURES
Sourced by ZipRecruiter
Industry
Business management consulting
Company size
11 - 50 Employees
Headquarters location
Canton, MS, US
Year founded
2013