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From Home Remote Rn Chart Review Jobs in Pennsylvania

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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?

AspectFrom Home Remote Rn Chart ReviewFrom Home Remote LPN Chart Review
Required CredentialsRegistered Nurse (RN) licenseLicensed Practical Nurse (LPN) license
Work EnvironmentRemote, home-basedRemote, home-based
Job ResponsibilitiesComprehensive chart review, clinical decision supportBasic chart review, data entry
Industry UsageHospitals, 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.

What are the most commonly searched types of Remote Rn Chart Review jobs in Pennsylvania? The most popular types of Remote Rn Chart Review jobs in Pennsylvania are:
What are popular job titles related to From Home Remote Rn Chart Review jobs in Pennsylvania? For From Home Remote Rn Chart Review jobs in Pennsylvania, the most frequently searched job titles are:
What job categories do people searching From Home Remote Rn Chart Review jobs in Pennsylvania look for? The top searched job categories for From Home Remote Rn Chart Review jobs in Pennsylvania are:
What cities in Pennsylvania are hiring for From Home Remote Rn Chart Review jobs? Cities in Pennsylvania with the most From Home Remote Rn Chart Review job openings:
From Home Remote Rn Chart Review jobs near you
Infographic showing various From Home Remote Rn Chart Review job openings in Pennsylvania as of August 2026, with employment types broken down into 50% Full Time, and 50% Part Time. Highlights an 100% Remote job distribution.

Nurse Reviewer - Allentown, PA

Healthcare Quality Strategies, Inc.

Allentown, PA • Remote

$40/hr

Part-time

Medical, Dental, Vision, Life, Retirement

Re-posted 16 hours 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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