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Marketing Operations Analyst
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Manager, Sales Operations
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$132K - $156K/yr
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Manager, Sales Operations
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$132K - $156K/yr
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Remote Monitoring Specialist
Portland, OR ยท Remote
Learn about our benefits designed for you to Thrive at work and at home. We boldly go. Where is the ... Responsible for the remote maintenance, operation, diagnosis, and programming of various HVAC ...
Remote Monitoring Specialist
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Learn about our benefits designed for you to Thrive at work and at home. We boldly go. Where is the ... Responsible for the remote maintenance, operation, diagnosis, and programming of various HVAC ...
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Quick apply
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Location: 100% Remote (Work From Home) About InsuraTec: InsuraTec is a leading provider in financial planning and insurance services. We're looking for driven individuals to join our team as Sales ...
Location: 100% Remote (Work From Home) About InsuraTec: InsuraTec is a leading provider in financial planning and insurance services. We're looking for driven individuals to join our team as Sales ...
Location: 100% Remote (Work From Home) About InsuraTec: InsuraTec is a leading provider in financial planning and insurance services. We're looking for driven individuals to join our team as Sales ...
Home Remote information
What are home remote jobs?
Will Amazon really pay you to work from home?
What jobs can I do from home remotely?
What are the key skills and qualifications needed to thrive as a Remote Worker, and why are they important?
What are some common challenges faced by professionals working in home remote roles, and how can they be managed?
How can I make 2000 a month working from home?
What is the difference between Home Remote vs Customer Service Representative?
| Aspect | Home Remote | Customer Service Representative |
|---|---|---|
| Required Credentials | High school diploma or equivalent; some roles may require specific certifications | High school diploma or equivalent; customer service training often preferred |
| Work Environment | Remote, home-based setting with flexible hours | Typically office or call center, but increasingly remote options available |
| Industry Usage | Used across various industries including tech, sales, and support | Primarily in retail, telecom, and service sectors |
| Common Search/Comparison | Yes | Yes |
Home Remote jobs and Customer Service Representative roles often overlap in work environment and required skills. While Home Remote positions offer flexibility and are suitable for those seeking remote work, Customer Service Representatives focus on assisting customers, often in call centers or online. Both roles are in high demand and frequently compared by job seekers looking for remote customer support opportunities.
What is the best remote work from home job?

Other
Posted 26 days 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