Jericho, NY · On-site
$38.46 - $43.27/hr
Clinical Reviewer (RN) As a Clinical Reviewer, you will complete the full spectrum of activities ... insurer requirements, complete decision templates and preparing final determinations. * Act as a ...
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Jericho, NY · On-site
$38.46 - $43.27/hr
Clinical Reviewer (RN) As a Clinical Reviewer, you will complete the full spectrum of activities ... insurer requirements, complete decision templates and preparing final determinations. * Act as a ...
Bakersfield, CA · On-site
$43.35 - $54.18/hr
Medical Dental Vision Simple IRA Plan with Employer Contribution Employer Paid Life Insurance ... The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the ...
Bakersfield, CA · On-site
$43.35 - $54.18/hr
Medical Dental Vision Simple IRA Plan with Employer Contribution Employer Paid Life Insurance ... The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the ...
Bakersfield, CA · On-site
$31 - $54.18/hr
... Life Insurance • Employee Assistance Program Compensation: The initial pay range for this ... The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the ...
Bakersfield, CA · On-site
$31 - $54.18/hr
... Life Insurance • Employee Assistance Program Compensation: The initial pay range for this ... The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the ...
OASIS Reviewer Join Synergy's dynamic clinical quality and data integrity team as an OASIS Reviewer ... Valid driver's license, vehicle insurance, and access to reliable transportation or public ...
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OASIS Reviewer Join Synergy's dynamic clinical quality and data integrity team as an OASIS Reviewer ... Valid driver's license, vehicle insurance, and access to reliable transportation or public ...
Nashville, TN · On-site
The OASIS Reviewer is responsible for analyzing the data integrity and consistency of OASIS ... Current Driver's License, vehicle insurance, and access to a dependable vehicle or public ...
Nashville, TN · On-site
The OASIS Reviewer is responsible for analyzing the data integrity and consistency of OASIS ... Current Driver's License, vehicle insurance, and access to a dependable vehicle or public ...
The OASIS Reviewer is responsible for analyzing the data integrity and consistency of OASIS ... Current Driver's License, vehicle insurance, and access to a dependable vehicle or public ...
Quick apply
The OASIS Reviewer is responsible for analyzing the data integrity and consistency of OASIS ... Current Driver's License, vehicle insurance, and access to a dependable vehicle or public ...
OASIS Reviewer Join Synergy's dynamic clinical quality and data integrity team as an OASIS Reviewer ... Valid driver's license, vehicle insurance, and access to reliable transportation or public ...
OASIS Reviewer Join Synergy's dynamic clinical quality and data integrity team as an OASIS Reviewer ... Valid driver's license, vehicle insurance, and access to reliable transportation or public ...
Nashville, TN · On-site
... insurance, and access to reliable transportation or public transportation. Preferred • At least two (2) years of home health clinical, coding, or billing experience. • OASIS certification (COS-C)
Nashville, TN · On-site
... insurance, and access to reliable transportation or public transportation. Preferred • At least two (2) years of home health clinical, coding, or billing experience. • OASIS certification (COS-C)
$85 - $115/hr
... insurance, Medicaid, and other funding sources. We are specifically seeking an experienced ... Nurse Practitioners with clinical leadership experience are strongly encouraged to apply , as this ...
New
$85 - $115/hr
... insurance, Medicaid, and other funding sources. We are specifically seeking an experienced ... Nurse Practitioners with clinical leadership experience are strongly encouraged to apply , as this ...
New
... physicians, nursing, therapists, and staff, participate in interdisciplinary team meetings ... Course work in the areas of Health Administration, Health Financing and Insurance is helpful.
... physicians, nursing, therapists, and staff, participate in interdisciplinary team meetings ... Course work in the areas of Health Administration, Health Financing and Insurance is helpful.
OASIS REVIEWER-HOME HEALTH POSITIONSUMMARY: TheOASIS Revieweris responsible foranalyzing the data ... Current Driver's License, vehicle insurance, and access to a dependable vehicle or public ...
OASIS REVIEWER-HOME HEALTH POSITIONSUMMARY: TheOASIS Revieweris responsible foranalyzing the data ... Current Driver's License, vehicle insurance, and access to a dependable vehicle or public ...
TX · Remote
The OASIS Reviewer is responsible for analyzing the data integrity and consistency of OASIS ... Current Driver's License, vehicle insurance, and access to a dependable vehicle or public ...
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TX · Remote
The OASIS Reviewer is responsible for analyzing the data integrity and consistency of OASIS ... Current Driver's License, vehicle insurance, and access to a dependable vehicle or public ...
Albany, NY · On-site
$60/hr
RN Clinical Reviewer - Jericho or Albany, NY Location: Jericho or Albany, NY Employment Type ... Health insurance (subject to plan eligibility). * Full-time, 5 days per week. * The opportunity to ...
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Albany, NY · On-site
$60/hr
RN Clinical Reviewer - Jericho or Albany, NY Location: Jericho or Albany, NY Employment Type ... Health insurance (subject to plan eligibility). * Full-time, 5 days per week. * The opportunity to ...
Albany, NY · On-site
$60/hr
RN Clinical Reviewer - Jericho or Albany, NY Location: Jericho or Albany, NY Employment Type ... Health insurance, subject to plan eligibility requirements. * Full-time, 5 days per week.
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Albany, NY · On-site
$60/hr
RN Clinical Reviewer - Jericho or Albany, NY Location: Jericho or Albany, NY Employment Type ... Health insurance, subject to plan eligibility requirements. * Full-time, 5 days per week.
Houston, TX · On-site
$85 - $115/hr
... insurance, Medicaid, and other funding sources. We are specifically seeking an experienced ... Nurse Practitioners with clinical leadership experience are strongly encouraged to apply , as this ...
Houston, TX · On-site
$85 - $115/hr
... insurance, Medicaid, and other funding sources. We are specifically seeking an experienced ... Nurse Practitioners with clinical leadership experience are strongly encouraged to apply , as this ...
Westbury, NY · On-site
$60/hr
RN Clinical Reviewer - Jericho or Albany, NY Location: Jericho or Albany, NY Employment Type ... Health insurance, subject to plan eligibility requirements. * Full-time, 5 days per week.
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Westbury, NY · On-site
$60/hr
RN Clinical Reviewer - Jericho or Albany, NY Location: Jericho or Albany, NY Employment Type ... Health insurance, subject to plan eligibility requirements. * Full-time, 5 days per week.
Pooler, GA · On-site
Additional benefits for fertility and family building, adoption assistance, life insurance ... for our RN Clinical Reviewer opening. We promptly review all applications. Highly qualified ...
New
Pooler, GA · On-site
Additional benefits for fertility and family building, adoption assistance, life insurance ... for our RN Clinical Reviewer opening. We promptly review all applications. Highly qualified ...
New
Houston, TX · On-site
... insurance, Medicaid, and other funding sources. We are specifically seeking an experienced ... Nurse Practitioners with clinical leadership experience are strongly encouraged to apply , as this ...
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Houston, TX · On-site
... insurance, Medicaid, and other funding sources. We are specifically seeking an experienced ... Nurse Practitioners with clinical leadership experience are strongly encouraged to apply , as this ...
Jericho, NY · On-site
$60/hr
RN Clinical Reviewer - Jericho or Albany, NY (#25332) Location: Jericho or Albany, NY Employment ... Insurance subject to plan eligibility requirements Work Schedule: Full-time position, 5 days per ...
Jericho, NY · On-site
$60/hr
RN Clinical Reviewer - Jericho or Albany, NY (#25332) Location: Jericho or Albany, NY Employment ... Insurance subject to plan eligibility requirements Work Schedule: Full-time position, 5 days per ...
Guilderland, NY · On-site
$60/hr
RN Clinical Reviewer - Jericho or Albany, NY (#25332) Location: Jericho or Albany, NY Employment ... Health Insurance subject to plan eligibility requirements * Work Schedule: Full-time position, 5 ...
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Guilderland, NY · On-site
$60/hr
RN Clinical Reviewer - Jericho or Albany, NY (#25332) Location: Jericho or Albany, NY Employment ... Health Insurance subject to plan eligibility requirements * Work Schedule: Full-time position, 5 ...
$28.37 - $29.68
12% of jobs
$29.68 - $30.99
4% of jobs
$30.99 - $32.30
3% of jobs
$32.30 - $33.61
3% of jobs
$33.81 is the 25th percentile. Wages below this are outliers.
$33.61 - $34.92
16% of jobs
$34.92 - $36.23
6% of jobs
The median wage is $37.22 / hr.
$36.23 - $37.54
6% of jobs
$37.54 - $38.85
10% of jobs
$38.85 - $40.17
1% of jobs
$40.94 is the 75th percentile. Wages above this are outliers.
$40.17 - $41.48
22% of jobs
$41.48 - $42.79
16% of jobs
$28
$37
$42
An Insurance Nurse Reviewer is a licensed nurse who evaluates medical claims to ensure they meet policy guidelines and medical necessity. They review patient records, treatment plans, and healthcare provider documentation to determine coverage eligibility. Their role helps insurance companies manage costs while ensuring patients receive appropriate care. Strong clinical knowledge and attention to detail are essential for assessing claims accurately.
On a typical day, an Insurance Nurse Reviewer spends much of their time reviewing patient medical records, evaluating insurance claims for medical necessity, and documenting their findings in detail. The role often involves collaborating with physicians, case managers, and adjusters to clarify information or seek additional insights when necessary. You may also participate in team meetings to discuss complex cases, ensure adherence to regulatory standards, and stay current with evolving policies. The work is largely independent but requires strong communication skills and a systematic approach to managing multiple cases effectively.
To thrive as an Insurance Nurse Reviewer, you need a current nursing license, clinical experience, and a strong understanding of medical terminology and claims review processes. Familiarity with utilization review software, health insurance claims systems, and URAC or CM certification is often required. Attention to detail, critical thinking, and effective written and verbal communication skills help you excel in this position. These qualifications and abilities are vital for accurately evaluating medical records, ensuring compliance, and making informed decisions regarding healthcare coverage.
Cities with the most Insurance Nurse Reviewer job openings:
The most popular types of Insurance Nurse Reviewer jobs are:
States with the most job openings for Insurance Nurse Reviewer jobs include:
The top searched job categories for Insurance Nurse Reviewer jobs are:
$38.46 - $43.27/hr
Full-time
Re-posted 21 days ago
Clinical Reviewer (RN)
As a Clinical Reviewer, you will complete the full spectrum of activities related to Independent Dispute Resolution (IDR) case determinations. Conducting clinical level review, managing case staging and appeal processes within strict deadlines. Duties include but are not limited to:
• Conduct reviews up to and including the appeal level. This includes documentation screening, writing case summaries, determining documentation adequacy, researching insurer requirements, complete decision templates and preparing final determinations.
• Act as a resource for the administrative and clinical staff in training, problem solving, and clarifying determinations.
• Training and mentoring new RNs as the project expands.
• Participate in collaborative training.
This is an in office position based in IPRO's headquarter office located in Jericho, NY
QUALIFICATIONS:
• Knowledge and experience with electronic medical records.
• Ability to oversee, problem solve, and work collaboratively with peers, medical, analytical, and administrative support staff.
• Excellent written and verbal skills.
• Ability to work independently with little supervision.
• Ability and desire to be flexible, innovative, and creative.
• Ability to meet deadlines in a time sensitive environment.
Education & Experience:
• New York Licensed Registered Nurse, required.
• A bachelor’s degree in nursing or graduate of an approved Registered Professional Nurses training program, required.
• Minimum of two (2) years’ experience in a clinical setting required.
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The hourly rate for this position is $38.46- $43.27. Actual salary and/or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.
The salary range and/or hourly rate listed does not include other forms of compensation or benefits.
IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or military status.
