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Medical Review Rn Medicare Fraud Jobs (NOW HIRING)

CoventBridge Integrity

$78K - $85K/yr

Overview Medicaid Medical Review RN (Medical Reviewer III) - REMOTE The Medicaid Medical Review RN ... of fraud, waste or abuse are noted * Knowledge of, and the ability to correctly identify, Medicare ...

Commence

VA · On-site

$88K - $115K/yr

Active, unrestricted RN license; compact multistate RN license acceptable * 5+ years of clinical ... Contribute to development and maintenance of medical review training materials and the Quality ...

LifeHealth

Medical Review RN

Washington, DC · On-site

Medical Review RN * Date: Start Date - TBD * Shift Time: 0800-1630 M-F * Location: Washington, DC Position Summary: LifeHealth Medical Review Nurse (MRN) is responsible for the initial chart review ...

CES, LLC

Medical Review Nurse III

Saint Augustine, FL · Remote

Primarily responsible for conducting clinical reviews of medical records during the course of fraud ... (RN). * Knowledge of, and the ability to correctly identify, Medicare coverage guidelines

Empower AI

Medical Reviewer III (Medicare/DME)

$28.38/hr

... Review Lead Specialist Requirements: * Must be a Registered Nurse obtained by either a Bachelor ... Prior work as a Medicare Contractor Medical Review Nurse or Commercial Insurance for DME * Optional ...

Empower AI Inc.

Medical Review Specialist V

Registered Nurse (RN) (Bachelors, Associate's degree or diploma-based) * Current licensure as a ... Previous fraud review/ investigation experience preferred * Ability to keep sensitive and ...

Empower AI Inc.

Medical Review Specialist V

Registered Nurse (RN) (Bachelors, Associate's degree or diploma-based) * Current licensure as a ... Previous fraud review/ investigation experience preferred * Ability to keep sensitive and ...

Empower AI Inc.

Medical Reviewer III (Medicare/DRG)

$28.38/hr

... the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse ... Prior work as a Medicare Contractor Medical Review Nurse or Commercial Insurance * Optional ...

Commence

VA · On-site

$82K - $95K/yr

... or fraud. Using established criteria/ and clinical guidelines, the Nurse Reviewer is responsible ... Experience in medical/claims review, including pre- and post-payment claims reviews and/or ...

Forrest General Hospital

RN-MEDICARE

Prentiss, MS · On-site

The Medicare registered nurse (RN) performs under the direct supervision of the Director of Nursing and is delegated an assignment by the Director of Nursing to achieve quality care for all Medicare ...

Forrest General Hospital

RN-MEDICARE

Prentiss, MS · On-site

The Medicare registered nurse (RN) performs under the direct supervision of the Director of Nursing and is delegated an assignment by the Director of Nursing to achieve quality care for all Medicare ...

KPC Health

Utilization Review RN

Santa Ana, CA · On-site

Coordinates and reviews all medical records, as assigned to caseload. * Actively participates in ... CA RN License Required * Minimum of 2 years' experience with the population of the facility and ...

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How much do medical review rn medicare fraud jobs pay per hour?

As of Sep 10, 2026, the average hourly pay for medical review rn medicare fraud in the United States is $56.31, according to ZipRecruiter salary data. Most workers in this role earn between $43.51 and $65.62 per hour, depending on experience, location, and employer.

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Infographic showing various Medical Review Rn Medicare Fraud job openings in the United States as of September 2026, with employment types broken down into 94% Full Time, 3% Part Time, and 3% Contract. Highlights an 62% In-person, 3% Hybrid, and 35% Remote job distribution, with an average salary of $117,115 per year, or $56.3 per hour.

Medicaid Medical Review RN (Medical Reviewer III)

Remote

CoventBridge Group
11 - 50 employees
Learn more about CoventBridge Groupexternal

$78K - $85K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

CoventBridge Group rating

6.7

Company rating: 6.7 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

310th of 501 rated business services

Job description

Overview
Medicaid Medical Review RN (Medical Reviewer III) - REMOTE
The Medicaid Medical Review RN (Medical Reviewer III) will primarily be responsible for conducting clinical reviews of medical records during the course of fraud investigations or other program integrity initiatives such as requests for information or in support of proactive data analysis efforts. In addition, this position applies Medicare and Medicaid guidelines in making clinical determinations as to the appropriateness of payment coverage.
In assuming this position, you will be a critical contributor to meeting CoventBridge Integrity System's objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.
This position will report directly to the Medical Review Supervisor and will work in our Grove City, OH office. If not local, remotely from a home office.
Responsibilities/ Requirements
Responsibilities:
  • Reviews information contained in Standard Claims Processing System files (e.g., claims history, provider files) to determine provider billing patterns and to detect potentially fraudulent or abusive billing practices or vulnerabilities in Medicare or Medicaid payment policies
  • Utilizes extensive knowledge of medical terminology, ICD-9-CM, ICD-10-CM HCPCS Level II and CPT coding along with analysis and processing of Medicare claims. Utilizes Medicare/Medicaid and Contractor guidelines for coverage determinations
  • Coordinates and compiles the written Investigative Summary Report to the PI Investigator upon completion of the records review
  • Incorporates leadership and communication skills to work with physicians and other health professionals as well as external regulatory agencies and law enforcement personnel
  • Provides training to UPIC staff on medical terminology, reading medical records, and policy interpretation
  • Provides expert witness testimony as required
  • Completes assignments in a manner that meets or exceeds the quality assurance goal of 98% accuracy
  • Maintains chain of custody on all documents and follows all confidentiality and security guidelines
  • Performs other duties as assigned by the Medical Review Supervisor that contribute to UPIC goals and objectives and comply with the Program Integrity Manual and Statement of Work guidelines and CMS directives and regulations

Requirements:
  • 2 years minimum experience with a state Medicaid agency or Managed Care Organization focused in Medicaid
  • 2 years minimum of working knowledge of ICD 10-CM/CPT coding experience
  • 4 years minimum experience auditing claims history or provider files to determine if the claim was payable and if any signed of fraud, waste or abuse are noted
  • Knowledge of, and the ability to correctly identify, Medicare and Medicaid coverage guidelines
  • Advance knowledge of medical terminology and experience in the analysis and processing of Medicare claims, utilization review/ quality assurance procedures, ICD 10-CM and CPT coding, Medicare coverage guidelines and payment methodologies (i.e., Correct Coding Initiative, DRG's, Prospective Payment Systems and Ambulatory Surgical center), NCPCP and other types of prescription drug claims
  • Ability to read Medicaid claims, both paper and electronic, and a basic knowledge of Medicaid is required
  • Should possess excellent verbal and written communication skills with an ability to write professional summary reports
  • Knowledge of and ability to use Microsoft Word, Excel, and Internet applications
  • Able to efficiently organize and manage workload and assignments
  • Must have and maintain a valid driver' license for the state of residence as on-site audits are part of the role as a nurse reviewer

Educational/Experience Qualifications:
  • Graduate from an accredited school of nursing and have an active license as a Registered Nurse (RN) required
  • Preference given to BSN or higher prepared nurses with recent medical review claims experience in Medicare or Medicaid reviews

Benefits
  • Medical, Dental, Vision plans
  • Life, LTD and STD paid by the employer
  • 401(k) with company match up to 4%
  • Paid Time Off and company paid holidays
  • Tuition assistance after 1 year of service

The salary range for this role is $78,000 to $85,000 annually. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.)
About Us:
CoventBridge Integrity Systems delivers investigative services, technology, and expertise that help healthcare and government organizations protect critical programs, strengthen oversight, and address fraud, waste, abuse, and operational risk.
CoventBridge Integrity Systems is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace.
CoventBridge Integrity Systems is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge Integrity Systems will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com.

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