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Medicare Rn Jobs in Virginia (NOW HIRING)

Healing Home Healthcare

Registered nurse

Manassas, VA · On-site

Provide advice and emotional support to patients and their family members * QA medicare charts, work as an intake and staffing Required Licensure:Registered Nurse - Virginia Job Types:Full-time, ...

Riverside Health System

RN

Newport News, VA · On-site

$25.80 - $35.48/hr

... the Physicians/Registered Nurses in the care of clients in their homes by provision of ... Has working knowledge of Medicare, Medicaid and insurance requirements, agency Policies and ...

Westport Healthcare

RN MDS Coordinator

Richmond, VA · On-site

$90K/yr

As an RN MDS Coordinator your primary responsibility will be to ensure that every patient has an ... Ensure Assessment Reference Date (ARD) stays within Medicare & Medicaid guidelines. * Participate ...

Riverside Health System Non-Providers

RN

Newport, VA

$25.80 - $35.48/hr

... the Physicians/Registered Nurses in the care of clients in their homes by provision of ... Has working knowledge of Medicare, Medicaid and insurance requirements, agency Policies and ...

Riverside

RN

Newport, VA

$25.80 - $35.48/hr

... the Physicians/Registered Nurses in the care of clients in their homes by provision of ... Has working knowledge of Medicare, Medicaid and insurance requirements, agency Policies and ...

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Medicare Rn information

What are the key skills and qualifications needed to thrive as a Medicare RN, and why are they important?

To thrive as a Medicare RN, you need a comprehensive understanding of clinical nursing practices, Medicare regulations, and care coordination, typically supported by an active RN license and experience in case management or utilization review. Familiarity with Medicare documentation requirements, electronic health records (EHRs), and case management software is essential. Strong communication, attention to detail, and critical thinking skills help Medicare RNs effectively advocate for patients and collaborate with healthcare teams. These skills ensure compliance with regulations, optimize patient outcomes, and support efficient healthcare delivery within the Medicare system.

What does a Medicare RN do?

A Medicare RN is a registered nurse who specializes in providing care and managing cases for patients covered under Medicare, the federal health insurance program for people 65 and older or with certain disabilities. Their duties often include patient assessments, developing care plans, coordinating services, ensuring compliance with Medicare regulations, and educating patients and families about their healthcare options. They may work in hospitals, home health agencies, or long-term care facilities, helping to optimize patient outcomes while ensuring proper documentation for Medicare reimbursement.

What is the difference between Medicare Rn vs Home Health Nurse?

AspectMedicare RnHome Health Nurse
CredentialsRegistered Nurse license, Medicare certificationRegistered Nurse license, home health certification
Work EnvironmentHospitals, clinics, Medicare facilitiesPatients' homes, community settings
Employer & IndustryMedicare providers, healthcare agenciesHome health agencies, hospice services
Search & Comparison IntentMedicare Rn vs Home Health NurseMedicare Rn vs Home Health Nurse

Both Medicare Rns and Home Health Nurses are registered nurses working within the Medicare system. While Medicare Rns often work in clinics or hospitals providing Medicare-related care, Home Health Nurses focus on delivering nursing services directly in patients' homes. Both roles require RN licensure, but their work environments and employer types differ, reflecting their specific patient care settings.

What are the typical challenges Medicare RNs face when coordinating patient care across multiple providers?

Medicare RNs often encounter challenges related to coordinating care among various healthcare providers, such as physicians, specialists, and home health agencies. Navigating different documentation systems and ensuring timely communication can be complex, especially when managing patients with multiple chronic conditions. Effective organization, strong communication skills, and a thorough understanding of Medicare guidelines are essential for overcoming these challenges and providing seamless care transitions.
What are popular job titles related to Medicare Rn jobs in Virginia? For Medicare Rn jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Medicare Rn jobs in Virginia look for? The top searched job categories for Medicare Rn jobs in Virginia are:
What cities in Virginia are hiring for Medicare Rn jobs? Cities in Virginia with the most Medicare Rn job openings:
Medicare Rn jobs near you
Infographic showing various Medicare Rn job openings in Virginia as of July 2026, with employment types broken down into 2% As Needed, 78% Full Time, 16% Part Time, and 4% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution.

Appeals and Grievances - RN, Consultant (MediCare)

Blue Shield of CA

Virginia Beach, VA • On-site

Other

Posted 5 days ago

Job description

Your Role

The Medicare Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post service or claim denial. The Medicare Appeals and Grievances RN Lead will report to the Appeals and Grievances Manger. In this role you will be leading a team of nurses who will be responsible for performing first level appeal reviews for members utilizing the National Coverage Determination (NCD) guidelines, Local Coverage Determination (LCD) Guidelines, and nationally recognized sources such as MCG, NCCN, and ACOG. Reviews will also be performed for medical necessity and to meet the criteria for the coding billed. You will also be responsible for quality audits, inventory management and reviews of department work process documents. The ideal candidate will have previous leadership experience, hold an active CA license from Board of Registered Nurses and higher-level certifications are highly desirable.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

  • Bachelor of Science in Nursing or advanced degree preferred
  • Requires a current California RN License
  • Requires at least 7 years of prior relevant experience
  • Requires independent motivation, a strong work ethic, and strong computer navigation skills
  • Requires familiarity with electronic health record (EHR) systems
  • At least 2 years of Supervisory and/or leadership experience preferred
  • General knowledge of claims processing logic/rules
  • Comprehensive knowledge of Medicare required
  • Comprehensive knowledge of health plan operations, regulatory agencies and state/federal regulations related to health care.

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come into the office based on business need.

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