The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
Claims Examiner III, Fraud and Abuse - LPN (Must live in vicinity of Madison, WI WPS campus)
Madison, WI · On-site +1
$19.35/hr
Please review Remote Worker FAQs for additional information. Benefits * Bargaining Unit position ... Professional and Leadership Development Programs * Review additional benefits: ( Who We Are WPS, a ...
Claims Examiner III, Fraud and Abuse - LPN (Must live in vicinity of Madison, WI WPS campus)
Madison, WI · On-site +1
$19.35/hr
Please review Remote Worker FAQs for additional information. Benefits * Bargaining Unit position ... Professional and Leadership Development Programs * Review additional benefits: ( Who We Are WPS, a ...
Claims Examiner III, Fraud and Abuse - LPN (Must live in vicinity of Madison, WI WPS campus)
Madison, WI · On-site +1
$19.35/hr
Please review Remote Worker FAQs for additional information. Benefits * Bargaining Unit position ... Professional and Leadership Development Programs * Review additional benefits: ( Who We Are WPS, a ...
Claims Examiner III, Fraud and Abuse - LPN (Must live in vicinity of Madison, WI WPS campus)
Madison, WI · On-site +1
$19.35/hr
Please review Remote Worker FAQs for additional information. Benefits * Bargaining Unit position ... Professional and Leadership Development Programs * Review additional benefits: ( Who We Are WPS, a ...
REMOTE MDS Coordinator
Milwaukee, WI · Remote
$33.75 - $43/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Milwaukee, WI · Remote
$33.75 - $43/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Green Bay, WI · On-site +1
$33.25 - $42.50/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Green Bay, WI · On-site +1
$33.25 - $42.50/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Madison, WI · On-site +1
$34.50 - $44/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Madison, WI · On-site +1
$34.50 - $44/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Madison, WI · On-site +1
$34.50 - $44/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Madison, WI · On-site +1
$34.50 - $44/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Green Bay, WI · Remote
$33.25 - $42.50/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Green Bay, WI · Remote
$33.25 - $42.50/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Milwaukee, WI · On-site +1
$33.75 - $43/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Milwaukee, WI · On-site +1
$33.75 - $43/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Green Bay, WI · On-site +1
$33.25 - $42.50/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Green Bay, WI · On-site +1
$33.25 - $42.50/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Milwaukee, WI · On-site +1
$33.75 - $43/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Milwaukee, WI · On-site +1
$33.75 - $43/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Madison, WI · Remote
$34.50 - $44/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
REMOTE MDS Coordinator
Madison, WI · Remote
$34.50 - $44/hr
This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...
Endocrinology
Eau Claire, WI · Remote
$330K/yr
The Model Advanced AI tools assist with chart review, patient history, care gap identification ... fully remote career. Facility Location This west-central Wisconsin city lies on the banks of the ...
Endocrinology
Eau Claire, WI · Remote
$330K/yr
The Model Advanced AI tools assist with chart review, patient history, care gap identification ... fully remote career. Facility Location This west-central Wisconsin city lies on the banks of the ...
RN Complex Care Specialist
Madison, WI · Remote
$72K - $90K/yr
Proficiency using Epic systems and remote monitoring programs. * Cultural competence and ... professional culture built upon the foundations of Respect, Responsibility, Relationships ...
RN Complex Care Specialist
Madison, WI · Remote
$72K - $90K/yr
Proficiency using Epic systems and remote monitoring programs. * Cultural competence and ... professional culture built upon the foundations of Respect, Responsibility, Relationships ...
RN Complex Care Specialist
Madison, WI · Remote
$72K - $90K/yr
Proficiency using Epic systems and remote monitoring programs. * Cultural competence and ... professional culture built upon the foundations of Respect, Responsibility, Relationships ...
RN Complex Care Specialist
Madison, WI · Remote
$72K - $90K/yr
Proficiency using Epic systems and remote monitoring programs. * Cultural competence and ... professional culture built upon the foundations of Respect, Responsibility, Relationships ...
Nurse Practitioner or Physician Assistant - Virtual Health - Second Shift/Weekends
New Berlin, WI · On-site +1
$51.05 - $76.60/hr
Leverages digital diagnostics and remote physiologic monitoring when indicated. * Provides health ... Substantiates and submits professional services consistent with compliant coding and billing ...
Nurse Practitioner or Physician Assistant - Virtual Health - Second Shift/Weekends
New Berlin, WI · On-site +1
$51.05 - $76.60/hr
Leverages digital diagnostics and remote physiologic monitoring when indicated. * Provides health ... Substantiates and submits professional services consistent with compliant coding and billing ...
NCLEX-RN Tutor
Milwaukee, WI · Remote
$40/hr
Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...
NCLEX-RN Tutor
Milwaukee, WI · Remote
$40/hr
Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...
NCLEX-RN Tutor
Madison, WI · Remote
$40/hr
Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...
NCLEX-RN Tutor
Madison, WI · Remote
$40/hr
Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...
Specialty Case Management RN
Madison, WI · On-site +1
$71K - $151K/yr
... review of the EDRP application. Learn more about this agency Duties Help The Specialty Case ... Fosters a safe and supportive environment conducive to the professional development of health care ...
Specialty Case Management RN
Madison, WI · On-site +1
$71K - $151K/yr
... review of the EDRP application. Learn more about this agency Duties Help The Specialty Case ... Fosters a safe and supportive environment conducive to the professional development of health care ...
APN/CRNA (Anesthesiology)
Madison, WI · On-site +1
$207K - $292K/yr
... review of the EDRP application. Learn more about this agency Duties Help The Advanced Practice ... Collaborate with a variety of health care professionals to achieve common goals for care, safety ...
APN/CRNA (Anesthesiology)
Madison, WI · On-site +1
$207K - $292K/yr
... review of the EDRP application. Learn more about this agency Duties Help The Advanced Practice ... Collaborate with a variety of health care professionals to achieve common goals for care, safety ...
Professional Remote Rn Chart Review information
What is the difference between Professional Remote Rn Chart Review vs Medical Records Reviewer?
| Aspect | Professional Remote Rn Chart Review | Medical Records Reviewer |
|---|---|---|
| Credentials | Registered Nurse (RN) license | Varies; often includes medical background or certification |
| Work Environment | Remote, healthcare-focused | Remote or onsite, administrative or healthcare settings |
| Industry Usage | Healthcare, insurance, legal cases | Healthcare, insurance, legal documentation |
| Job Focus | Reviewing patient charts for accuracy, compliance, and medical necessity | Reviewing medical records for completeness, accuracy, and compliance |
The Professional Remote Rn Chart Review primarily involves licensed RNs analyzing patient charts for medical accuracy and compliance, often for insurance or legal purposes. Medical Records Reviewers may have a broader background and focus on verifying the completeness and correctness of medical documentation. While both roles are remote and healthcare-related, the RN chart review emphasizes clinical expertise, whereas medical records reviewers may not require nursing credentials.
How to become a professional remote RN chart reviewer?
What cities in Wisconsin are hiring for Professional Remote Rn Chart Review jobs?
Cities in Wisconsin with the most Professional Remote Rn Chart Review job openings:
Weekend RN Coordinator Utilization Management (1.0 FTE)
Menasha, WI • On-site, Remote
Full-time
Re-posted 8 days ago
Network Health rating
7.9
Based on 5 frontline employees who took The Breakroom Quiz
Job description
Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day. Training is required in person at our Menasha location for the first 6-8 weeks, Monday through Friday 8am - 5pm.
Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Saturday and Sunday core hours, weekdays available to make up remaining 40 hours. August - September 2026 start date.
Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.
Job Responsibilities:
- Evaluate and process prior authorization requests/referrals submitted from contracted and non-contracted providers
- Follow Network Health process, policies, and procedures in authorization review of all membership on a pre-service, concurrent and post-service basis. This process includes verifying eligibility and benefits, as well as documenting all utilization management communication
- Provide education regarding utilization management activities and processes to members, caregivers, providers, and their administrative staff
- Participate in Utilization Management auditing (i.e. Utilization Management Inter-reviewer reliability and denial files)
- Refer all members with complex health problems and needs to Network Health Case Management to reduce medical costs while providing a higher quality of life and an ability to take charge of their diseases. This requires an extensive holistic approach to care management assessment
- Collaborate with other NH departments to develop interdepartmental operational processes
- Support Utilization Management department programs and goals through active participation
- Identify and screen candidates for Case Management intervention and determines appropriate level of care from Utilization Management criteria
- Complete assessments and plans of care including need for medication regime, treatment plans, practitioner follow-up appointments, knowledge of red flags, disease management, Advance Directives, life planning, and self-management of illness to the best of member ability
- Evaluate cases for cost savings/quality improvement potential
- Other duties and responsibilities as assigned
Job Requirements:
- Bachelor of Science in Nursing, preferred
- Associate Degree in Nursing, required
- Current registered nurse licensure in Wisconsin required
- Minimum of four (4) years clinical health care experience as a Registered Nurse (RN) required
- Experience in insurance, managed care and utilization management preferred
Network Health is an Equal Opportunity Employer
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
About Network Health
Sourced by ZipRecruiter
Industry
Insurance services
Company size
201 - 500 Employees
Headquarters location
Menasha, WI, US
Year founded
1982