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Remote Case Reviewer Jobs in Florida (NOW HIRING)

VIVA USA INC

Nurse Case Manager

Miami, FL · On-site +1

Remote The Case Manager utilizes a collaborative process of assessment, planning, facilitation and ... data review, conducts comprehensive assessments of referred member's needs/eligibility and ...

Advocate

SSDI Case Manager

Orlando, FL · Remote

Familiarity with Salesforce or a similar CRM This is a remote position and Advocate is currently a ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...

Advocate

SSDI Case Manager

Orlando, FL · On-site +1

Familiarity with Salesforce or a similar CRM This is a remote position and Advocate is currently a ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...

MedWatch, LLC

Case Manager / RN

Lake Mary, FL · On-site +1

$72K - $81K/yr

This is a remote/work-from-home position. License Requirements : * Registered Nurse (current active ... Review all medical data which can be provided to establish, update and maintain accountability for ...

YO AI Labs

Criminal Lawyer - Remote

Miami, FL · Remote

$140 - $400/hr

Review and analyze legal documents, court filings, and case materials to support AI system ... Remote Collaboration * Digital Platform Adaptability * Knowledge of Current Statutes & Case Law

FCCI Insurance Group

Medical Case Manager

Sarasota, FL · On-site +1

$62K - $96K/yr

... remote. In exchange for your talents, FCCI offers competitive salaries and an excellent benefits ... For further information, please review the Know Your Rights notice from the Department of Labor.

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Remote Case Reviewer information

What is a remote case reviewer?

Remote case reviewers are professionals who assess and evaluate cases, such as medical, legal, or insurance files, from a remote location rather than working on-site. Their responsibilities typically include reviewing documentation, ensuring compliance with policies and regulations, and providing recommendations or decisions based on their findings. Remote case reviewers use secure digital platforms to access and analyze case materials, enabling flexibility and efficiency in their work. This role can be found in industries like healthcare, law, insurance, and finance. Strong attention to detail and analytical skills are essential for success in this position.

What are the key skills and qualifications needed to thrive as a remote case reviewer?

To thrive as a Remote Case Reviewer, you need strong analytical skills, attention to detail, and relevant professional credentials, often in fields like healthcare, insurance, or law. Familiarity with case management software, electronic documentation systems, and industry regulations (such as HIPAA for healthcare) is typically required. Excellent written communication, time management, and independent decision-making are standout soft skills for this role. These abilities ensure accurate, compliant, and efficient case evaluations while maintaining high-quality standards in a remote work environment.

What are some common challenges remote case reviewers face, and how can they effectively manage them?

Remote Case Reviewers often encounter challenges such as managing a high volume of cases, staying organized with digital documentation, and maintaining clear communication with team members across different locations. To address these, it's important to develop strong time management skills, utilize standardized review checklists, and take advantage of collaboration tools like secure messaging platforms. Regular virtual meetings and clear protocols help ensure consistency and quality, while ongoing training can keep reviewers up to date on best practices.

What is the difference between Remote Case Reviewer vs Remote Claims Processor?

AspectRemote Case ReviewerRemote Claims Processor
Required CredentialsHigh school diploma or equivalent; healthcare or legal background often preferredHigh school diploma or equivalent; experience in insurance or claims processing beneficial
Work EnvironmentHome-based, independent review settingHome-based, processing insurance claims
Industry UsageHealthcare, legal, insurance sectorsInsurance companies, third-party administrators
Common Search/ComparisonRemote Case Reviewer vs Remote Claims Processor

While both roles are remote and involve handling cases or claims, Remote Case Reviewers primarily evaluate and assess cases, often requiring specialized knowledge in healthcare or legal fields. Remote Claims Processors focus on processing insurance claims, verifying information, and ensuring accurate payment. Understanding these differences helps job seekers identify the role that best matches their skills and career goals.

What are the most commonly searched types of Case Reviewer jobs in Florida?

The most popular types of Case Reviewer jobs in Florida are:

What are popular job titles related to Remote Case Reviewer jobs in Florida?

For Remote Case Reviewer jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Remote Case Reviewer jobs in Florida look for?

The top searched job categories for Remote Case Reviewer jobs in Florida are:

What cities in Florida are hiring for Remote Case Reviewer jobs?

Cities in Florida with the most Remote Case Reviewer job openings:

Remote Case Reviewer jobs near you
Infographic showing various Remote Case Reviewer job openings in Florida as of August 2026, with employment types broken down into 43% Full Time, 43% Part Time, and 14% Contract. Highlights an 100% Remote job distribution.

Nurse Reviewer - Sarasota, FL

Sarasota, FL • Remote

Healthcare Quality Strategies, Inc.
See more jobs at Healthcare Quality Strategies, Inc.external

$40/hr

Part-time

Medical, Dental, Vision, Life, Retirement

Re-posted 9 days ago

Job description

Nurse Reviewer
PT (20-30 hours week) – Remote Work Environment
Non-Exempt: $40.00 hour
Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely.
Essential Duties and Responsibilities:
  • Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies
  • Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines
  • Document evidence-based criteria applicable to specific contract requirements
  • Record and report screening results, including relevant referral questions, into a centralized database
  • Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity
  • Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations
  • Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards
Knowledge, Experience, Skills and Education:
  • Medical terminology, ICD-10, CPT and HCPCS
  • Clinical criteria (InterQual and MCG)
  • Utilization/Medical record review and chart abstraction
  • Current standards of medical practice
  • Comply with HIPAA/HITECH laws and regulations
Experience in:
  • At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred)
  • Experience performing medical record review, audit for federal or state contracts
  • Knowledge and experience of Medicare and Medicaid policy
  • Proficiency with Microsoft Office (Word, Excel, and Outlook)
  • Proficiency with Adobe PDF files and features
  • Generating accurate, timely, and understandable correspondence
  • Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG)
Skills Requirements include:
  • Professional interpersonal skills; ability to interact with providers, physicians and peers
  • Solid analytical, assessment and documentation skills
  • Effective written and verbal communication, both internally and externally
  • Strong attention to detail
  • Strong attention to deadlines
  • Organizational skills including effective time management, priority setting and process improvement
  • Ability to work independently and as a member of a team
  • Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations
Educational Background:
  • BSN with active RN licensure in good standing
Physical Demands:
Remote Work, Prolonged Sitting, Screen Exposure
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
Healthcare Quality Strategies, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD amp;D, voluntary life/AD amp;D, 401k
For immediate consideration, please apply via the HQSI Careers Page at: www.hqsi.org gt; Careers gt; Current Employment Opportunities
EOE: Minorities/Females/Disabled/Veterans
Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace
Healthcare Quality Strategies, Inc. is an E-Verify Employer

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