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Remote Independent Medical Review Jobs (NOW HIRING)

ePATHUSA Inc

Medical Review Nurse

Clive, IA · Remote

$80K - $90K/yr

This is a remote position. Seeking Registered Nurse for fully remote role to perform complex medical record and claim reviews (Standard or Program Integrity) to make coverage determinations based on ...

Novacore

Medical Review Nurse

Conshohocken, PA · Remote

Medical Review Nurse Carbon Stop Loss Solutions is a leading managing general underwriter (MGU) in ... Ability to work independently in a remote setting. * Ability to work with multiple offices and ...

TechData Service Company LLC

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Remote Independent Medical Review information

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How much do remote independent medical review jobs pay per year?

As of Jun 16, 2026, the average yearly pay for remote independent medical review in the United States is $164,731.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,000.00 and $268,500.00 per year, depending on experience, location, and employer.

What is the difference between Remote Independent Medical Review vs Remote Medical Coder?

AspectRemote Independent Medical ReviewRemote Medical Coder
CredentialsMedical license, certification (e.g., CCM, AMIC)Coding certifications (e.g., CPC, CCS)
Work EnvironmentHealthcare review companies, insurance providersHospitals, insurance companies, billing services
Industry UsageUsed in insurance claims, workers' comp, disabilityUsed in medical billing, claims processing

The main difference is that Remote Independent Medical Review involves evaluating medical records and providing expert opinions on claims, requiring medical credentials. In contrast, Remote Medical Coders focus on translating medical documentation into standardized codes for billing, requiring coding certifications. Both roles are remote and industry-specific but serve different functions within healthcare and insurance sectors.

What cities are hiring for Remote Independent Medical Review jobs? Cities with the most Remote Independent Medical Review job openings:
What are the most commonly searched types of Independent Medical Review jobs? The most popular types of Independent Medical Review jobs are:
What states have the most Remote Independent Medical Review jobs? States with the most job openings for Remote Independent Medical Review jobs include:
Remote Independent Medical Review jobs near you
Medical Review Nurse

Medical Review Nurse

ePATHUSA Inc

Clive, IA • Remote

$80K - $90K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 11 days ago

Job description

This is a remote position.

Seeking Registered Nurse for fully remote role to perform complex medical record and claim reviews (Standard or Program Integrity) to make coverage determinations based on applicable Medicare coverage policies and payment rules, coding guidelines, National and Local Coverage Determinations, utilization/practice guidelines, clinical review judgment and when appropriate, monitor for potential indicators of fraud, waste, and abuse. Provides professional assessment, planning, coordination, implementation, and reporting of complex data to support the Medical Review Accuracy Contract (MRAC).

Essential Functions

  • Perform complex medical record and claims review in accordance with all State and Federal mandated regulations/guidelines.
  • Accurately enter medical review data into the medical review system.
  • Apply clinical review judgment, based on clinical experience when applicable and review completeness of documentation to determine if documentation supports claim as billed.
  • Reasonably determines appropriateness to consult a Subject Matter Expert (SME) for clarification.
  • When performing Program Integrity (PI) reviews, assess investigative allegations and medical review findings, and/or other claims data to determine patterns and detect potential indicators of fraud, waste and abuse (FWA).
  • Accurately identify additional findings in the review of evidence of potential FWA not detected by the Medical Review Contractor.
  • Consistently meet or exceed productivity and accuracy standards of 98% minimum


Requirements
  • Registered Nurse, with a current unobstructed license to practice nursing in the United States. Graduate of a Board approved Registered Nursing program.
  • A Bachelor’s Degree in Nursing (BSN) or other related field is preferred.
  • Certification in coding highly preferred.
  • A minimum of five (5) years clinical experience in an acute care hospital, skilled nursing facility, and/or an office/clinic-based medical practice.
  • A minimum of three (3) or more years’ experience in medical review for payment accuracy, particularly with Medicare Part A, Skilled Nursing Facility, and/or Home Health
  • Minimum of 2 (two) years’ experience in the medical review processes of MACs, SMRC, and/or UPICs.
  • Desired experience performing medical review for fraud, waste, and abuse (FWA) investigations.
  • Knowledgeable of ICD-9-CM, ICD-10, CPT-4 and HCPCS coding.
  • One year or more of utilizing InterQual and/or Milliman guidelines against inpatient services experience is preferred.


Benefits

Benefit Package includes:

  • Paid Sick Time
  • Insurance for Medical, Dental, Vision and Life Available
  • 401(k) including Employer Match
  • HSA, Short-term & Long-term Disability Available
  • We are an EEO/Veterans/Disabled employer.