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Remote Medical Necessity Reviewer Jobs (NOW HIRING)

InGenesis

RN / Medical Reviewer / Remote

RN / Medical Reviewer / Remote Job Details Professional Discipline : Registered Nurse Specialty ... Ensure coverage for appropriate services within benefit and medical necessity guidelines. * Assess ...

Comagine

Clinical Reviewer

In this role, you will review clinical documentation to determine medical necessity and ... This is a remote position based in Oregon and travel is required. Why Comagine Health? Comagine ...

TEEMA Group

Medical Director

Phoenix, AZ · Remote

... necessity reviews, appeals, and clinical governance supporting military members, veterans, and ... remote administrative operations and 25% (1 day per week) to your own private practice or locum ...

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All JobsMedical Necessity Reviewer JobsRemote Medical Necessity Reviewer Jobs

Remote Medical Necessity Reviewer information

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$11

$42

$100

How much do remote medical necessity reviewer jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for remote medical necessity reviewer in the United States is $42.06, according to ZipRecruiter salary data. Most workers in this role earn between $22.84 and $54.09 per hour, depending on experience, location, and employer.

What is the difference between Remote Medical Necessity Reviewer vs Remote Utilization Review Nurse?

AspectRemote Medical Necessity ReviewerRemote Utilization Review Nurse
CredentialsRN or licensed healthcare professional, often with certification in medical reviewRN license, often with utilization review certification
Work EnvironmentRemote, healthcare insurance or managed care companiesRemote, insurance companies or healthcare organizations
Industry UsageCommonly involved in approving or denying coverage based on medical necessityFocuses on evaluating the appropriateness of healthcare services for insurance approval

The Remote Medical Necessity Reviewer and Remote Utilization Review Nurse roles share similar credentials and work environments, both operating remotely within healthcare insurance settings. The main difference lies in their focus: the Medical Necessity Reviewer primarily assesses whether treatments meet medical necessity criteria, while the Utilization Review Nurse evaluates overall appropriateness of healthcare services for insurance purposes.

What are some common challenges faced by remote medical necessity reviewers and how can they be managed effectively?

Remote Medical Necessity Reviewers often encounter challenges such as interpreting complex medical records, staying current with evolving payer guidelines, and balancing productivity targets with detailed case analysis. Managing these effectively involves strong organizational skills, continuous education on medical policies, and leveraging robust communication tools to collaborate with care teams or other reviewers. Regularly participating in peer discussions and utilizing available reference resources can also help maintain accuracy and efficiency in decision-making.

What is a remote medical necessity reviewer?

A Remote Medical Necessity Reviewer is a healthcare professional, often a registered nurse or physician, who evaluates medical records and documentation to determine if treatments, procedures, or hospital stays meet established criteria for medical necessity. They typically work from home, reviewing cases for insurance companies, hospitals, or third-party organizations. Their assessments help ensure that patients receive appropriate care and that services are in line with payer guidelines and regulations. This work supports both cost management and quality assurance in healthcare.

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

To thrive as a Remote Medical Necessity Reviewer, you need a strong clinical background, such as an RN or allied health degree, and in-depth knowledge of utilization management and medical necessity criteria. Familiarity with electronic medical record (EMR) systems, InterQual or MCG guidelines, and URAC/NCQA standards is typically required. Attention to detail, critical thinking, and effective written communication are vital soft skills for accurately evaluating cases and collaborating with healthcare teams. These qualifications ensure objective, compliant reviews that support quality patient care and cost-effective resource utilization.
More about Remote Medical Necessity Reviewer jobs
What cities are hiring for Remote Medical Necessity Reviewer jobs? Cities with the most Remote Medical Necessity Reviewer job openings:
What are the most commonly searched types of Medical Necessity Reviewer jobs? The most popular types of Medical Necessity Reviewer jobs are:
What states have the most Remote Medical Necessity Reviewer jobs? States with the most job openings for Remote Medical Necessity Reviewer jobs include:
What job categories do people searching Remote Medical Necessity Reviewer jobs look for? The top searched job categories for Remote Medical Necessity Reviewer jobs are:
Remote Medical Necessity Reviewer jobs near you
Infographic showing various Remote Medical Necessity Reviewer job openings in the United States as of August 2026, with employment types broken down into 59% Full Time, 27% Part Time, and 14% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,476 per year, or $42.1 per hour.

Nurse Reviewer - Williamsport, PA

Healthcare Quality Strategies, Inc.

Williamsport, PA • Remote

$40/hr

Part-time

Medical, Dental, Vision, Life, Retirement

Re-posted 27 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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