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Remote 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 ...

Mindlance

Medical Reviewer

North Chicago, IL · Remote

... Remote Role Duration: 1 year - based on performance and business needs We are seeking an experienced Sr. Manager, Medical Review, to support promotional and medical content review activities within ...

Integrated Management Strategies LLC

Remote Medical Coder

$19.25 - $24.25/hr

... Medical Coder to join our healthcare consulting practice. The role is fully remote within the US ... Review and respond to each audit within set time window, with corrections made immediately after ...

Managed Medical Review Organization

About MMRO Managed Medical Review Organization (MMRO) is an established, URAC-accredited ... Flexible, remote contract opportunity. * Set your own schedule and case volume. * Collaborate with ...

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

Be Seen First

Director, Medical Reviewer (Contractor)(Remote) LPTK10113

OR · Remote

$125 - $150/hr

This role will focus on the medical review and assessment of individual case safety reports for ... Ability to work independently in a remote environment while collaborating with global, cross ...

Ourhrconnect

Serves as the Medical Review and Prior Authorization liaison between internal and external ... This is a remote position. Typical work hours are from 8:30am - 5pm, Monday through Friday. What ...

Ourhrconnect

Serves as the Medical Review and Prior Authorization liaison between internal and external ... This is a remote position. Typical work hours are from 8:30am - 5pm, Monday through Friday. What ...

Ourhrconnect

Serves as the Medical Review and Prior Authorization liaison between internal and external ... This is a remote position. Typical work hours are from 8:30am - 5pm, Monday through Friday. What ...

Managed Medical Review Organization

About MMRO Managed Medical Review Organization (MMRO) is an established, URAC-accredited ... Flexible, remote contract opportunity. * Set your own schedule and case volume. * Collaborate with ...

Performant

Medical Review Nurse II - SNF/MDS

Effectively work independently and as a team, in a remote setting. Required and Preferred ... One (1) or more years' experience performing medical records review. * One (1) or more years ...

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How much do remote medical review jobs pay per year?

As of Jun 12, 2026, the average yearly pay for remote 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 are the most commonly searched types of Medical Review jobs? The most popular types of Medical Review jobs are:
Medical Review Nurse

Medical Review Nurse

ePATHUSA Inc

Clive, IA • Remote

$80K - $90K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 7 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.