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Remote Medical Review Nurse Jobs (NOW HIRING)

ePATHUSA Inc

Medical Review Nurse

VA · Remote

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 ...

RELI GROUP INC

Medical Review Nurse III

Baltimore, MD · Remote

May be asked to assist with precepting of new Medical Review Nurses (MRNs). * Perform other duties ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

May be asked to assist with precepting of new Medical Review Nurses (MRNs). * Perform other duties ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...

Machinify

Medical Review Nurse II - SNF/MDS Auditor

$85K - $100K/yr

The Medical Review Nurse II - SNF/MDS primarily performs Skilled Nursing Facility (SNF) medical ... Effectively work independently and as a team, in a remote setting. Required Qualifications:

Peraton

Medical Review Nurse- Medicare

$66K - $106K/yr

We are looking to add a Nurse Reviewer to our SGS team of talented professionals. What you'll do: The position requires the individual to conduct medical record reviews and to apply sound clinical ...

Peraton

Medical Review Nurse- Medicaid

$66K - $106K/yr

We are looking to add a Nurse Reviewer to our SGS team of talented professionals. What you'll do: The position requires the individual to conduct medical record reviews and to apply sound clinical ...

Peraton

Medical Review Nurse- Medicare

$66K - $106K/yr

We are looking to add a Nurse Reviewer to our SGS team of talented professionals. What you'll do: The position requires the individual to conduct medical record reviews and to apply sound clinical ...

Machinify

Medical Review Nurse II - SNF/MDS Auditor

$85K - $100K/yr

The Medical Review Nurse II - SNF/MDS primarily performs Skilled Nursing Facility (SNF) medical ... Effectively work independently and as a team, in a remote setting. Required Qualifications:

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

Ensures medical director written decision is consistent with criteria (CMS, state, medical policy ... For positions that are available as remote work, Sentara Health employs associates in the following ...

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How much do remote medical review nurse jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for remote medical review nurse in the United States is $38.62, according to ZipRecruiter salary data. Most workers in this role earn between $29.57 and $43.27 per hour, depending on experience, location, and employer.

What is a remote medical review nurse?

A Remote Medical Review Nurse evaluates medical records, treatment plans, and insurance claims to ensure compliance with healthcare regulations and policies. They work from home, reviewing clinical documentation to determine medical necessity, accuracy, and adherence to guidelines. This role often involves collaborating with healthcare providers, insurance companies, and case managers to support appropriate patient care and cost management. Strong clinical knowledge, attention to detail, and experience in utilization review or case management are essential for success in this position.

What are the typical daily responsibilities of a remote medical review nurse?

A Remote Medical Review Nurse primarily reviews patient medical records to ensure accuracy and compliance with clinical guidelines, and evaluates the necessity or appropriateness of treatments and services. They communicate with healthcare providers to clarify documentation or gather additional information and may participate in case discussions with insurance or healthcare teams. Nurses in this role also document findings and recommendations using specialized software and maintain up-to-date knowledge of regulatory requirements. The work is generally autonomous, but collaboration and timely reporting are key parts of daily routines.

What are the key skills and qualifications needed to thrive as a remote medical review nurse?

A Remote Medical Review Nurse must possess a valid RN license, strong clinical knowledge, experience in medical chart review, and excellent decision-making abilities. Familiarity with medical review software, electronic health records (EHRs), and URAC or relevant utilization management certifications are often required. Outstanding attention to detail, time management, and communication skills help set top candidates apart in this remote role. These core and soft skills enable nurses to evaluate medical records accurately, communicate findings clearly, and uphold healthcare quality standards while working independently.

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Remote Medical Review Nurse jobs near you
Infographic showing various Remote Medical Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Medical Review Nurse

ePATHUSA Inc

VA • Remote

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 6 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 IRR established by the customer and/or the Company.


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.
  • A minimum of three (3) or more years’ experience in medical/utilization medical record review particularly with Medicare and/or Medicaid.
  • A minimum of three years of lead/supervisory experience in the health insurance industry, a utilization review firm, or another health care claims processing organization involving medical and coding reviews of a variety of medical and surgical claims from a variety of provider types.
  • Minimum of 2 (two) years’ experience in the medical review processes (i.e. MACs, SMRC, CERT, QICs and/or BFCC-QIOs).
  • Working experience with electronic medical records or electronic transmission of medical records. 
  • 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 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