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Remote Medical Review Nurse Jobs in Puerto Rico (NOW HIRING)

OncoHealth

Case Review Representative

Guaynabo, PR · On-site +1

$13 - $15/hr

Remote/hybrid work experience preferred * A minimum of 2 years of healthcare related administrative ... The Opportunity The cost of cancer related medical services and prescription drugs in the United ...

OncoHealth

Case Review Specialist - PR

Guaynabo, PR · On-site +1

Remote/hybrid experience preferred * A minimum of 2-4 years' administrative experience and/or ... The Opportunity The cost of cancer related medical services and prescription drugs in the United ...

LifeLink

Remote Administrator on Call PR

Guaynabo, PR · On-site +1

  • Medical

  • Dental

  • Life

  • Retirement

  • PTO

Engages in review, education, and required organizational meetings to promote best practice sharing ... Advanced knowledge of human anatomy and medical terminology, organ perfusion, strong decision ...

Capitol Bridge, LLC

Senior Billing Specialist (Remote)

PR · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Review and analyze Job Cost Reports for invoice validation and research discrepancies. * Establish ... Health Insurance- medical, dental, vision & pharmacy benefits. (Employer contribution included)

RelateCare

$11/hr

  • Retirement

  • PTO

We are a multidisciplinary team of nurses, contact management specialists and technologists who ... Remote

RelateCare

$11/hr

We are a multidisciplinary team of nurses, contact management specialists and technologists who ... Remote

Deloitte

Epic Denials Management Operator

San Juan, PR · Remote

$17.75 - $23.50/hr

This is a primarily remote role supporting enterprise Epic support, with minimal travel and ... Review hospital account records and payer remittance records, communicate with relevant Client RCM ...

Red Ventures

Senior Software Engineer | Education | RVPR

San Juan, PR · On-site +1

$120K - $158K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Participate in code reviews, design discussions, and mentoring opportunities to help raise the bar ... Medical, dental, and vision coverage * Casual dress code, yes, that means jeans! Who We Are:

Bristol Myers Squibb

... Medical Affairs, IT, and HR. Key Responsibilities * APAC Privacy Legal Advisor. Serve as the ... Advise on applicable transfer mechanisms and review/negotiate DPAs, vendor contracts, and data ...

DaVita

Regional Operations Director (ROD)

San Juan, PR · Remote

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

This is a field-based/remote position. Candidates can reside in Newport News, Hampton, Norfolk ... Review, analyze, and address gaps in service excellence, policies, and/or procedures proactively ...

DaVita

Regional Operations Director (ROD)

San Juan, PR · Remote

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

This is a field-based/remote position. Candidates can reside in Newport News, Hampton, Norfolk ... Review, analyze, and address gaps in service excellence, policies, and/or procedures proactively ...

DaVita

Regional Operations Director (ROD)

San Juan, PR · Remote

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

This is a field-based/remote position. Candidates can reside in Newport News, Hampton, Norfolk ... Review, analyze, and address gaps in service excellence, policies, and/or procedures proactively ...

DaVita

Regional Operations Director (ROD)

San Juan, PR · Remote

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

This is a field-based/remote position. Candidates can reside in Newport News, Hampton, Norfolk ... Review, analyze, and address gaps in service excellence, policies, and/or procedures proactively ...

Veterans Health Administration

$124K - $400K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... after review of the EDRP application. Former EDRP participants ineligible to apply. The ... Provides medical management of patients who are rendered unconscious or insensible to pain and ...

All JobsMedical Review Nurse JobsRemote Medical Review Nurse JobsRemote Medical Review Nurse Jobs in Puerto Rico

Remote Medical Review Nurse information

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.

What are popular job titles related to Remote Medical Review Nurse jobs in Puerto Rico?

For Remote Medical Review Nurse jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Remote Medical Review Nurse jobs in Puerto Rico look for?

The top searched job categories for Remote Medical Review Nurse jobs in Puerto Rico are:

Remote Medical Review Nurse jobs near you
Infographic showing various Remote Medical Review Nurse job openings in Puerto Rico as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, 2% Temporary, and 5% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution.

Case Review Representative

OncoHealth

Guaynabo, PR • On-site, Remote

$13 - $15/hr

Full-time

Re-posted 8 days ago

Job description

About OncoHealth
OncoHealth is a leading digital health company dedicated to helping health plans, employers, providers, and patients navigate the physical, mental, and financial complexities of cancer through technology enabled services. Supporting more than 14 million people in the US and Puerto Rico, OncoHealth offers digital solutions for treatment review and virtual care across all cancer types.
About the Role
The Case Review Representative serves as a one-stop shop and intake of all calls (members and providers). Resolves tier one issues (user resets, provider data management, fax and letter receipt, general questions).
Primary Responsibilities
  • Flexible to work rotational shifts inside our office hours from 8:00 a.m. – 8:00 p.m. EST to cover the operational needs of the company. Shifts can range anywhere between Monday – Friday 8:00 am to 8:00 pm EST and Saturdays 8:30 am - 5:00 pm EST (Office hours may change/extend upon operational needs)
  • Fax intake and labeling
  • Prior authorization creation
  • Quality Performance Program Outreach when assigned
  • Triage and manage inbound calls, routing case specific calls to an appropriate team member, and resolving tier 1 level issues
  • Triage and manage inbound emails from health plan clients, routing case specific emails to an appropriate team member, and resolving tier 1 level issues
  • Triage request/claims processing issues to health plans as needed Prior authorization creation
  • Quality Performance Program Outreach when assigned
About You
  • College degree or relevant experience preferred
  • Fully Bilingual (English and Spanish)
  • Remote/hybrid work experience preferred
  • A minimum of 2 years of healthcare related administrative experience and/or customer service or relevant educational attainment required
  • Skills for implementation of systems for program effectiveness and productivity required
  • Systems/Tools: MS Office Suite proficient
About the Location
OncoHealth is committed to remote, hybrid or in office work options. Our Team in Puerto Rico reports to the office at least 2 times per month (advance notice provided/mandatory requirement) and can work remotely from home the rest of the days. Employees are welcome to work from the office every day if wanted.

Our Culture

Taking ownership of quick action, critically thinking through the needs, and working well with others are key competencies of team member success. Our leadership is dedicated to building a culture based on respect, clinical excellence, innovation – all with a focused mission of putting patients first!

We offer a full benefit package on your first day, along with a company bonus. You may visit or work from our very modern and engaging offices, and experience a fun, collaborative environment where social activities and community events matter. We enjoy being together!
OncoHealth is committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and team members without regard to race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law. All employment decisions are based on qualifications, merit, and business need.

The Opportunity

The cost of cancer related medical services and prescription drugs in the United States is expected to reach $246 billion by 2030. OncoHealth has enjoyed rapid growth over the past 3 years and seeks smart, collaborative people to join its team. We have just under 250 team members, so we can move swiftly but precisely to the market needs of our customers. Strongly backed financially by Arsenal Capital Partners amp; McKesson Corporation, we remain in an investment and growth mode. This means we are open-minded to how we get the work done – now is the perfect time to talk to us!

Our Current Solutions

Through the use of OncoHealth's utilization management system, OneUM, our customers can use a single e-Prior Authorization portal for all oncology drug request and treatments. Our system improves quality of care, reduces provider abrasion and gives health plans visibility into the total cost of oncology treatment.

OncoHealth offers Oncology Insights Pro, an analytic software solution that enables health plans to use data and analytics to improve oncology programs. Using real world data, our engineers normalize data to create analytic dashboards with drill down compatibilities. The data is the paired with expert guidance providing the strategies an insight needed to keep up with the continuing evolving cancer treatment landscape.

OncoHealth offers Pharmacy Consulting services to health plans and pharmaceutical companies. New cancer treatments are entering the market at an unrelenting pace. Since 2018, the FDA approved 121 new cancer applications including 49 novel cancer drug entities. Our Board-Certified Oncology Pharmacologists can help health plans update drug policies, offer utilization management and formulary advice, and development training for staff.

OncoHealth's latest offering is Iris, a digital telehealth platform that delivers personalized, oncology-specific support to navigate the physical symptoms and emotional challenges caused by cancer and cancer treatment. Powered by technology, staffed 24X7, and delivered with empathy, Iris allows patients to connect with trained oncology experts and receive personalized, oncology-specific telehealth support.

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