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Remote Medical Review Nurse Jobs (NOW HIRING)

Empower AI

Medical Reviewer III (Medicare/DRG)

$28.38/hr

Completes other projects or duties assigned by the Medical Review Lead Specialist Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate's degree - OR ...

Empower AI

Medical Reviewer III (Medicare/DME)

$28.38/hr

Completes other projects or duties as assigned by the Medical Review Lead Specialist Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate's degree - OR ...

Actalent

Utilization Review Nurse

$30 - $40/hr

This role ensures that medical necessity for services is determined in accordance with policies ... This is a fully remote position. Application Deadline: This position is anticipated to close on Aug ...

Empower AI Inc.

Medical Reviewer III (Medicare/DME)

Completes other projects or duties as assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

Empower AI Inc.

Medical Reviewer III (Medicare/DME)

Completes other projects or duties as assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

Empower AI Inc.

Medical Reviewer III (Medicare/DRG)

$28.38/hr

Completes other projects or duties assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

Empower AI Inc.

Medical Reviewer III (Medicare/DME)

Completes other projects or duties as assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

Empower AI Inc.

Medical Reviewer III (Medicare/DRG)

$28.38/hr

Completes other projects or duties assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

Empower AI Inc.

Medical Reviewer III (Medicare/DRG)

$28.38/hr

Completes other projects or duties assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

Empower AI Inc.

Medical Reviewer III (Medicare/DRG)

$28.38/hr

Completes other projects or duties assigned by the Medical Review Lead Specialist Qualifications Requirements: * Must be a Registered Nurse obtained by either a Bachelor's degree - OR - Associate ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... the medical necessity and appropriateness of the treatment plan. JOB RESPONSIBILITIES: * This ...

Actalent

Clinical Review Nurse - Remote

$34 - $40/hr

Review medical records, provider documentation, treatment plans, and related clinical information. * Apply evidence-based guidelines, regulatory standards, and company policies during the review ...

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Remote Medical Review Nurse information

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$17

$38

$65

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 - CMS/RAC Auditor, Government Audits

Machinify

Remote

Full-time

Re-posted 7 days ago

Job description

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.
The Medical Review Nurse - CMS / RAC (Government Audits) primarily performs medical claims audit reviews for government clients. As a MR Nurse, you will join a team of experienced medical auditors and coders performing retrospective and prepayment audits on claims for Government Payers. You will work remotely in a fast paced and dynamic environment and be part of a multi-location team.
Please note: RAC certification is preferred for this role. The selected candidate may need to work toward RAC certification if they do not currently have it.
Key Responsibilities:
  • Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules.
  • Document all findings referencing the appropriate policies and rules.
  • Generate letters articulating audit findings.
  • Supporting your findings during the appeals process if requested.
  • Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse.
  • Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits.
  • Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients.
  • Work with the team to minimize the number of appeals; Suggest ideas that may improve audit workflows; Assist with QA functions and training team members.
  • Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines.
  • Interface with and support the Medical Director and cross train in all clinical departments/areas.
  • Other duties as required to meet business needs.

Knowledge, Skills and Abilities Needed:
  • Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual.
  • Experience with and deep knowledge of ICD-9, ICD-10, CPT-4 or HCPCS coding.
  • Knowledge of insurance programs program, particularly the coverage and payment rules.
  • Ability to maintain high quality work while meeting strict deadlines.
  • Excellent written and verbal communication skills.
  • Ability to manage multiple tasks including desk audits and claims review.
  • Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings.
  • Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload
  • Effectively work independently and as a team, in a remote setting.

Required and Preferred Qualifications:
  • Active unrestricted RN license in good standing, is required.
  • Must not be currently sanctioned or excluded from the Medicare program by the OIG.
  • Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting.
  • One (1) or more years' experience performing medical records review.
  • One (1) or more years' experience in health care claims that demonstrates expertise in, ICD-9/ICD-10 coding, HCPS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital required.
  • Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions.
  • RAC certification preferred.

Equal Employment Opportunity at Machinify
We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/

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