Chicago, IL · Remote
$41/hr
Remote position, however, candidates must reside in the State of TX or State of IL This position is ... This Position Is Responsible For Performing Accurate And Timely Medical Review Of Claims Suspended ...
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Chicago, IL · Remote
$41/hr
Remote position, however, candidates must reside in the State of TX or State of IL This position is ... This Position Is Responsible For Performing Accurate And Timely Medical Review Of Claims Suspended ...
Dallas, TX · Remote
$41/hr
Remote position, however, candidates must reside in the State of TX or State of IL This position is ... This Position Is Responsible For Performing Accurate And Timely Medical Review Of Claims Suspended ...
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Dallas, TX · Remote
$41/hr
Remote position, however, candidates must reside in the State of TX or State of IL This position is ... This Position Is Responsible For Performing Accurate And Timely Medical Review Of Claims Suspended ...
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 ...
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 ...
Dallas, TX · Remote
$42/hr
The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS) survey. The review nurse is responsible for ...
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Dallas, TX · Remote
$42/hr
The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS) survey. The review nurse is responsible for ...
Denial of payment may be based on insufficient medical record documentation to support the level of ... Normal remote home business office conditions
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Denial of payment may be based on insufficient medical record documentation to support the level of ... Normal remote home business office conditions
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 ...
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 ...
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 ...
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 ...
Monterey Park, CA · Remote
$34 - $47/hr
This is a remote position for CA-licensed nurses. Candidates must live in California. We are ... Refer cases to Medical Directors as needed/appropriate * Maintain knowledge of state and federal ...
Monterey Park, CA · Remote
$34 - $47/hr
This is a remote position for CA-licensed nurses. Candidates must live in California. We are ... Refer cases to Medical Directors as needed/appropriate * Maintain knowledge of state and federal ...
Monterey Park, CA · Remote
$34 - $47/hr
This is a remote position for CA-licensed nurses. Candidates must live in California. We are ... Refer cases to Medical Directors as needed/appropriate * Maintain knowledge of state and federal ...
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Monterey Park, CA · Remote
$34 - $47/hr
This is a remote position for CA-licensed nurses. Candidates must live in California. We are ... Refer cases to Medical Directors as needed/appropriate * Maintain knowledge of state and federal ...
Medical Reviewer/Safety Reviewer III Part time ~ 20-25 hours per week Remote (candidates must be ... The ideal candidate will have either prior experience in medical review for the Pharmaceutical ...
Medical Reviewer/Safety Reviewer III Part time ~ 20-25 hours per week Remote (candidates must be ... The ideal candidate will have either prior experience in medical review for the Pharmaceutical ...
Medical Reviewer/Safety Reviewer III Part time ~ 20-25 hours per week Remote (candidates must be ... The ideal candidate will have either prior experience in medical review for the Pharmaceutical ...
Medical Reviewer/Safety Reviewer III Part time ~ 20-25 hours per week Remote (candidates must be ... The ideal candidate will have either prior experience in medical review for the Pharmaceutical ...
Atlanta, GA · Remote
$35 - $45.94/hr
You will perform frequent case reviews, check medical records and speak with care providers ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;
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Atlanta, GA · Remote
$35 - $45.94/hr
You will perform frequent case reviews, check medical records and speak with care providers ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;
Dallas, TX · Remote
$35 - $45.94/hr
You will perform frequent case reviews, check medical records and speak with care providers ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;
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Dallas, TX · Remote
$35 - $45.94/hr
You will perform frequent case reviews, check medical records and speak with care providers ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;
Miami, FL · Remote
$35 - $45.94/hr
You will perform frequent case reviews, check medical records and speak with care providers ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;
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Miami, FL · Remote
$35 - $45.94/hr
You will perform frequent case reviews, check medical records and speak with care providers ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;
... Full time remote Candidates must be based in TX. RN working in the insurance or managed care ... Knowledge of medical terminology and procedures. * Verbal and written communication skills.
... Full time remote Candidates must be based in TX. RN working in the insurance or managed care ... Knowledge of medical terminology and procedures. * Verbal and written communication skills.
New Lenox, IL · On-site +1
$34.73 - $45.15/hr
Performs medical record review for severity of illness and intensity of service; liaison function ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...
New Lenox, IL · On-site +1
$34.73 - $45.15/hr
Performs medical record review for severity of illness and intensity of service; liaison function ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...
Tempe, AZ · Remote
$35 - $45.94/hr
You will perform frequent case reviews, check medical records and speak with care providers ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;
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Tempe, AZ · Remote
$35 - $45.94/hr
You will perform frequent case reviews, check medical records and speak with care providers ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;
Dallas, TX · Remote
$40/hr
... Full time remote Candidates must be based in TX. RN working in the insurance or managed care ... Knowledge of medical terminology and procedures. * Verbal and written communication skills.
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Dallas, TX · Remote
$40/hr
... Full time remote Candidates must be based in TX. RN working in the insurance or managed care ... Knowledge of medical terminology and procedures. * Verbal and written communication skills.
Franklin, TN · On-site +1
Affordable Medical/Dental/Vision insurance options * Generous paid time-off program and paid ... The Utilization Review Nurse is to assess the medical necessity and quality of healthcare services ...
Franklin, TN · On-site +1
Affordable Medical/Dental/Vision insurance options * Generous paid time-off program and paid ... The Utilization Review Nurse is to assess the medical necessity and quality of healthcare services ...
Affordable Medical/Dental/Vision insurance options * Generous paid time-off program and paid ... The Utilization Review Nurse is to assess the medical necessity and quality of healthcare services ...
Affordable Medical/Dental/Vision insurance options * Generous paid time-off program and paid ... The Utilization Review Nurse is to assess the medical necessity and quality of healthcare services ...
$17.31 - $21.68
3% of jobs
$21.68 - $26.05
7% of jobs
$29.33 is the 25th percentile. Wages below this are outliers.
$26.05 - $30.42
20% of jobs
The median wage is $34.13 / hr.
$30.42 - $34.79
24% of jobs
$34.79 - $39.16
14% of jobs
$41.84 is the 75th percentile. Wages above this are outliers.
$39.16 - $43.53
11% of jobs
$43.53 - $47.90
7% of jobs
$47.90 - $52.27
5% of jobs
$52.27 - $56.64
3% of jobs
$56.64 - $61.01
3% of jobs
$61.01 - $65.38
2% of jobs
$17
$38
$65
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.
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.
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.
$41/hr
Full-time
Posted 4 days ago
Remote position, however, candidates must reside in the State of TX or State of IL
This position is a contract for about 9 months.
Pay: $41/hour
RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. This Position Is Responsible For Performing Accurate And Timely Medical Review Of Claims Suspended For Medical Necessity, Contract Interpretation, Pricing; And To Initiate And/Or Respond To Correspondence From Providers Or Members Concerning Medical Determinations.
Knowledge of accreditation, i.e. URAC, NCQA standards and health insurance legislation. Awareness of claims processes and claims processing systems. PC proficiency to include Microsoft Word and Excel and health insurance databases. Verbal and written communication skills with ability to communicate to physicians, members and providers and compose and explain document findings. Organizational skills and prioritization skills. :Registered Nurse (RN) with unrestricted license in state. 3 years clinical experience.
Needs to be able to navigate MCG and Medical policies with the reviews.
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