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Remote Medicare Reviewer Jobs (NOW HIRING)

Integrated Resources

Pharmacist - Advisor Medicare

$59.50 - $71.75/hr

Remote Position Summary: As a Clinical Pharmacist Advisor Medicare you will be directly supporting ... You will be responsible for ensuring cases are accurately set up for our members, review clinical ...

ICONMA

*Pharmacist - Clinical Pharmacist Advisor Medicare

$59.50 - $71.75/hr

... for their Remote location. Responsibilities: * As a Clinical Pharmacist Advisor, Medicare B ... Responsible for accurate case set up, review of clinical information for decisioning the request ...

Mercor

Medicare Advantage Broker - Expert

New York, NY · Remote

$140/hr

Remote Duration: 20 minutes Role Responsibilities * Complete a structured ~20-minute online survey ... Our team reviews applications daily. Please complete your AI interview and application steps to be ...

New

Imh

$59.50 - $91.84/hr

Ensure operational readiness for CMS audits, program reviews, and regulatory changes as it relates ... Currently, we are not hiring remote workers in the following states: CA, CT, HI, IL, MA, MN, NY, PA ...

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Remote Medicare Reviewer information

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How much do remote medicare reviewer jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for remote medicare reviewer in the United States is $29.88, according to ZipRecruiter salary data. Most workers in this role earn between $22.60 and $36.54 per hour, depending on experience, location, and employer.

What are the most common challenges faced by remote Medicare reviewers, and how can they be managed effectively?

Remote Medicare Reviewers often encounter challenges such as interpreting complex medical documentation, staying updated with frequently changing Medicare guidelines, and managing high caseloads while working independently. To manage these effectively, it's important to develop strong time-management skills, actively participate in ongoing training, and utilize available resources such as clinical guidelines and team communication tools. Regular check-ins with team members and supervisors can also provide support and help resolve complex cases efficiently.

Does Medicare hire remote workers?

Medicare itself does not directly hire employees; however, many companies and contractors that handle Medicare claims, customer service, and reviews often offer remote positions. These roles typically require relevant certifications, computer skills, and sometimes specific software knowledge, and they may be available as remote or telecommuting jobs depending on the employer.

What is the difference between Remote Medicare Reviewer vs Remote Medical Coder?

AspectRemote Medicare ReviewerRemote Medical Coder
Required CredentialsCertifications like CMS Certification, medical backgroundCertified Coding Specialist (CCS), CPC, or equivalent
Work EnvironmentHome-based, healthcare insurance industryHome-based, healthcare billing and coding industry
Employer & Industry UsageInsurance companies, Medicare/Medicaid providersHospitals, clinics, billing companies
Comparison Search IntentUnderstanding roles in Medicare review processUnderstanding medical coding and billing roles

The Remote Medicare Reviewer and Remote Medical Coder roles share similarities in healthcare industry experience and certification requirements. However, the Medicare Reviewer focuses on evaluating Medicare claims and coverage, while the Medical Coder specializes in translating medical procedures into billing codes. Both roles are remote, industry-specific, and require relevant certifications, but they serve different functions within healthcare administration.

What are the key skills and qualifications needed to thrive as a remote Medicare reviewer?

To thrive as a Remote Medicare Reviewer, you generally need a background in nursing or healthcare, knowledge of Medicare guidelines, and relevant licensure such as an RN or LPN. Familiarity with claims review software, electronic medical records (EMR), and CMS regulations is typically required, and certifications in case management can be beneficial. Excellent attention to detail, strong analytical skills, and effective written communication help reviewers interpret medical records and document findings accurately. These skills are critical for ensuring compliance, preventing fraud, and supporting the integrity of Medicare services.

What is a remote Medicare reviewer?

A Remote Medicare Reviewer is a healthcare professional who evaluates medical records and claims to ensure they meet Medicare guidelines and compliance requirements. Working remotely, they review documentation submitted by healthcare providers to verify that services billed to Medicare are medically necessary and properly documented. Their role helps prevent fraud, waste, and abuse in the Medicare system, while ensuring accurate reimbursement for providers. This position typically requires a background in nursing, coding, or healthcare administration, along with knowledge of Medicare policies.
More about Remote Medicare Reviewer jobs
What cities are hiring for Remote Medicare Reviewer jobs? Cities with the most Remote Medicare Reviewer job openings:
What are the most commonly searched types of Medicare Reviewer jobs? The most popular types of Medicare Reviewer jobs are:
What states have the most Remote Medicare Reviewer jobs? States with the most job openings for Remote Medicare Reviewer jobs include:
What job categories do people searching Remote Medicare Reviewer jobs look for? The top searched job categories for Remote Medicare Reviewer jobs are:
Remote Medicare Reviewer jobs near you
Infographic showing various Remote Medicare Reviewer job openings in the United States as of August 2026, with employment types broken down into 85% Full Time, 5% Part Time, 5% Temporary, and 5% Contract. Highlights an 100% Remote job distribution, with an average salary of $62,159 per year, or $29.9 per hour.

Pharmacist - Advisor Medicare

Integrated Resources

Remote

$59.50 - $71.75/hr

Other

Posted 9 days ago

Job description

Job Title: Pharmacist - Advisor Medicare
Duration: 11 Months
Location: Remote
Position Summary:
As a Clinical Pharmacist Advisor Medicare you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.
Duties:
  • The role involves ensuring the accuracy of case setup and clinical review of Medicare appeals cases by thoroughly reviewing internal notes or fax requests for pertinent information, providing clear and concise documentation, and contacting providers when necessary to obtain clinical details for case decisions.
  • It requires adherence to work instructions and Medicare guidelines to ensure proper case processing.
  • The position also demands compliance with CMS-mandated timelines, as well as departmental productivity and quality standards.
  • Clinical judgment and knowledge must be applied effectively, utilizing drug compendia resources, evolving work instructions, and CMS Medicare guidance.
  • Additionally, the role includes participating in development discussions and receiving feedback from the direct supervisor to support continuous improvement.

Experience:
  • Previous experience in Managed Care/PBM environment (preferred).

Education:
  • Bachelor's degree in pharmacy or Pharm D. required.
  • Must have an active license in good standing in state of residence.
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About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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