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Remote Nurse Reviewer Jobs (NOW HIRING)

Angel City VA

Remote Nurse

Remote Nurse Position: Remote Nurse Employment Type: Part-Time to Full-Time (flexible transition) Compensation: $7 USD per hour Location: Remote (work from home) About the Role We are seeking a ...

Peraton

Nurse Reviewer - Medicaid

$66K - $106K/yr

At least 3 years of experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity. * Current/Active ...

Dane Street, LLC

Registered Nurse Reviewer

Dane Street has embarked on a program where we are looking for Registered Nurses to perform reviews and clinical summaries for disability claims. The expected report turnaround time for the reviewer ...

New

Peraton

Nurse Reviewer - Medicaid

$66K - $106K/yr

At least 3 years of experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity. * Current/Active ...

Peraton

Nurse Reviewer - Medicaid

$66K - $106K/yr

At least 3 years of experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity. * Current/Active ...

Cohere Health

Lead RN Reviewer

$35 - $37/hr

Lead RN Reviewer Cohere's Service Operations team is responsible for ensuring that our healthcare ... Fully remote opportunity with about 5% travel Medical, dental, vision, life, disability insurance ...

Dane Street

PRN Utilization Review Nurse Reviewer

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring ... Apple equipment and a media stipend are provided for remote workspace. ABOUT DANE STREET: A fast ...

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Remote Nurse Reviewer information

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How much do remote nurse reviewer jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for remote nurse reviewer in the United States is $37.04, according to ZipRecruiter salary data. Most workers in this role earn between $34.13 and $41.35 per hour, depending on experience, location, and employer.

What is a remote nurse reviewer?

Remote Nurse Reviewers are registered nurses who assess medical records, insurance claims, or healthcare documentation from a remote location, typically from home. They play a crucial role in ensuring that patient care meets established guidelines and that services billed to insurance are medically necessary and appropriately documented. Their work often involves collaborating with physicians, insurance companies, and healthcare providers to review cases, determine coverage, and support utilization management. This position requires strong clinical knowledge, attention to detail, and proficiency with electronic health records and telecommunication tools.

What does a remote nurse reviewer do?

As a remote nurse reviewer, you work from home to conduct pre-authorization, check out-of-network benefit information, and determine treatment appropriateness, along with other reviewing responsibilities. In this role, you follow clinical and departmental guidelines when reviewing documents to determine if the treatment used was needed and appropriate. Your duties are to consider medical necessity clinical screenings, determine if medical necessity criteria are met for the patient, communicate with insurance companies for pre-authorization, notify physicians about insurance decisions, and document all reviews. You make phone calls and examine the record from home, allowing you to work a flexible schedule.

What are the key skills and qualifications needed to thrive as a remote nurse reviewer, and why are they important?

To thrive as a Remote Nurse Reviewer, you need a current RN license, clinical experience, and a strong understanding of medical terminology and healthcare regulations. Familiarity with utilization review platforms, electronic health records (EHRs), and coding systems such as ICD-10 and CPT is typically required. Exceptional attention to detail, critical thinking, and effective written communication skills help you stand out in this role. These competencies are vital to ensuring accurate medical reviews, regulatory compliance, and clear communication with providers and payers in a remote work environment.

What are some common challenges faced by remote nurse reviewers, and how can they be managed?

Remote Nurse Reviewers often encounter challenges such as balancing productivity with quality, adapting to frequent changes in healthcare regulations, and managing communication across virtual teams. To manage these, it's important to stay organized, participate in ongoing training, and utilize digital collaboration tools effectively. Regular check-ins with supervisors and colleagues can also help maintain connection and clarity on case review expectations, ensuring both accuracy and efficiency in your work.

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

AspectRemote Nurse ReviewerRemote Medical Coder
Required CredentialsRN license, clinical experienceCertification (CPC, CCS), coding training
Work EnvironmentHealthcare organizations, insurance companiesHospitals, billing companies, insurance firms
Industry UsageMedical review, claims assessmentMedical billing, coding, reimbursement
Search/Comparison IntentUnderstanding clinical review rolesUnderstanding coding and billing roles

Remote Nurse Reviewers primarily evaluate medical records to ensure accuracy and compliance, requiring nursing credentials and clinical experience. Remote Medical Coders focus on translating medical procedures into billing codes, requiring coding certifications. Both roles are remote, serve healthcare and insurance industries, but differ in daily tasks and required qualifications.

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Remote Nurse Reviewer jobs near you
Infographic showing various Remote Nurse Reviewer job openings in the United States as of August 2026, with employment types broken down into 4% As Needed, 53% Full Time, 16% Part Time, and 27% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $77,034 per year, or $37 per hour.

Nurse Reviewer (Registered Nurse) - Remote

Gainwell Technologies

Remote

$78K - $88K/yr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

New

Gainwell Technologies rating

7.8

Company rating: 7.8 out of 10

Based on 82 frontline employees who took The Breakroom Quiz

138th of 245 rated software companies

Job description

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
Summary
We are seeking a Nurse Reviewer (RN) who will be responsible for performing clinical reviews to determine whether medical record documentation supports the need for services based on clinical criteria, coverage policies, and utilization and practice guidelines. This role involves accessing proprietary systems to review medical records, accurately documenting findings, and providing policy and regulatory support for review determinations.
Your role in our mission

  • Reviews and interprets medical records to determine medical necessity and appropriateness of care while meeting quality and productivity standards.
  • Documents review decisions and supporting rationale accurately and timely.
  • Determines approvals or refers cases to physician consultants and processes consultant decisions.
  • Performs prior authorization, precertification, and retrospective reviews; prepares decision letters as needed.
  • Assists with training, mentoring, and supporting new Nurse Reviewers.
  • Maintains RN licensure and knowledge of clinical criteria, policies, and regulations.
  • Cross-trains on multiple claim types to support business needs.
  • Recommends process improvements and technology solutions to enhance quality, productivity, and client satisfaction.
What we're looking for
  • Proficiency in computer and typing skills, including Microsoft Windows, Outlook, Excel, Word, PowerPoint, and internet browsers.
  • Active, unrestricted RN license in the United States and primary state of residence, along with an active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
  • Minimum of 5+ years of clinical experience in an inpatient hospital setting.
  • Minimum of 2+ years of utilization review or claims auditing experience.
  • Experience using Milliman or InterQual criteria.
  • Ability to work standard business hours, collaborate effectively with cross-functional teams and departments, and maintain the flexibility to work extended hours as needed to support business demands.
What you should expect in this role
  • Full-time position.
  • Day-one eligibility for medical, dental, vision, and paid time off benefits.
  • Monday through Friday work schedule.Remote role available to employees residing within the United States.
  • Travel requirement: 0-10%.

This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis
The pay range for this position is $78,000.00 - $88,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

What Gainwell Technologies employees say

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Hours and flexibility

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About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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