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Remote Nurse Reviewer Jobs (NOW HIRING)

Massgeneralbrigham

Senior Nurse Reviewer

Somerville, MA · Remote

$79K - $115K/yr

The Senior Nurse Reviewer plays an important role in appealing challenges to charging policy and ... Remote, M-F eastern standard business hours. Requires a quiet, secure, HIPAA-compliant working ...

Mass General Brigham

Senior Nurse Reviewer

Somerville, MA · On-site +1

$79K - $115K/yr

The Senior Nurse Reviewer plays an important role in appealing challenges to charging policy and ... Remote, M-F eastern standard business hours. Requires a quiet, secure, HIPAA-compliant working ...

BreatheSuite

Job Title:Remote Nurse Practitioner Classification: 1099 Independent Contractor Work Structure ... review * Develop and manage individualized care plans for patients with chronic lung conditions

New

StudyFetch

NCLEX-PN Expert Question Reviewer

$60 - $80/hr

About the role * We're looking for an experienced practical nurse to join our content quality team ... This is a contract position - flexible, remote, and project-based. You'll work independently ...

TEEMA

RN Clinical Quality Reviewer

Phoenix, AZ · Remote

$40 - $43/hr

Job Summary RN Clinical Quality Reviewer TEEMA Full-time Remote | Phoenix, AZ, United States Overview: We are partnering with a leading organization supporting a large-scale federal healthcare ...

STI

Healthcare Construction Plan Reviewer - REMOTE

Healthcare Construction Plan Reviewer REMOTE 9+ Months Description: The Healthcare Construction Plan Reviewer is responsible for evaluating electronic construction drawings and specifications for ...

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Remote Nurse Reviewer information

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How much do remote nurse reviewer jobs pay per hour?

As of Jun 17, 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 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.

How to make 300,000 dollars as a nurse online?

A remote nurse reviewer can increase earnings by gaining specialized certifications, such as in case management or legal nurse consulting, and building a strong reputation through consistent, high-quality work. Combining multiple freelance or consulting roles, leveraging telehealth platforms, and working with healthcare legal or insurance companies can help reach higher income levels. Earning $300,000 annually typically requires advanced skills, a high volume of cases, and efficient time management.

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 Remote Nurse Reviewers?

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 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.

How to make an extra $1000 a month as a nurse?

A remote nurse reviewer can increase income by taking on additional review assignments, working flexible hours, and leveraging specialized knowledge in areas like medical coding or documentation. Building a reputation for accuracy and efficiency can lead to higher-paying opportunities or freelance contracts, helping to reach the extra $1000 monthly goal.

How can I make 2000 a week working from home?

A remote nurse reviewer can potentially earn $2,000 a week by working full-time hours, often requiring specialized nursing knowledge, certification, and experience. Increasing income may involve taking on multiple clients, working overtime, or specializing in high-demand areas such as medical coding or clinical review, which can command higher pay rates.

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.

How to become a nurse reviewer?

To become a nurse reviewer, you typically need a valid registered nurse (RN) license and several years of clinical experience. Strong attention to detail, good communication skills, and familiarity with medical documentation are essential, and some positions may require knowledge of insurance or healthcare policies.
More about Remote Nurse Reviewer jobs
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Remote Nurse Reviewer jobs near you
Infographic showing various Remote Nurse Reviewer job openings in the United States as of June 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $77,034 per year, or $37 per hour.

Nurse Reviewer - Allentown, PA

Healthcare Quality Strategies, Inc.

Allentown, PA • Remote

$40/hr

Part-time

Medical, Dental, Vision, Life, Retirement

Posted 5 days ago

Job description

Nurse Reviewer
PT (20-30 hours week) – Remote Work Environment
Non-Exempt: $40.00 hour
Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely.
Essential Duties and Responsibilities:
  • Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies
  • Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines
  • Document evidence-based criteria applicable to specific contract requirements
  • Record and report screening results, including relevant referral questions, into a centralized database
  • Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity
  • Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations
  • Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards
Knowledge, Experience, Skills and Education:
  • Medical terminology, ICD-10, CPT and HCPCS
  • Clinical criteria (InterQual and MCG)
  • Utilization/Medical record review and chart abstraction
  • Current standards of medical practice
  • Comply with HIPAA/HITECH laws and regulations
Experience in:
  • At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred)
  • Experience performing medical record review, audit for federal or state contracts
  • Knowledge and experience of Medicare and Medicaid policy
  • Proficiency with Microsoft Office (Word, Excel, and Outlook)
  • Proficiency with Adobe PDF files and features
  • Generating accurate, timely, and understandable correspondence
  • Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG)
Skills Requirements include:
  • Professional interpersonal skills; ability to interact with providers, physicians and peers
  • Solid analytical, assessment and documentation skills
  • Effective written and verbal communication, both internally and externally
  • Strong attention to detail
  • Strong attention to deadlines
  • Organizational skills including effective time management, priority setting and process improvement
  • Ability to work independently and as a member of a team
  • Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations
Educational Background:
  • BSN with active RN licensure in good standing
Physical Demands:
Remote Work, Prolonged Sitting, Screen Exposure
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
Healthcare Quality Strategies, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD amp;D, voluntary life/AD amp;D, 401k
For immediate consideration, please apply via the HQSI Careers Page at: www.hqsi.org gt; Careers gt; Current Employment Opportunities
EOE: Minorities/Females/Disabled/Veterans
Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace
Healthcare Quality Strategies, Inc. is an E-Verify Employer

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