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Remote Nurse Reviewer Jobs (NOW HIRING)

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 ...

New

Broadway Ventures

Medical Claims Reviewer (RN)

Remote (U.S. - Work from home) Remote Work Requirements : High-speed internet (non-satellite) and a ... About the Role We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team

BreatheSuite Inc

Remote Nurse Practitioner

Denver, CO · On-site +1

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

BreatheSuite

Remote Nurse Practitioner

Denver, CO · Remote

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

BreatheSuite Inc

Remote Nurse Practitioner

Denver, CO · Remote

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

Comagine

Clinical Reviewer RN - Alabama

Clinical Utilization Review Nurses (RN) Based In Alabama Comagine Health is a national, mission ... We go beyond merely providing a remote work option; we support and embrace it. We offer ...

BreatheSuite

Remote Nurse Practitioner

Denver, CO · Remote

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

Ourhrconnect

RN Medical Reviewer II

Tennessee, IL · On-site +1

This a full-time remote position. You will work an 8-hour shift scheduled during our normal ... Performs medical claim reviews for one or more of the following: claims for medically complex ...

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Remote Nurse Reviewer information

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$28

$37

$42

How much do remote nurse reviewer jobs pay per hour?

As of Aug 1, 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.

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.

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.
More about Remote Nurse Reviewer jobs
What cities are hiring for Remote Nurse Reviewer jobs? Cities with the most Remote Nurse Reviewer job openings:
What states have the most Remote Nurse Reviewer jobs? States with the most job openings for Remote Nurse Reviewer jobs include:
What job categories do people searching Remote Nurse Reviewer jobs look for? The top searched job categories for Remote Nurse Reviewer jobs are:
Remote Nurse Reviewer jobs near you
Infographic showing various Remote Nurse Reviewer job openings in the United States as of July 2026, with employment types broken down into 67% Full Time, and 33% Contract. 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

Re-posted 19 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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