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Remote Nurse Reviewer Jobs in Puerto Rico (NOW HIRING)

RelateCare

$11/hr

  • Retirement

  • PTO

We are a multidisciplinary team of nurses, contact management specialists and technologists who ... Remote

RelateCare

$11/hr

We are a multidisciplinary team of nurses, contact management specialists and technologists who ... Remote

All JobsNurse Reviewer JobsRemote Nurse Reviewer JobsRemote Nurse Reviewer Jobs in Puerto Rico

Remote Nurse Reviewer information

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.

More about Remote Nurse Reviewer jobs

What are popular job titles related to Remote Nurse Reviewer jobs in Puerto Rico?

For Remote Nurse Reviewer jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Remote Nurse Reviewer jobs in Puerto Rico look for?

The top searched job categories for Remote Nurse Reviewer jobs in Puerto Rico are:

What cities in Puerto Rico are hiring for Remote Nurse Reviewer jobs?

Cities in Puerto Rico with the most Remote Nurse Reviewer job openings:

Remote Nurse Reviewer jobs near you
Infographic showing various Remote Nurse Reviewer job openings in Puerto Rico as of August 2026, with employment types broken down into 50% Full Time, and 50% Part Time. Highlights an 100% Remote job distribution.

PART TIME: Patient Service Representative - English Speaking/Bilingual, Puerto Rico based

RelateCare

Remote

$11/hr

Part-time

Retirement, PTO

Re-posted 29 days ago

Job description

Job description:

Please note that this role is ONLY open to candidates currently residing in Puerto Rico.

Mission Statement

We connect patients, providers, and caregivers to the right care, at the right time, in the right place, resulting in exceptional experiences and outcomes for patients and providers.

Our vision is to be the partner of choice for healthcare organizations in the delivery of patient access solutions.

The specific behaviors and skills we care about most are Integrity, Innovation, Collaboration, Empathy and Excellence.

Summary

We are rapidly expanding and we are looking for Patient Scheduling Representatives who reside in Puerto Rico and are available to work remotely.

We specialize in connecting patients, providers and caregivers ensuring that patients can access the right care at the right time and in the right place. We are a multidisciplinary team of nurses, contact management specialists and technologists who work with leading hospital and health organizations.

Shift pattern:

Shifts between 9am - 2pm, Monday to Friday

We also Provide 15 PTO days as part of the role.

Key Duties:

  • Receiving inbound calls from patients looking to schedule physician appointments
  • Connecting patients, providers and caregivers to the right care, at the right time, in the right place, resulting in an exceptional experience and outcome for patients and providers
  • Verifying and reviewing patient insurance coverage and benefit eligibility
  • Resolving patient requests efficiently
  • Accurately entering patient data into multiple systems

Candidate Requirements:

  • Must be resident in Puerto Rico
  • Must be able to work remotely
  • Must have fixed line broadband internet connectivity
  • Exceptional customer service skills
  • Empathy and the ability to soothe anxious callers
  • Previous customer service experience (face to face or contact center)
  • Excellent communication skills, both written and verbal
  • Fluent English and the ability to relay information to callers in an easily understood manner
  • Ability to multitask
  • Computer literacy and ability to learn new systems
  • Adaptability to changes in processes and procedures

Benefits:

  • 401(k)
  • Employee assistance program
  • Paid time off

Experience:

  • customer service: 1 year (Preferred)

Language:

  • English (Required)

Location:

  • Puerto Rico (Required)

Work Location: Remote

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