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Remote Nurse Reviewer Jobs in Racine, WI (NOW HIRING)

MDS Solutions

REMOTE MDS Coordinator

Milwaukee, WI · Remote

$33.75 - $43/hr

Review and verify MDS documentation and charting requirements to support the clinical services ... Nursing Experience in MDS Assessment: 3+ year * RN required * RAC-CT preferred * Thorough ...

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How much do remote nurse reviewer jobs pay per hour?

As of Jul 27, 2026, the average hourly pay for remote nurse reviewer in Racine, WI is $34.73, according to ZipRecruiter salary data. Most workers in this role earn between $32.02 and $38.75 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.
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What are popular job titles related to Remote Nurse Reviewer jobs in Racine, WI? For Remote Nurse Reviewer jobs in Racine, WI, the most frequently searched job titles are:
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Remote Nurse Reviewer jobs near you
Infographic showing various Remote Nurse Reviewer job openings in Racine, WI as of July 2026, with employment types broken down into 83% Full Time, and 17% Contract. Highlights an 100% Remote job distribution, with an average salary of $72,233 per year, or $34.7 per hour.

REMOTE MDS Coordinator

MDS Solutions

Milwaukee, WI • Remote

$33.75 - $43/hr

Other

Medical, Life, Retirement, PTO

Posted 27 days ago

Job description

Overview

MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS consulting group.  The role of the Remote MDS Coordinator is to work with our contract partners to plan, organize, and coordinate the completion of the Minimum Data Set (MDS) in accordance with current Federal and State Regulations. If you are looking for something that is flexible and collaborative, come join us!  We thrive on Quality Resident Care.

What do we offer you?

  • Creative, fun, and flexible working environment
  • The following benefits:
  • Competitive salaries and bonuses.
  • Comprehensive health and life insurance.
  • 401K with discretionary match
  • Mileage and licensure reimbursements.
  • Flexible Spending Account and HSA
  • Reasonable working hours.
  • CE opportunities.
  • Paid sick, holiday, and vacation leave.
  • Promotion/Transfer/Advancement opportunities.
  • Meaningful work and job satisfaction.
Responsibilities
  • MDS scheduling and coordinating to ensure timeliness of assigned sections of MDS per RAI guidelines, including coordinating care plan development and completion with the interdisciplinary team.
  • Provide Medicare, Medicaid (case mix), and Managed Care oversight to ensure appropriate clinical services are provided and appropriate reimbursement is received for each resident.
  • Develop an individualized, comprehensive resident care plan in collaboration with the interdisciplinary team to ensure care area triggers are addressed.
  • Ensure care plans are reviewed quarterly and updated as needed to reflect current resident status with individualized problems, goals, and interventions.
  • Review and verify MDS documentation and charting requirements to support the clinical services provided for each resident.
  • Ensure timely submission of all Minimum Data Sets to the state data base and ensures that the necessary follow-up action is taken.
  • Promote highest degree of quality care through QI/QM data with facility team and identify trends to assist facility in advancing facility processes, improve resident outcomes, and optimize reimbursement.
Qualifications
  • Nursing Experience in MDS Assessment: 3+ year
  • RN required 
  • RAC-CT preferred
  • Thorough understanding of PDPM requirements
  • Able to negotiate through EMR and possess strong computer skills
  • Promotes and demonstrates excellence in customer service
Employment Type: OTHER

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