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Remote Nurse Reviewer Jobs in Raleigh, NC (NOW HIRING)

Scribe-X

Remote Medical Scribe

Durham, NC · Remote

$14 - $17/hr

Anyone looking to begin a career in medicine (MD, DO, PA, NP, or RN) should consider becoming a ... Review completed charts with the provider between patients or at the completion of shift * Update ...

micro1 AI

Clinical Pharmacy Technicians

Durham, NC · Remote

$70 - $80/hr

Remote micro1 is engaging Pharmacovigilance Experts to contribute their advanced drug safety ... Author and review evaluation tasks based on DSURs, PSURs/PBRERs, and associated safety data and ...

micro1 AI

Pharmacovigilance Expert

Cary, NC · Remote

$70 - $80/hr

Remote micro1 is engaging Pharmacovigilance Experts to contribute their advanced drug safety ... Author and review evaluation tasks based on DSURs, PSURs/PBRERs, and associated safety data and ...

micro1 AI

Clinical Pharmacy Technicians

Raleigh, NC · Remote

$70 - $80/hr

Remote micro1 is engaging Pharmacovigilance Experts to contribute their advanced drug safety ... Author and review evaluation tasks based on DSURs, PSURs/PBRERs, and associated safety data and ...

micro1 AI

Pharmacovigilance Expert

Raleigh, NC · Remote

$70 - $80/hr

Remote micro1 is engaging Pharmacovigilance Experts to contribute their advanced drug safety ... Author and review evaluation tasks based on DSURs, PSURs/PBRERs, and associated safety data and ...

micro1 AI

Pharmacovigilance Expert

Durham, NC · Remote

$70 - $80/hr

Remote micro1 is engaging Pharmacovigilance Experts to contribute their advanced drug safety ... Author and review evaluation tasks based on DSURs, PSURs/PBRERs, and associated safety data and ...

micro1 AI

Clinical Pharmacy Technicians

Cary, NC · Remote

$70 - $80/hr

Remote micro1 is engaging Pharmacovigilance Experts to contribute their advanced drug safety ... Author and review evaluation tasks based on DSURs, PSURs/PBRERs, and associated safety data and ...

Scribe-X

Medical Scribe (Remote)

Raleigh, NC · Remote

$14 - $17/hr

Anyone looking to begin a career in medicine (MD, DO, PA, NP, or RN) should consider becoming a ... Review completed charts with the provider between patients or at the completion of shift * Update ...

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Showing results 21-40

All JobsNurse Reviewer JobsRemote Nurse Reviewer JobsRemote Nurse Reviewer Jobs in Raleigh, NC

Remote Nurse Reviewer information

See Raleigh, NC salary details

$27

$35

$41

How much do remote nurse reviewer jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for remote nurse reviewer in Raleigh, NC is $36.00, according to ZipRecruiter salary data. Most workers in this role earn between $33.17 and $40.19 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 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 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 are popular job titles related to Remote Nurse Reviewer jobs in Raleigh, NC? For Remote Nurse Reviewer jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Remote Nurse Reviewer jobs in Raleigh, NC look for? The top searched job categories for Remote Nurse Reviewer jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Remote Nurse Reviewer jobs? Cities near Raleigh, NC with the most Remote Nurse Reviewer job openings:
Remote Nurse Reviewer jobs near you
Infographic showing various Remote Nurse Reviewer job openings in Raleigh, NC as of August 2026, with employment types broken down into 92% Full Time, and 8% Contract. Highlights an 100% Remote job distribution, with an average salary of $74,879 per year, or $36 per hour.

NCQA Quality & Accreditation Specialist (Full Time, Remote, North Carolina Based)

Alliance

Morrisville, NC • On-site, Remote

$69K - $88K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 12 days ago

Job description

The NCQA Quality & Accreditation Specialist serves as the project management lead and subject matter expert for assigned NCQA standard areas and manages the assessment of related business functions for corresponding departments within the scope of NCQA standards (e.g. Provider and Member Services, Utilization Management, Population Health, Care Management, Provider Network, Member and Provider Communications, Delegation Oversight) to support high-quality performance and ensure successful NCQA Accreditation process.
This position is fulltime remote. While there is no expectation of being in the office routinely, they may be required to report to the Alliance Home Office (Morrisville, North Carolina) for business meetings as needed.
Responsibilities & Duties
Implement and Monitor Accreditation Workplan
  • Project management lead for assigned NCQA standard categories within the organization's QI workplan to achieve and maintain Health Plan Accreditation with LTSS distinction and any additional accreditations Alliance Health pursues
  • Identify gaps and risks and provide regular status reports from NCQA tracker to leadership
  • Serve as lead for NCQA Accreditation reviews for assigned standard categories by gathering all necessary documents and information from business areas, managing timely document submissions to NCQA, facilitating NCQA requests for additional information, and coordinating onsite review activities
  • Review and update policies and procedures, reports, materials, and files for completeness, accuracy, and compliance with NCQA Standards
  • Maintain calendar of documentation due dates, ongoing collection and tagging relevant policies/procedures, reports, materials, and files as appropriate
  • Participate in Delegation Oversight and audits as appropriate

Drive Organizational Accreditation Efforts
  • Provide technical support and education to staff regarding NCQA Health Plan Accreditation and LTSS Distinction Standards and supporting documentation
  • Assess business area functions against current and upcoming NCQA standards and identify potential performance gaps and associated risks and update NCQA tracker upon release of new/updated standards
  • Serve as the accreditation subject matter expert within organizational wide, cross-functional, and multi-disciplinary teams to bring each business area to a state of readiness
  • Identify and facilitate business area process improvements via means such as policies, workflows, and processes; follow-up to ensure improved outcomes
  • Coordinate and collaborate with cross-departmental teams to identify and implement organization-wide strategic initiatives that support quality performance
  • Communicate reporting due dates and reminders to business leads and leadership as appropriate
  • Maintain clear status updates regarding NCQA Readiness on NCQA Tracker, communicating risks as appropriate

Minimum Requirements
Education & Experience
Required:
Bachelor's degree in Healthcare, Human Services, Public Health Administration, Nursing, Business, or related field and three (3) years of project management experience in a managed care or healthcare setting with knowledge and practical experience health care quality or NCQA Health Plan accreditation processes and requirements.
Preferred:
Experience with NCQA Accreditation standards.
Knowledge of regulatory reporting, compliance requirements, and auditing procedures.
Project management.
Knowledge, Skills, & Abilities
  • Knowledge of NCQA accreditation processes and standards
  • Knowledge and understanding of federal and state regulations
  • Planning, project management and organizational skills
  • Excellent communication skills (written and verbal).
  • Interpersonal skills which are effective, respectful, and sensitive to a diverse and multicultural population of children, families, and co-workers,
  • Problem-solving, mediation, and conflict resolution skills
  • Teamwork and collaboration skills
  • Microsoft Project, Excel, Word (Edits and Tracking), and PowerPoint skills
  • Facilitation skills
  • Ability to work in a fast-paced environment with frequent interruptions
  • Ability to work under minimal supervision

Salary Range
$69,592 - $88,729/ Annual
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity
An excellent fringe benefit package accompanies the salary, which includes:
    • Medical, Dental, Vision, Life, Long Term Disability
    • Generous retirement savings plan
    • Flexible work schedules including hybrid/remote options
    • Paid time off including vacation, sick leave, holiday, management leave
    • Dress flexibility

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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