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Remote Nurse Reviewer Jobs in Springfield, MA (NOW HIRING)

Option Care

Chronic Practice Liaison

Hartford, CT · Remote

$66K - $88K/yr

Participate in provider business reviews and performance discussions * Recommend process ... Pharmacy operations, Nursing Operations, Patient Onboarding, or Revenue Cycle Management.

Option Care

Chronic Practice Liaison

Hartford, CT · Remote

$66K - $88K/yr

Participate in provider business reviews and performance discussions * Recommend process ... Pharmacy operations, Nursing Operations, Patient Onboarding, or Revenue Cycle Management.

All JobsNurse Reviewer JobsRemote Nurse Reviewer JobsRemote Nurse Reviewer Jobs in Springfield, MA

Remote Nurse Reviewer information

See Springfield, MA salary details

$28

$36

$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 Springfield, MA is $36.91, according to ZipRecruiter salary data. Most workers in this role earn between $34.04 and $41.20 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 are popular job titles related to Remote Nurse Reviewer jobs in Springfield, MA? For Remote Nurse Reviewer jobs in Springfield, MA, the most frequently searched job titles are:
What job categories do people searching Remote Nurse Reviewer jobs in Springfield, MA look for? The top searched job categories for Remote Nurse Reviewer jobs in Springfield, MA are:
What cities near Springfield, MA are hiring for Remote Nurse Reviewer jobs? Cities near Springfield, MA with the most Remote Nurse Reviewer job openings:
Remote Nurse Reviewer jobs near you
Infographic showing various Remote Nurse Reviewer job openings in Springfield, MA as of July 2026, with employment types broken down into 72% Full Time, and 28% Contract. Highlights an 100% Remote job distribution, with an average salary of $76,764 per year, or $36.9 per hour.

Remote Registered Nurse (RN) Case Manager

Valeris

Hartford, CT • Remote

$50K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 29 days ago

Job description

Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris™ revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana. To learn more about Valeris, please visit www.valeris.com.
As a Nurse Advocate you are responsible for contact with program patients and assessing any barriers that may be present for successful initiation and completion of therapy. The Nurse Advocate will play an active role with each patient from the first point of patient program enrollment and throughout treatment to facilitate a timely and successful patient experience.
Key Responsibilities:
  • Serve as a consistent resource throughout the continuum of program services, which includes identifying barriers to therapy and helping the patient understand and navigate such barriers.
  • Serve as an educator who possesses knowledge and practical experience about clinical treatments and the strong emotions and financial implications associated with a new diagnosis, living with a chronic medical condition or life-threatening condition.
  • Enable patients by providing them with information and education about:
    • their prescribed therapy and course of treatment, fairly balanced with benefits and known side effects per manufacturer product information
    • proper administration and dosing of prescribed therapy
    • calling and working with the patient’s insurance payer to determine coverage benefits, anticipated out-of-pocket costs associated with their therapy and resources for financial assistance, where applicable based upon needs communicated by the patient
    • support to help better manage the stress involved in their diagnosis.
    • Empower the patient to participate in their personal care process by triaging the patient to support for other non-program needs such as social or other intervention programs.
  • Reporting of Adverse Events/ Product Complaint received in accordance with SOP and good manufacturer practices
  • Utilize Valeris’ values as the driving force behind the team’s success
  • On time adherence to training deadlines for all corporate policies and procedures
  • Ensure all SOPs are followed with consistency
  • Perform additional tasks or projects as assigned
Qualifications:
  • Must have active RN licensure in current state of practice.
  • 2-3 years of nursing experience with relevant disease state experience preferred.
  • Nurseline triage, Call Center Utilization Management, Call Center Case Management, a plus.
  • Case management or Clinical Trial Nurse experience, a plus.
  • Bachelor's degree preferred.
  • Remote work eligibility is subject to all work from home criteria met and based on business need.
Physical Demands amp; Work Environment
  • While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy.
  • Although very minimal, flexibility to travel as needed is preferred.
  • This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.
Why Work for Valeris?
We’re committed to supporting the well-being and success of our team members. As part of our organization, full-time employees can expect:
  • Medical, dental, and vision plans, including HSA- and FSA-eligible options, with Valeris contributing toward premium costs
  • Additional health support, including telehealth and Employee Assistance Program (EAP) services
  • Company match on Health Savings Account contributions
  • Free Basic Life and AD amp;D coverage equal to your annual earnings, with a minimum of $50,000 and a maximum of $300,000
  • Company-paid Short-Term Disability coverage, with the option to purchase Long-Term Disability
  • 401(k) Retirement Savings Plan with 100% match on the first 5% you contribute, with immediate vesting
  • Paid Time Off (PTO) and Sick Leave to support work-life balance
  • Team members receive nine paid holidays plus two floating holidays
  • Opportunities for advancement in a company that supports personal and professional growth
  • A challenging, stimulating work environment that encourages new ideas
  • Work for a company that values diversity and makes deliberate efforts to create an inclusive workplace
  • A mission-driven, inclusive culture where your work makes a meaningful impact
Any offer of employment is contingent upon the successful completion of a background check and, depending on the position, a drug screen in accordance with company standards. Please note that this job description is not intended to be an exhaustive list of all duties, responsibilities, or activities associated with the position. Responsibilities and tasks may be modified at any time, with or without notice.
Our Commitment to Equal Opportunity
At Valeris, we don’t just accept difference – we celebrate it, support it and we thrive on it for the benefit of our employees, our products and our community. Valeris is proud to be an equal opportunity employer.
Important Notice

Due to an increase in hiring scams, please be aware that if you are selected to move forward in our hiring process, a member of our Talent Acquisition team will contact you directly using an official @pharmacord.com and/or @valeris.com, @echo.newtonsoftware.com email address regarding next steps in our interview process.

Please Note:
  • PharmaCord will never use Microsoft Teams to reach out to candidates for interview scheduling. However, video interviews are typically conducted via Microsoft Teams. Official meeting links will always be sent from an @valeris.com, @pharmacord.com or @echo.newtonsoftware.com email address, or through our scheduling platform, Calendly.
  • We will never request your bank account information at any stage of the hiring process.
  • We will never send a check (electronic or physical) to purchase home office equipment.

If you receive any suspicious communication regarding employment with PharmaCord, please report it to our Talent Acquisition team immediately at careers@pharmacord.com

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