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

The Hartford

Nurse Case Manager

Hartford, CT · On-site +1

$69K - $104K/yr

Nurse Case Manager This fully remote or hybrid role provides telephonic case management for injured ... case reviews Required Qualifications * RN with current unrestricted state licensure * Associate ...

New

The Hartford

Nurse Case Manager

Hartford, CT · On-site +1

$69K - $104K/yr

Nurse Case Manager This fully remote or hybrid role provides telephonic case management for injured ... case reviews Required Qualifications * RN with current unrestricted state licensure * Associate ...

New

Aflac Incorporated

Mgr, Review Services

Windsor, CT · Remote

$100K - $125K/yr

If the role is remote, there may be occasions that you are requested to come to the office based on ... Bachelor's Degree In nursing, healthcare or a related field. * Certification in Active and ...

New

Trinity Health

Analyst Charge-RIO (Remote)

Springfield, MA · On-site +1

$21.52 - $32.28/hr

Performs regular reviews of process adherence and identify missing charges. Coordinates with key ... RHIA, RHIT, CCS, CPC/COC, AAPC or other coding credentials and/or Licensed Vocational Nurse ...

Aflac, Incorporated

Mgr, Review Services

Windsor, CT · Remote

$100K - $125K/yr

If the role is remote, there may be occasions that you are requested to come to the office based on ... Bachelor's Degree In nursing, healthcare or a related field. * Certification in Active and ...

New

Aflac Incorporated

Behav Health Clinician Rev

Windsor, CT · Remote

$75K - $90K/yr

If the role is remote, there may be occasions that you are requested to come to the office based on ... Utilization review experience and/or experience using specific behavioral health criteria or ...

Aflac, Incorporated

Behav Health Clinician Rev

Windsor, CT · Remote

$75K - $90K/yr

If the role is remote, there may be occasions that you are requested to come to the office based on ... Utilization review experience and/or experience using specific behavioral health criteria or ...

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

Remote Nurse Reviewer information

See Springfield, MA salary details

$27

$36

$41

How much do remote nurse reviewer jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for remote nurse reviewer in Springfield, MA is $36.05, according to ZipRecruiter salary data. Most workers in this role earn between $33.22 and $40.24 per hour, depending on experience, location, and employer.

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.

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For Remote Nurse Reviewer jobs in Springfield, MA, the most frequently searched job titles are:

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The top searched job categories for Remote Nurse Reviewer jobs in Springfield, MA are:

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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 August 2026, with employment types broken down into 2% As Needed, 60% Full Time, 16% Part Time, and 22% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $74,975 per year, or $36 per hour.

Nursing Home Billing Specialist - Remote

The Carmelite System Inc

Holyoke, MA • Remote

$31.25/hr

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 5 days ago

Job description

Billing Specialist 

The Carmelite System is a multi-state, not-for-profit senior living organization sponsored by the Carmelite Sisters for the Aged & Infirm operating a network of Skilled Nursing Facilities and Assisted Living/Independent Living communities.

We are seeking to hire a Nursing Home Billing Specialist - Remote.

  • This corporate level position is fully remote.  Current Team members work in Eastern and Central Standard Time.    
  • $27 per hour to $31.25 per hour based on skills and experience. 

Nursing Home Billing Specialist Qualifications:

  • High School diploma or equivalent.
  • 2+ years experience in Skilled Nursing Facility (SNF) billing required.
  • 2+ years experience using PCC (Point Click Care) required.
  • Extensive knowledge of Medicare, Medicaid, managed care networks and insurance carriers required.
  • Extensive knowledge of accounts receivable functions including CPT and ICD-10 coding required.
  • Solid understanding of the current Medicare Compliance, OSHA, and HIPAA regulations and medical terminology required.
  • Strong basic mathematical skills required.
  • Understanding of Medicaid, Medicare, and Third Party Billing preferred.

Nursing Home Billing Specialist Job Summary:

  • Prepare, review, and transmit claims using billing software.
  • Analyze explanation of benefits forms to review denial codes and make appropriate corrections.
  • Follow up on balances, unpaid claims, appeals & denials within the set timeframe.
  • Post payments and adjustments to accounts and maintain backup records.
  • Maintain patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Ensure proper records handling.
  • Input ancillary charges into the billing software in accordance with protocol.
  • File all charge, payment, adjustment batches, refund requests and write off requests in the appropriate format and location (PCC and shared drive).
  • Prepare and review claims for billing prior to triple check.
  • Attend and lead monthly triple check reviews.
  • Follow claims process from submission to clearinghouse and ensure acceptance at payer.
  • Process refunds to insurance companies in accordance with policy.
  • Monitor reimbursement from managed care networks and insurance carriers.

This is a brief overview of job responsibilities and not intended to be all inclusive. 

We aim to create a supportive workplace where you are valued, compensated fairly and provided the tools to thrive!

The Carmelite System Can Offer You:

  • Competitive Compensation
  • Health (Aetna), Dental, Vision, HSA with employer contribution
  • Flexible Spending Account
  • Fully paid Life and Long-Term Disability insurance
  • Benefits available 1st of the mo. following 30 days
  • Supplemental insurances
  • Retirement Plan
  • Student Loan Forgiveness Guidance
  • Employee Assistance Program with Discount Marketplace
  • Generous Paid-Time-Off with 11 Holidays

Please consider joining our team working where The Difference is Love℠!

The Carmelite System, Inc. is an Equal Opportunity Employer and adheres to a policy that prohibits discrimination on the basis of race, color, sex, sexual orientation, gender identity, religion, creed, national or ethnic origin, citizenship status, age, disability, veteran status, and any other legally protected class.

#CS2024