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Remote Nurse Reviewer Jobs (NOW HIRING)

TEEMA

RN Clinical Quality Reviewer

Phoenix, AZ · Remote

$40 - $43/hr

Job Summary RN Clinical Quality Reviewer TEEMA Full-time Remote | Phoenix, AZ, United States Overview: We are partnering with a leading organization supporting a large-scale federal healthcare ...

New

STI

Healthcare Construction Plan Reviewer - REMOTE

Healthcare Construction Plan Reviewer REMOTE 9+ Months Description: The Healthcare Construction Plan Reviewer is responsible for evaluating electronic construction drawings and specifications for ...

AlediumHR

About the job Remote Nurse Practitioner - HRT Experience AlediumHR is partnering with a forward ... Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans * Initiate and ...

AlediumHR

About the job Remote Nurse Practitioners - HRT Experience AlediumHR is partnering with a forward ... Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans * Initiate and ...

AlediumHR

About the job Remote Nurse Practitioner - HRT Experience AlediumHR is partnering with a forward ... Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans * Initiate and ...

AlediumHR

About the job Remote Nurse Practitioners - HRT Experience AlediumHR is partnering with a forward ... Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans * Initiate and ...

PRIDE Healthcare

Remote Nurse Practitioner

Cincinnati, OH · Remote

$65 - $70/hr

Pride Health is hiring a Remote Nurse Practitioner! (Contract to Hire) Schedule : * Various shift ... Review orders and interventions for appropriateness and response to treatment to identify the most ...

AlediumHR

About the job Remote Nurse Practitioner - HRT Experience AlediumHR is partnering with a forward ... Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans * Initiate and ...

AlediumHR

About the job Remote Nurse Practitioner - HRT Experience AlediumHR is partnering with a forward ... Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans * Initiate and ...

AlediumHR

About the job Remote Nurse Practitioners - HRT Experience AlediumHR is partnering with a forward ... Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans * Initiate and ...

AlediumHR

About the job Remote Nurse Practitioners - HRT Experience AlediumHR is partnering with a forward ... Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans * Initiate and ...

AlediumHR

About the job Remote Nurse Practitioner - HRT Experience AlediumHR is partnering with a forward ... Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans * Initiate and ...

AlediumHR

About the job Remote Nurse Practitioners - HRT Experience AlediumHR is partnering with a forward ... Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans * Initiate and ...

AlediumHR

About the job Remote Nurse Practitioners - HRT Experience AlediumHR is partnering with a forward ... Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans * Initiate and ...

AlediumHR

About the job Remote Nurse Practitioners - HRT Experience AlediumHR is partnering with a forward ... Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans * Initiate and ...

AlediumHR

About the job Remote Nurse Practitioner - HRT Experience AlediumHR is partnering with a forward ... Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans * Initiate and ...

AlediumHR

About the job Remote Nurse Practitioner - HRT Experience AlediumHR is partnering with a forward ... Review labs, diagnose hormone imbalances, and develop evidence-based treatment plans * Initiate and ...

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Remote Nurse Reviewer information

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$28

$37

$42

How much do remote nurse reviewer jobs pay per hour?

As of May 28, 2026, the average hourly pay for remote nurse reviewer in the United States is $37.04, according to ZipRecruiter salary data. Most workers in this role earn between $34.13 and $41.35 per hour, depending on experience, location, and employer.

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 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.

More about Remote Nurse Reviewer jobs
What cities are hiring for Remote Nurse Reviewer jobs? Cities with the most Remote Nurse Reviewer job openings:
What states have the most Remote Nurse Reviewer jobs? States with the most job openings for Remote Nurse Reviewer jobs include:
What job categories do people searching Remote Nurse Reviewer jobs look for? The top searched job categories for Remote Nurse Reviewer jobs are:
Remote Nurse Reviewer jobs near you
Infographic showing various Remote Nurse Reviewer job openings in the United States as of May 2026, with employment types broken down into 19% As Needed, 4% Full Time, 60% Part Time, and 17% Contract. Highlights an 66% Physical, and 34% Remote job distribution, with an average salary of $77,034 per year, or $37 per hour.
Clinical Reviewer (Part-Time, Remote)

Clinical Reviewer (Part-Time, Remote)

Astyra Corporation

Indianapolis, IN • Remote

$35 - $40/hr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 8 days ago

Job description

Job Summary

The purpose of this position is to utilize clinical expertise to review medical records against established criteria in accordance with contract requirements.

Location: Remote (U.S.-based)
Licensure Requirement: Must hold an active clinical license in the State of Indiana or a Compact State license

Work Schedule:

  • Up to 25 hours per week
  • Weekend and/or holiday availability required based on business needs

Training Requirement:

  • Must be fully available to attend 100% of training
  • Schedule: Monday–Friday, 9:00 AM – 6:00 PM EST
  • Duration: Minimum of 3 weeks
Key Responsibilities
  • Ensure accuracy and timeliness of all review cases in accordance with contract requirements
  • Manage daily workload and queues; adjust workflow as needed to meet departmental demands
  • Collaborate with Supervisor on quality monitoring and improvement activities
  • Maintain current knowledge of clinical practices and review processes
  • Serve as a liaison for providers regarding customer service issues and resolution
  • Perform various review types as assigned based on workload
  • Build and maintain professional relationships with internal and external stakeholders
  • Attend required trainings and team meetings
  • Cross-train to support business and client needs
  • Comply with all corporate policies, including HIPAA Privacy and Security regulations

Note: Responsibilities may evolve based on business needs.
 

Required Qualifications
  • Active, unrestricted LPN/LVN or RN license in Indiana or Compact State
  • Associate’s degree (Bachelor’s preferred) or diploma from an accredited nursing program
  • 2+ years of Utilization Review/Management (UR/UM) and/or Prior Authorization experience
  • 2+ years of medical necessity review experience
  • 1+ year of InterQual and/or Milliman Care Guidelines (MCG) experience
  • Strong knowledge of medical records, terminology, and disease processes
  • Excellent clinical assessment and critical thinking skills
  • Strong written and verbal communication skills
  • Ability to navigate multiple systems efficiently
  • Strong organizational skills and flexibility
Preferred Qualifications
  • 3+ years of clinical experience (acute care, behavioral health, and/or med-surgical)
  • Knowledge of NCQA and URAC standards
  • Experience working in a team-based environment
  • Proficiency in Microsoft Office
  • Strong time management and prioritization skills
  • Demonstrated ability to maintain confidentiality and ensure HIPAA compliance
Weekend and holiday flexibility is required
Proper email communication will only be done to and from @astyra.com email addresses. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. Please ensure you are communicating within these guidelines and proper channels for the quickest possible interview consideration!
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