CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses ... These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to ...
Quick apply
CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses ... These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to ...
Remote Sales Specialist
Gainesville, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Gainesville, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
North Port, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
North Port, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Jacksonville, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Jacksonville, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Jupiter, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Jupiter, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Miami, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Miami, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Zephyrhills, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Zephyrhills, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Boynton Beach, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Boynton Beach, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Deltona, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Deltona, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Altamonte Springs, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Altamonte Springs, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Lake Worth, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Lake Worth, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
West Palm Beach, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
West Palm Beach, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Hollywood, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Hollywood, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Port Saint Lucie, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Port Saint Lucie, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Palm Harbor, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Palm Harbor, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Orlando, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Orlando, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Fort Walton Beach, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Fort Walton Beach, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Delray Beach, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Delray Beach, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Sarasota, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Sarasota, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Sales Specialist
Fort Myers Beach, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
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Remote Sales Specialist
Fort Myers Beach, FL · Remote
$69K/yr
... paths for advancement into leadership and management. You will work remotely, serving clients by ... We do not hire candidates residing outside North America Responsibilities * Contact provided leads ...
Remote Path Hire Reviews Complaints information
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Job description
CLINICAL REVIEW NURSE - REMOTE
ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to join a dynamic and well-respected organization offering tremendous career growth potential.
At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply.
100% REMOTE!
Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering).
SUMMARY STATEMENT
The Clinical Review Nurse is responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prior authorization, complex pre-payment medical review or post-payment medical review.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
90% of time will be spent on one or more of the following activities depending on assignments:
Review and analyze pre and post pay complex health care claims from a medical perspective, inclusive of prior authorization:
The remaining 10% of time will be spent on the following activities depending on assignments:
Identify providers needing education and individually educate providers who are subject to medical
review processes:
REQUIRED QUALIFICATIONS
* Valid nursing degree
* 2 years' clinical experience
* Excellent written and oral communication skills
* Demonstrated experience with evaluating medical and health care delivery issues (e.g., Inpatient Rehab Facility)
* Strong computer skills to include Microsoft Office proficiency
* Valid unrestricted Registered Nurse (RN) license
PREFERRED QUALIFICATIONS
* Inpatient Rehabilitation Facility Experience
* Bachelor of Science in Nursing (BSN)
* Insurance industry experience
* Certified Coder
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position is offered with no fee to candidate.
ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to join a dynamic and well-respected organization offering tremendous career growth potential.
At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply.
100% REMOTE!
Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering).
SUMMARY STATEMENT
The Clinical Review Nurse is responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prior authorization, complex pre-payment medical review or post-payment medical review.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
90% of time will be spent on one or more of the following activities depending on assignments:
Review and analyze pre and post pay complex health care claims from a medical perspective, inclusive of prior authorization:
- Perform clinical review work as assigned; may provide guidance to other team members and accurately interpret and apply broad CMS guidelines to specific and highly variable situations.
- Conduct review of claim data and medical records to make clinical decisions on the coverage, medical necessity, utilization and appropriateness of care per national and local policies, as well as accepted medical standards of care.
- Review provider practices and identify issues of concern, overpayment and need for corrective action as necessary; includes surfacing potential fraud and abuse or practice concerns.
- May develop recommendations for further corrective action based on medical review findings.
- May refer for review, or implement, corrective action related to medical review activities.
- May process claims and complete project work in the appropriate computer system(s).
The remaining 10% of time will be spent on the following activities depending on assignments:
Identify providers needing education and individually educate providers who are subject to medical
review processes:
- Initiate or participate in provider teaching activities, creating written teaching material, providing one on one education or education to a group as a result of a medical review (e.g., probe, progressive corrective action, consent, etc.) or appeal.
- This may involve discussion with CMS leaders and leaders in the provider community.
- Participate in special projects as assigned.
REQUIRED QUALIFICATIONS
* Valid nursing degree
* 2 years' clinical experience
* Excellent written and oral communication skills
* Demonstrated experience with evaluating medical and health care delivery issues (e.g., Inpatient Rehab Facility)
* Strong computer skills to include Microsoft Office proficiency
* Valid unrestricted Registered Nurse (RN) license
PREFERRED QUALIFICATIONS
* Inpatient Rehabilitation Facility Experience
* Bachelor of Science in Nursing (BSN)
* Insurance industry experience
* Certified Coder
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position is offered with no fee to candidate.
About ARC Group
Sourced by ZipRecruiter
Company size
11 - 50 Employees
Headquarters location
Orange Park, FL, US
Year founded
2000