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Remote Phone Rn Jobs in Pennsylvania (NOW HIRING)

Merakey

LumiLink RN

Lafayette Hill, PA · Remote

The Remote LumiLink Registered Nurse is responsible for professionally answering LumiLink calls for health-related concerns for all contracted providers. This position is responsible for the ...

MVP Recovery

PRN Remote CRNP

Chester, PA · On-site +1

$90K - $121K/yr

Flexible | PRN Position Overview MVP Recovery is seeking a Certified Registered Nurse Practitioner (CRNP) to provide follow-up medication management appointments in a PRN, primarily remote capacity.

Corry Manor

RNAC (PT) | Local Remote

Corry, PA · Remote

$29.75 - $38/hr

Overview20 hours Remote -- must reside local to Erie/Crawford County PA A RNAC coordinates the MDS ... Benefits for a MDS RN: * Promotion opportunities * Flexibility * Education/Learning * Competitive ...

Harris

$10/hr

Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no ... Applies exemplary phone etiquette to every call. * Committed to excellence in patient care and ...

HCF of Corry Inc

RNAC (PT) | Local Remote

Corry, PA · Remote

$29.75 - $38/hr

Position Summary: 20 hours Remote -- must reside local to Erie/Crawford County PA A RNAC ... Current license as a Registered Nurse with the State Board of Nursing. CPR certification ...

Harris

$10/hr

Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no ... Applies exemplary phone etiquette to every call. * Committed to excellence in patient care and ...

Harris

$10/hr

Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no ... Applies exemplary phone etiquette to every call. * Committed to excellence in patient care and ...

NOMAD

Travel Nurse - Telemetry $2,016/wk

Scranton, PA · Remote

$2K/wk

Nomad offers Registered Nurses a hassle-free experience, industry-leading pay rates, full benefits ... Additional Confirmations Ability to float to Med Surg and remote Tele is required. * Travel ...

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All JobsPhone Rn JobsRemote Phone Rn JobsRemote Phone Rn Jobs in Pennsylvania

Remote Phone Rn information

What is the difference between Remote Phone Rn vs Remote Medical Assistant?

AspectRemote Phone RnRemote Medical Assistant
CredentialsRegistered Nurse (RN) licenseCertified Medical Assistant (CMA) or similar certification
Work EnvironmentRemote, telehealth settingsRemote or clinical, administrative support
Industry UsageHealthcare, telehealth servicesHealthcare, clinics, administrative roles
Common Search/ComparisonYesYes

The Remote Phone Rn primarily provides nursing advice and patient support via phone in telehealth settings, requiring an RN license. In contrast, Remote Medical Assistants handle administrative tasks and basic patient support, often with CMA certification. Both roles are remote and serve the healthcare industry, but the RN role involves clinical decision-making, while the Medical Assistant focuses on administrative and support functions.

What are the most commonly searched types of Phone Rn jobs in Pennsylvania? The most popular types of Phone Rn jobs in Pennsylvania are:
What cities in Pennsylvania are hiring for Remote Phone Rn jobs? Cities in Pennsylvania with the most Remote Phone Rn job openings:
Remote Phone Rn jobs near you

Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Medical Assistance Expert)

The CKHobbie Group

Harrisburg, PA • On-site, Remote

$40 - $42/hr

Full-time

PTO

Posted 8 days ago

Job description

Job Description
Are you a registered nurse ready to take your career in an exciting new direction-one where your expertise truly makes a difference? Join Pennsylvania's premier Quality Improvement Organization and step into a dynamic role focused on advocacy and program integrity through compliance management. Here, you'll champion the needs of vulnerable populations, safeguard the quality of care, and influence healthcare outcomes on a meaningful scale. Enjoy the freedom of working from home, the flexibility and autonomy to manage your workday, and the opportunity for continuous professional growth-all while being part of a passionate, mission-driven team dedicated to improving healthcare across the Commonwealth.
In this rewarding role, you'll use your clinical knowledge outside of the traditional bedside setting to review and audit claims, support program integrity initiatives, and advocate for beneficiaries across the Commonwealth. You'll enjoy the flexibility of working from home, the autonomy to manage your work, and meaningful opportunities for professional growth-all while contributing to a mission that truly matters.
What You'll Do
  • Conduct clinical reviews and ensure quality, appropriateness, and compliance with healthcare standards
  • Support program integrity efforts by identifying trends, risks, and opportunities for improvement
  • Advocate for beneficiaries, with a strong focus on protecting and improving care for vulnerable populations
  • Apply nursing judgment to analyze medical records, documentation, and billing data
  • Collaborate with interdisciplinary teams, providers, and stakeholders to promote best practices
  • Contribute to quality improvement initiatives that strengthen healthcare delivery across Pennsylvania

What We're Looking For
  • Active, unrestricted Registered Nurse (RN) license
  • Strong clinical background with the ability to apply nursing judgment analytically
  • Interest in advocacy, quality improvement, and healthcare program integrity
  • Excellent written and verbal communication skills
  • Ability to work independently while managing multiple priorities
  • Comfort with technology and electronic medical records

Experience in utilization review, case management, quality improvement, compliance, or claims review is a plus-but not required.
Why Join Us
  • Mission-driven work with Pennsylvania's leading Quality Improvement Organization
  • Make a real impact on healthcare quality and outcomes for vulnerable populations
  • Remote work - enjoy the convenience and balance of working from home
  • Autonomy and flexibility in how you manage your workday
  • Advocacy-focused role that values your nursing voice and expertise
  • Career development opportunities to grow beyond traditional nursing roles
  • Supportive, collaborative team culture committed to excellence and integrity

If you're a registered nurse seeking purpose-driven work, professional growth, and the flexibility to balance your life and career-this is your opportunity. Apply today and help shape the future of healthcare quality in Pennsylvania.
Requirements
Be available as a full-time consultant, approximately 37.5 hours per week;
• Possess a current license to practice as a Registered Nurse issued by the Pennsylvania
State Board of Nursing; or possess a non-renewable temporary practice permit issued
by the Pennsylvania State Board of Nursing. Resources possessing non-renewable
temporary practice permits must obtain licensing as a Registered Nurse within the
one-year period as defined by the Pennsylvania State Board of Nursing;
• Possess a documented work history of three (3) or more years of professional
experience with medical assistance, health care services or human services or any
equivalent combination of experience and training;
• Possess basic computer skills, including familiarity with Microsoft Office programs.
Principal Duties and Responsibilities (RN - Utilization Review / Program Integrity)
  • Conduct clinical utilization reviews by evaluating medical records, treatment plans, and supporting documentation to determine medical necessity, appropriateness, quality, and level of care in accordance with Medical Assistance (MA) program requirements.
  • Apply nursing judgment and evidence-based clinical standards to ensure MA recipients receive safe, appropriate, and high-quality care while supporting program integrity and regulatory compliance.
  • Assess provider billing and documentation to verify compliance with MA policies and identify potential fraud, waste, or abuse.
  • Review clinical documentation submitted through electronic provider portals, telephone communications, fax, and U.S. mail, ensuring completeness and accuracy for utilization determinations.
  • Make authorization determinations by approving, modifying, or denying service requests within RN scope of practice, or refer cases to physician advisors for secondary medical review when medical necessity or level of care is unclear.
  • Collaborate with physician/medical consultants to support peer-to-peer reviews and facilitate discussions with ordering providers regarding clinical justification, appropriate care settings, and service coverage.
  • Accurately document utilization review decisions and clinical rationale in electronic systems, generating authorization notices, denial letters, reason codes, and appeal rights in compliance with regulatory standards.
  • Participate in retrospective, concurrent, and prospective utilization reviews, including re-evaluations of previously denied services upon request by providers or facilities.
  • Review and prepare appeal cases by analyzing medical records, developing exhibits and correspondence, and providing testimony at administrative hearings using knowledge of MA regulations, utilization management principles, and appeal processes.
  • Interpret MA policies, regulations, and utilization management guidelines for internal staff, providers, and stakeholders through consultation, meetings, and educational sessions.
  • Engage in interdisciplinary collaboration with internal departments, medical consultants, legal staff, and external stakeholders to support consistent and defensible utilization determinations.
  • Maintain ongoing professional development through continuing education, conferences, and review of current medical literature to remain current with standards of care, clinical guidelines, and utilization review best practices.
  • Provide cross-coverage in other program areas as needed, maintaining competency through training and updates to ensure continuity of program operations.
  • Respond to inquiries from recipients, providers, legislators, legal offices, and external agencies to explain utilization decisions, coverage policies, and administrative processes.
  • Maintain accurate case records and documentation in accordance with MA regulations, accreditation standards, and organizational policies.
  • Perform related duties and special projects as assigned, with expectations and performance standards communicated for each assignment.
  • When required, work at Department-designated locations. The primary duty location is Harrisburg, PA, where appropriate workspace, technology, and resources will be provided to support assigned responsibilities.

Benefits
Attractive Compensation plan.Holiday and Vacation program.

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