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Remote Preservice Review Nurse Jobs (NOW HIRING)

VIVA

HEDIS Review Nurse

$31 - $41/hr

Remote Review Nurse SUMMARY DESCRIPTION: The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS ...

New

VIVA USA INC

HEDIS Review Nurse

Chicago, IL · On-site +1

$31.25 - $41.25/hr

Remote Review Nurse SUMMARY DESCRIPTION: The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS ...

Actalent

Clinical Review Clinician - Appeals

$30 - $40/hr

RN Clinical Review Nurse (Utilization Review Nurse) The Clinical Review Clinician for Appeals is ... You will complete clinical reviews for preservice authorization denials and retrospective claim ...

New

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

The Utilization Review Nurse is responsible for utilization management services within the scope of ... For positions that are available as remote work, Sentara Health employs associates in the following ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... This position is responsible for performing initial, concurrent review activities; discharge care ...

Actalent

Clinical Review Nurse - Remote

$34 - $40/hr

Clinical Review Nurse (Remote) Make a meaningful impact on patient care from the comfort of your home. We are seeking an experienced Clinical Review Nurse (RN) to join our growing healthcare team. In ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site +1

$34.73 - $45.15/hr

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

Actalent

Clinical Review Clinician - Appeals

$30 - $40/hr

RN Clinical Review Nurse (Utilization Review Nurse) The Clinical Review Clinician for Appeals is ... You will complete clinical reviews for preservice authorization denials and retrospective claim ...

New

Actalent

Clinical Review Clinician - Appeals

$30 - $40/hr

RN Clinical Review Nurse (Utilization Review Nurse) The Clinical Review Clinician for Appeals is ... You will complete clinical reviews for preservice authorization denials and retrospective claim ...

New

ePATHUSA Inc

Medical Review Nurse

VA · Remote

$76K - $97K/yr

This is a remote position. Seeking Registered Nurse for fully remote role to perform complex medical record and claim reviews (Standard or Program Integrity) to make coverage determinations based on ...

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Remote Preservice Review Nurse information

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How much do remote preservice review nurse jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for remote preservice review nurse in the United States is $38.62, according to ZipRecruiter salary data. Most workers in this role earn between $29.57 and $43.27 per hour, depending on experience, location, and employer.

What is the difference between Remote Preservice Review Nurse vs Remote Prior Authorization Nurse?

AspectRemote Preservice Review NurseRemote Prior Authorization Nurse
CertificationsRN license, possibly case-specific certificationsRN license, often with additional authorization or insurance certifications
Work EnvironmentHome-based, healthcare insurance review settingsHome-based, insurance and healthcare provider settings
Job FocusReviewing medical necessity for services before approvalAssessing and authorizing insurance claims for services
Industry UsageHealthcare insurance companies, third-party administratorsInsurance companies, healthcare providers

The Remote Preservice Review Nurse primarily evaluates medical necessity for services before approval, focusing on pre-authorization. In contrast, the Remote Prior Authorization Nurse handles the review and approval of insurance claims after services are provided. Both roles require nursing licensure and involve remote work within the healthcare insurance industry, but their focus points differ in the patient care and claims process.

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Remote Preservice Review Nurse jobs near you
Infographic showing various Remote Preservice Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

HEDIS Review Nurse

VIVA

Remote

$31 - $41/hr

Other

Posted 3 days ago

New

Job description

Remote
Review Nurse
SUMMARY DESCRIPTION:
The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS) survey. The review nurse is responsible for reviewing and accurately performing comprehensive review of medical records to abstract relevant clinical data during HEDIS. HEDIS abstractions are completed in accordance with NCQA guidelines and technical specifications. Additional responsibilities include but not limited to folder and file management, annotating medical records and saving completed documents with correct naming conventions on a shared drive as well as data entry into QSHR.
ESSENTIAL FUNCTIONS:
Abstract medical records
Apply product/plan specific abstraction criteria/requirements during medical record review process
Maintain defined productivity volumes
Sustain accuracy rate of 95% during abstraction and data entry throughout the HEDIS survey
Perform quality reviews of abstracted medical records as assigned
Ensure open and honest communication with management/designee regarding development or assistance needed throughout project
Escalate work related challenges/issues to Senior Director or designee
Attend scheduled daily and ad-hoc meetings with HEDIS Project Manager, and /or Quality Management Specialist/ designee to discuss project status, open issues and productivity
Comply with HIPAA, PHI, patient confidentiality, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies
Other duties as assigned
JOB REQUIREMENTS:
Registered Nurse (RN)/ Licensed Practical Nurse (LPN) with unrestricted license
2 years' HEDIS abstraction/over-reading experience
Data entry proficiency
Working knowledge PDF, Word and Excel
Excellent written and communication skills
Database management
Preferred Skills:
Experience in Pediatrics, Cardiology, Endocrinology and/or Obstetrics
QSHR proficiency
VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status

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