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Remote Rn Auditor Jobs in San Jose, CA (NOW HIRING)

Vynca

Manager, Case Management (RN)

San Mateo, CA · Remote

$90K - $125K/yr

Remote with up to 25% travel - must be based in one of the following states: Arizona, California ... Active, unrestricted RN license with the ability to obtain California licensure within 6 months of ...

SimX, Inc

Territory Manager (Remote)

San Francisco, CA · Remote

$70K - $90K/yr

... industry (RN, EMT, Paramedic, PA, MD, DO, etc). Degree in marketing, communications, business ... Remote work environment SimX covers 99% of employee premiums and 50% of dependent premiums for ...

Ross Stores, Inc

Lease Auditor

Dublin, CA · On-site +1

$62K - $101K/yr

This position may be performed remotely anywhere within the United States. #LI-Remote SUPERVISORY ... registered domestic partnership status, medical condition (including cancer or genetic ...

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Remote Rn Auditor information

See San Jose, CA salary details

$23

$38

$54

How much do remote rn auditor jobs pay per hour?

As of Sep 8, 2026, the average hourly pay for remote rn auditor in San Jose, CA is $38.66, according to ZipRecruiter salary data. Most workers in this role earn between $33.80 and $42.26 per hour, depending on experience, location, and employer.

What is a Remote RN Auditor?

A Remote RN Auditor is a registered nurse who reviews medical records, clinical documentation, and billing information to ensure compliance with healthcare regulations and standards—all while working remotely. Their primary focus is to verify accuracy in coding, billing, and adherence to clinical guidelines, often for insurance companies, hospitals, or healthcare organizations. They play a crucial role in identifying errors, preventing fraud, and improving the quality of patient care. This job typically requires an active RN license, strong attention to detail, and experience with healthcare compliance and auditing.

What does a Remote RN Auditor do?

As a remote RN auditor, your job is to review claims and audit financial statements to ensure validity and accuracy. In this role, you may examine documentation from the patient or clinic, evaluate the effectiveness of care, or ensure that claims comply with government regulations. RN auditors often provide advice for cutting costs and contact both healthcare providers and clients to negotiate specific claims or resolve billing issues. Remote RN auditors often work with daily or weekly batches of work as assigned, but in rare cases, you may be asked to prioritize auditing certain material when time is of the essence.

What are the key skills and qualifications needed to thrive as a Remote RN Auditor?

To thrive as a Remote RN Auditor, you need a strong background in nursing, clinical documentation, and auditing practices, typically with an active RN license and experience in medical record review. Familiarity with electronic health record (EHR) systems, coding standards (such as ICD-10 and CPT), and auditing software is essential. Attention to detail, strong analytical thinking, and effective written communication are standout soft skills in this role. These capabilities ensure accurate audits, regulatory compliance, and clear reporting in a remote healthcare environment.

What are some common challenges faced by Remote RN Auditors, and how can they be effectively managed?

Remote RN Auditors often encounter challenges such as navigating complex electronic health record systems, ensuring data accuracy while working independently, and staying updated on frequently changing compliance regulations. To manage these, successful auditors develop strong organizational skills, maintain regular communication with team members, and participate in ongoing training. Proactively seeking clarification on ambiguous cases and leveraging available resources from their organization can also help maintain high-quality audit outcomes and job satisfaction.

What is the difference between Remote Rn Auditor vs Remote Rn Reviewer?

AspectRemote Rn AuditorRemote Rn Reviewer
CertificationsRN license, auditing certifications (e.g., CHAP, RAC)RN license, clinical review certifications
Work EnvironmentHealthcare organizations, insurance companies, auditing firmsHealthcare providers, insurance companies, utilization review
Primary ResponsibilitiesAuditing medical records for compliance, coding accuracy, and billingReviewing medical records for appropriateness and medical necessity

Remote Rn Auditors focus on compliance and coding accuracy through audits, while Remote Rn Reviewers primarily assess medical necessity and appropriateness of care. Both roles require RN licensure and related certifications, often working within healthcare or insurance settings. The key difference lies in their core functions: auditing versus clinical review, though both contribute to quality and compliance in healthcare reimbursement.

How do I become a remote RN auditor?

To become a remote RN auditor, you typically need a valid registered nurse license, relevant experience in healthcare or medical record review, and knowledge of coding and compliance standards such as HIPAA. Many employers also prefer candidates with certifications like Certified Professional Medical Auditor (CPMA) or Certified Coding Specialist (CCS). Strong attention to detail and proficiency with electronic health record systems are essential for success in this role.
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Remote Rn Auditor jobs near you
Infographic showing various Remote Rn Auditor job openings in San Jose, CA as of June 2026, with employment types broken down into 1% Internship, 44% Full Time, 6% Part Time, 4% Temporary, 43% Contract, and 2% Nights. Highlights an 52% Physical, 3% Hybrid, and 45% Remote job distribution, with an average salary of $80,419 per year, or $38.7 per hour.

RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)

Molina Healthcare

San Francisco, CA • Remote

$30.37 - $59.21/hr

Full-time

Re-posted 4 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

172nd of 315 rated insurance

Job description

JOB DESCRIPTION Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. 
Essential Job Duties 
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. 
Analyzes clinical service requests from members or providers against evidence based clinical guidelines. 
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. 
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. 
Processes requests within required timelines. 
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. 
Requests additional information from members or providers as needed. 
Makes appropriate referrals to other clinical programs. 
Collaborates with multidisciplinary teams to promote the Molina care model. 
Adheres to utilization management (UM) policies and procedures. 
Required Qualifications 
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. 
Registered Nurse (RN). License must be active and unrestricted in state of practice. 
Ability to prioritize and manage multiple deadlines. 
Excellent organizational, problem-solving and critical-thinking skills. 
Strong written and verbal communication skills. 
Microsoft Office suite/applicable software program(s) proficiency. 
Preferred Qualifications 
Certified Professional in Healthcare Management (CPHM). 

Utilization review, prior authorization, inpatient review desirable. MCG experience, strongly preferred.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $30.37 - $59.21 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

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Benefits

Hours and flexibility

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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