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Remote Rn Case Review Jobs in Maryland (NOW HIRING)

Corvel

Telephonic Case Manager I

Nottingham, MD · Remote

$63K - $95K/yr

This is a remote role. This position requires a California RN Nursing License. ESSENTIAL FUNCTIONS ... Strong cost containment background, such as utilization review or managed care helpful

Varsity Tutors

NCLEX-RN Tutor

Bowie, MD · Remote

$18 - $40/hr

... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...

Varsity Tutors

NCLEX-RN Tutor

Rockville, MD · Remote

$18 - $40/hr

... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...

Varsity Tutors

NCLEX-RN Tutor

Baltimore, MD · Remote

$18 - $40/hr

... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...

Varsity Tutors

NCLEX-RN Tutor

College Park, MD · Remote

$18 - $40/hr

... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...

Varsity Tutors

NCLEX-RN Tutor

Laurel, MD · Remote

$18 - $40/hr

... NCLEX case study formats. Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates ...

CareFirst

Clinical Appeals Nurse (Remote)

Baltimore, MD · Remote

Organizes the appeal case for physician review by compiling clinical, contractual, medical policy ... Licenses/Certifications: * RN - Registered Nurse - State Licensure And/or Compact State Licensure ...

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

Registered Nurse, with a current unobstructed license to practice nursing in the United States ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...

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Remote Rn Case Review information

What is the difference between Remote Rn Case Review vs Remote Rn Utilization Review?

AspectRemote Rn Case ReviewRemote Rn Utilization Review
CredentialsRegistered Nurse (RN), licensure, case review certificationsRegistered Nurse (RN), licensure, utilization review certifications
Work EnvironmentRemote, healthcare settings, insurance companiesRemote, healthcare settings, insurance companies
Employer & IndustryHospitals, insurance firms, healthcare providersInsurance companies, healthcare management organizations

Remote Rn Case Review and Remote Rn Utilization Review roles both involve remote nursing work within the healthcare and insurance industries. While they share similar credentials and work environments, case review focuses on evaluating individual patient cases, whereas utilization review assesses the necessity and appropriateness of healthcare services. Understanding these distinctions helps job seekers identify the right role based on their skills and career goals.

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Remote Rn Case Review jobs near you

Medical Reviewer, Registered Nurse

Millersville, MD • On-site, Remote

J29 Inc.
Business Management Consulting • 1 - 10 employees
Learn more about J29 Inc.external

$40 - $55/hr

Temporary

Posted 19 days ago

Job description

Medical Reviewer, RN - Temporary Position
Location: Remote
*This role is a temporary position and that employment is expected to be for a limited duration.
About J29
J29, Inc. (J29) has been supporting commercial, State, and Federal health and human service programs since company inception in 2017 as an employee-centered healthcare management consulting company. Our team of 260 employees focuses on providing processing, review, and analysis of medical claims, records, data, and audits between areas of compliance, policy, and clinical expertise. Our team is experienced in program, payment, provider, and patient integrity as we continue to support advanced programs of policy, clinical requirements, and compliance measures at the commercial, State, and Federal levels.
J29 was founded to be an employee-centric company that prioritizes the well-being and value of its employees. Our mission is to empower our employees to do great things for the benefit of those that need it most. The J29 mission supports not only our health and human service programs, but also the philanthropy efforts of our team. We are proud to continue our support to non-profit groups with critical missions as J29 continues to grow.
Key Responsibilities
RVC Reviewers perform both automated and complex reviews of Medicare Fee-for-Service (FFS) claims-including Part A/B, DMEPOS, and Home Health/Hospice-to assess overpayments, underpayments, and proper payments as determined by Recovery Audit Contractors (RACs). They apply Medicare policies and guidelines, ensuring claims are evaluated according to National and Local Coverage Determinations and CMS rules, and document clear, accurate findings for each claim.
Reviewers participate in dispute resolution by re-examining claims and providing supporting documentation, support quality assurance through audits and ongoing training, and maintain compliance with CMS security and privacy standards. They also collaborate closely with key personnel to ensure consistency, accuracy, and continuous process improvement in all review activities.
Qualifications
  • 5+ years of direct medical coding or medical billing experience, specifically in a healthcare environment.
  • 3+ years working in a productivity-based claims or case working environment, out of a queued case management system.
  • 3+ years working remotely with various technology systems. Ideally, candidate will have 3+ years of Medicare Fee For Service (FFS) experience in a medical coding role or program.
  • Active Medical Coding Certification (CPC, CCS or equivalent) required
  • Experience with low-code, no-code case management systems as an end-user is preferred but not required.

Education/Certification
  • Active license as a Registered Nurse, in good standing, in the United States (as verified by Nurses). Verified regularly.

Hourly Rate: $40-55 hourly depending on years of experience
J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.
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About J29

Sourced by ZipRecruiter

Industry

Business management consulting

Company size

1 - 10 Employees

Headquarters location

Millersville, MD, US

Year founded

2017

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