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Remote Rn Case Review Jobs in Lexington, SC (NOW HIRING)

Amerihealth Caritas

Care Manager II

Columbia, SC · Remote

Care Manager II (Field-Based, Remote) Responsible for managing and coordinating care, services, and ... Must hold a current and unrestricted Registered Nurse (RN) license in good standing in South ...

Amerihealth Caritas

Care Manager II

Columbia, SC · Remote

Care Manager II (Field-Based, Remote) Responsible for managing and coordinating care, services, and ... Must hold a current and unrestricted Registered Nurse (RN) license in good standing in South ...

VIVA USA INC

Clinical Analyst & Coding Specialist

SC · On-site +1

$68.87 - $73.87/hr

... a Registered Nurse. Currently credentialed as CPC (Certified Professional Coder) or as CCS ... Fully Remote VIVA is an equal opportunity employer. All qualified applicants have an equal ...

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$68

How much do remote rn case review jobs pay per hour?

As of May 30, 2026, the average hourly pay for remote rn case review in Lexington, SC is $40.69, according to ZipRecruiter salary data. Most workers in this role earn between $30.24 and $49.18 per hour, depending on experience, location, and employer.

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.

What are the most commonly searched types of Rn Case Review jobs in Lexington, SC? The most popular types of Rn Case Review jobs in Lexington, SC are:
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Remote Rn Case Review jobs near you
Clinical Analyst & Coding Specialist (Remote)

Clinical Analyst & Coding Specialist (Remote)

Serigor, Inc.

Columbia, SC • On-site, Remote

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

Job Title: Clinical Analyst & Coding Specialist (Remote)
Location: Columbia, SC
Duration: 12+ Months
Job Description:
The IT Healthcare Consultant - Business Analyst Advanced will support the medical code change requests by researching and making recommendations to policy and process owners and stakeholders for review and approval.
This position requires an individual with strong analytical skills and experience in:
  • Managing multiple work efforts simultaneously
  • Medical Coding
  • Nursing
  • Time management skills
  • CPT/HCPCS and ICD-10 translation
  • Ability to write and understand business and functional requirements.

The principal duties of this position are to assist with the CPT/HCPCS and ICD-10 code maintenance. As the IT Healthcare Consultant - Business Analyst - Advanced (Clinical Analyst and Coding Specialist):
Specific duties include, but are not limited to:
  • Initiates annual (and quarterly) updates from CMS of all ICD-10, CPT/HCPCS coding changes.
  • Performs initial review of codes to determine scope of changes.
  • Prepares listings of codes changes to Reference Administration staff and Medicaid Program staff for review and analysis.
  • Conducts meetings with Agency personnel, stakeholders, and process owners. (Future) Participates in DASH (Replacement MMIS) project meetings, as needed, where reference administration expertise is required.
  • Serves as an agency subject matter expert (SME) for medical coding methodologies, Medicaid policy, and related topics.
  • Research business rules, requirements, and models to complete initial analysis and recommendations.
  • Maintains business rules, requirements, and models in a repository.
  • Collaborates with team to ensure process documentation is complete, owner and stakeholder, as needed, training content is complete and routinely updated.
  • May serve as a back-up to review patient records against established criteria to determine medical necessity.
  • Other project-related duties.
  • 5+ years written and oral communications skills, strong proficiency in English.
  • Knowledge of Microsoft Office Suite.

Required Education:
  • Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)

Required Certifications:
  • Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.
  • Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment.

Required Skills (rank in order of importance):
  • 5+ years in healthcare insurance; medical review, program integrity, or appeals.
  • 5+ years working with IT developers/programmers in a payor environment.
  • 5+ years Medical Coding in payer environment.
  • 3+ years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
  • 5+ years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
  • 5+ years knowledge of anatomy, physiology, pharmacology, and medical terminology.

Preferred Skills (rank in order of Importance):
  • 5+ years' experience in policy remediation.
  • 5+ years claims processing systems experience.
  • 5+ years Optum Encoder and/or other medical coding software programs.

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