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Remote Rn Case Review Jobs in Reading, PA (NOW HIRING)

Varsity Tutors

NCLEX-RN Tutor

Reading, PA · Remote

$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 ...

ConcertoCare

Field Nurse (LPN)

Reading, PA · Remote

$28 - $32/hr

Works with providers, market RNs, nurse case managers, social workers, pharmacists, community ... Skilled in online patient portals for reviewing patient care information. E. Personal Traits ...

ATULO HEALTH INC

PRN Home Infusion RN

Reading, PA · Remote

Home Infusion RN Per Diem Company: Atulo Health About Atulo Health: Atulo Health is a multi-state provider of home infusion services. We deliver high-quality, patient-centered care using smart ...

ZOLL Medical

Patient Service Representative

Pottstown, PA · Remote

$17 - $21.75/hr

Preferred Candidates include (not limited to): RN, EMT, Paramedic, EMS, Firefighter, PA, LPN, MA ... All candidates reviewed on an individual basis. Summary Description: The Cardiac Management ...

ZOLL Medical

Patient Service Representative

Reading, PA · Remote

$16.75 - $21.25/hr

Preferred Candidates include (not limited to): RN, EMT, Paramedic, EMS, Firefighter, PA, LPN, MA ... All candidates reviewed on an individual basis. Summary Description: The Cardiac Management ...

Varsity Tutors

NCLEX Tutor

Reading, PA · Remote

$40/hr

Adapts instruction using NCLEX review resources, practice question banks, and clinical scenario ... as registered nurses or licensed practical nurses. * Effective Teaching Methods: Ability to ...

Varsity Tutors

NCLEX-PN Tutor

Reading, PA · Remote

$40/hr

... RN scope questions, pharmacology calculations, and managing anxiety with the adaptive testing format. Adapts instruction using NCLEX-PN specific practice question banks, content review focused on ...

Maximus

Assoc SW Engineer - Java, Spring Boot, AWS

Reading, PA · Remote

$49.75 - $68.25/hr

This is a remote position. Essential Duties and Responsibilities: - Design systems and programs to ... reviews. - Understand business processes and develop test scenario in accordance with system ...

New

Fulton Bank

Fraud Prevention and Detection Manager

PA · On-site +1

$81/hr

Overview This is a full-time career opportunity that can be remote. As a trusted subject matter ... Monitor case metrics on a regular basis. Review Analyst Team SARs for adherence to FinCEN ...

Fulton Bank

Fraud Prevention and Detection Manager

PA · Remote

$81.20K - $135.30K/yr

This is a full-time career opportunity that can be remote. As a trusted subject matter expert ... Monitor case metrics on a regular basis. Review Analyst Team SARs for adherence to FinCEN ...

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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 Reading, PA is $45.65, according to ZipRecruiter salary data. Most workers in this role earn between $33.94 and $55.19 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 Reading, PA? The most popular types of Rn Case Review jobs in Reading, PA are:
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Remote Rn Case Review jobs near you

Nurse Reviewer - Reading, PA

Healthcare Quality Strategies, Inc.

Reading, PA • Remote

$40/hr

Part-time

Medical, Dental, Vision, Life, Retirement

Posted 17 days ago

Job description

Nurse Reviewer
PT (20-30 hours week) – Remote Work Environment
Non-Exempt: $40.00 hour
Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely.
Essential Duties and Responsibilities:
  • Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies
  • Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines
  • Document evidence-based criteria applicable to specific contract requirements
  • Record and report screening results, including relevant referral questions, into a centralized database
  • Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity
  • Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations
  • Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards
Knowledge, Experience, Skills and Education:
  • Medical terminology, ICD-10, CPT and HCPCS
  • Clinical criteria (InterQual and MCG)
  • Utilization/Medical record review and chart abstraction
  • Current standards of medical practice
  • Comply with HIPAA/HITECH laws and regulations
Experience in:
  • At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred)
  • Experience performing medical record review, audit for federal or state contracts
  • Knowledge and experience of Medicare and Medicaid policy
  • Proficiency with Microsoft Office (Word, Excel, and Outlook)
  • Proficiency with Adobe PDF files and features
  • Generating accurate, timely, and understandable correspondence
  • Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG)
Skills Requirements include:
  • Professional interpersonal skills; ability to interact with providers, physicians and peers
  • Solid analytical, assessment and documentation skills
  • Effective written and verbal communication, both internally and externally
  • Strong attention to detail
  • Strong attention to deadlines
  • Organizational skills including effective time management, priority setting and process improvement
  • Ability to work independently and as a member of a team
  • Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations
Educational Background:
  • BSN with active RN licensure in good standing
Physical Demands:
Remote Work, Prolonged Sitting, Screen Exposure
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
Healthcare Quality Strategies, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD amp;D, voluntary life/AD amp;D, 401k
For immediate consideration, please apply via the HQSI Careers Page at: www.hqsi.org gt; Careers gt; Current Employment Opportunities
EOE: Minorities/Females/Disabled/Veterans
Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace
Healthcare Quality Strategies, Inc. is an E-Verify Employer

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