Registered Nurse / RN - Utilization Management I The Registered Nurse - Utilization Management I is ... UM program functions include Benefit Management, Benefit Review, Appeals and Grievances and Health ...
Registered Nurse / RN - Utilization Management I The Registered Nurse - Utilization Management I is ... UM program functions include Benefit Management, Benefit Review, Appeals and Grievances and Health ...
Psychiatric Registered Nurse Part Time
Camas, WA · Remote
$43 - $54/hr
You will complete medication reviews, establish priorities of client care, and link clients to ... Flexible daytime/evening schedule with remote/community work * Productivity Incentives * New hire ...
Psychiatric Registered Nurse Part Time
Camas, WA · Remote
$43 - $54/hr
You will complete medication reviews, establish priorities of client care, and link clients to ... Flexible daytime/evening schedule with remote/community work * Productivity Incentives * New hire ...
You will complete medication reviews, establish priorities of client care, and link clients to ... Flexible daytime/evening schedule with remote/community work * Productivity Incentives * New hire ...
Quick apply
You will complete medication reviews, establish priorities of client care, and link clients to ... Flexible daytime/evening schedule with remote/community work * Productivity Incentives * New hire ...
Psychiatric Registered Nurse Part Time
Vancouver, WA · Remote
$43 - $54/hr
You will complete medication reviews, establish priorities of client care, and link clients to ... Flexible daytime/evening schedule with remote/community work * Productivity Incentives * New hire ...
Psychiatric Registered Nurse Part Time
Vancouver, WA · Remote
$43 - $54/hr
You will complete medication reviews, establish priorities of client care, and link clients to ... Flexible daytime/evening schedule with remote/community work * Productivity Incentives * New hire ...
Psychiatric Registered Nurse Part Time
Camas, WA · Remote
$43 - $54/hr
You will complete medication reviews, establish priorities of client care, and link clients to ... Flexible daytime/evening schedule with remote/community work * Productivity Incentives * New hire ...
Quick apply
Psychiatric Registered Nurse Part Time
Camas, WA · Remote
$43 - $54/hr
You will complete medication reviews, establish priorities of client care, and link clients to ... Flexible daytime/evening schedule with remote/community work * Productivity Incentives * New hire ...
Triage RN (Remote)
Portland, OR · On-site +1
The Triage RN is responsible for using discretion and independent judgment in coordinating the delivery of quality patient care. This position requires skill in planning and organizing care. This ...
Triage RN (Remote)
Portland, OR · On-site +1
The Triage RN is responsible for using discretion and independent judgment in coordinating the delivery of quality patient care. This position requires skill in planning and organizing care. This ...
Remote Care Management Nurse
Portland, OR · Remote
$34.20 - $55.70/hr
Are you a Registered Nurse looking to transition out of bedside care and into a role that still ... review * Active, unrestricted licensure or certification in a U.S. state or territory that allows ...
Remote Care Management Nurse
Portland, OR · Remote
$34.20 - $55.70/hr
Are you a Registered Nurse looking to transition out of bedside care and into a role that still ... review * Active, unrestricted licensure or certification in a U.S. state or territory that allows ...
NCLEX-RN Tutor
Portland, OR · Remote
$18 - $40/hr
Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...
NCLEX-RN Tutor
Portland, OR · Remote
$18 - $40/hr
Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...
Payment Integrity Nurse I
Vancouver, WA · Remote
$66K - $106K/yr
As a member of the Post Service Claim Review team, our Payment Integrity Nurse I conducts post ... Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or ...
Payment Integrity Nurse I
Vancouver, WA · Remote
$66K - $106K/yr
As a member of the Post Service Claim Review team, our Payment Integrity Nurse I conducts post ... Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or ...
Payment Integrity Nurse I
Beaverton, OR · Remote
$66K - $106K/yr
As a member of the Post Service Claim Review team, our Payment Integrity Nurse I conducts post ... Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or ...
Payment Integrity Nurse I
Beaverton, OR · Remote
$66K - $106K/yr
As a member of the Post Service Claim Review team, our Payment Integrity Nurse I conducts post ... Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or ...
Payment Integrity Nurse I
Portland, OR · Remote
$66K - $106K/yr
As a member of the Post Service Claim Review team, our Payment Integrity Nurse I conducts post ... Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or ...
Payment Integrity Nurse I
Portland, OR · Remote
$66K - $106K/yr
As a member of the Post Service Claim Review team, our Payment Integrity Nurse I conducts post ... Bachelor's degree (or higher) in a health or human services-related field (psychiatric RN or ...
Advice RN
Tualatin, OR · Remote
Implement and monitor quality assurance measures for advice services, conducting regular reviews of ... Registered Nurse (RN) license in Oregon. Basic Life Support (BLS) for Health Care Providers ...
New
Quick apply
Advice RN
Tualatin, OR · Remote
Implement and monitor quality assurance measures for advice services, conducting regular reviews of ... Registered Nurse (RN) license in Oregon. Basic Life Support (BLS) for Health Care Providers ...
New
Clinical Manager (RN), Home Health, Full Time
Portland, OR · On-site +1
$103K - $155K/yr
Registered Nurse (RN) or Physical Therapist (PT) licensure in the state of practice: Required ... Conducts daily rounds on nursing units to review home care discharge plan needs and complete ...
Clinical Manager (RN), Home Health, Full Time
Portland, OR · On-site +1
$103K - $155K/yr
Registered Nurse (RN) or Physical Therapist (PT) licensure in the state of practice: Required ... Conducts daily rounds on nursing units to review home care discharge plan needs and complete ...
Case Manager, RN (Portland, OR / Hybrid / Per Diem)
Portland, OR · On-site +1
$45 - $50/hr
Reviews the caregiver notes daily and appropriately addresses changes in the consumer's condition ... Valid and Active Registered Nursing License issued by the Oregon Board of Nursing * Ability to ...
Case Manager, RN (Portland, OR / Hybrid / Per Diem)
Portland, OR · On-site +1
$45 - $50/hr
Reviews the caregiver notes daily and appropriately addresses changes in the consumer's condition ... Valid and Active Registered Nursing License issued by the Oregon Board of Nursing * Ability to ...
Review of workflow to implement delegated activities * Pre-delegation audit of sample files ... A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work.
Quick apply
Review of workflow to implement delegated activities * Pre-delegation audit of sample files ... A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work.
RN Delegation & Quality Coordinator
Portland, OR · Remote
$71K - $89K/yr
Review of workflow to implement delegated activities * Pre-delegation audit of sample files ... A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work.
RN Delegation & Quality Coordinator
Portland, OR · Remote
$71K - $89K/yr
Review of workflow to implement delegated activities * Pre-delegation audit of sample files ... A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work.
Ability to conduct coding reviews and quality performance measures; prepare chart review reports ... Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT ...
Ability to conduct coding reviews and quality performance measures; prepare chart review reports ... Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT ...
Ability to conduct coding reviews and quality performance measures; prepare chart review reports ... Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT ...
Ability to conduct coding reviews and quality performance measures; prepare chart review reports ... Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT ...
Medical Coder - Hematology/Oncology Clinic
Portland, OR · On-site +1
$20 - $26.50/hr
... Remote * Review documentation ofprofessional services in EPIC, obtain copies of chart notes ... Registered Health InformationAdministrator (RHIA), Registered Health Information Technician (RHIT ...
Medical Coder - Hematology/Oncology Clinic
Portland, OR · On-site +1
$20 - $26.50/hr
... Remote * Review documentation ofprofessional services in EPIC, obtain copies of chart notes ... Registered Health InformationAdministrator (RHIA), Registered Health Information Technician (RHIT ...
Nurse (Case Manager)
Vancouver, WA · On-site +1
$96K - $161K/yr
Summary The Community Care Nurse Case Manager Registered Nurse (RN) is responsible for executing a ... Possesses intimate knowledge of the internal referral care process, clinical review criteria ...
Nurse (Case Manager)
Vancouver, WA · On-site +1
$96K - $161K/yr
Summary The Community Care Nurse Case Manager Registered Nurse (RN) is responsible for executing a ... Possesses intimate knowledge of the internal referral care process, clinical review criteria ...
Remote Rn Chart Review information
See Vancouver, WA salary details
$16.28 - $20.59
3% of jobs
$20.59 - $24.90
4% of jobs
$28.85 is the 25th percentile. Wages below this are outliers.
$24.90 - $29.21
19% of jobs
The median wage is $31.92 / hr.
$29.21 - $33.52
37% of jobs
$37.29 is the 75th percentile. Wages above this are outliers.
$33.52 - $37.83
13% of jobs
$37.83 - $42.14
9% of jobs
$42.14 - $46.45
4% of jobs
$46.45 - $50.76
3% of jobs
$50.76 - $55.07
3% of jobs
$55.07 - $59.38
1% of jobs
$59.38 - $63.69
3% of jobs
$16
$36
$63
How much do remote rn chart review jobs pay per hour?
What are the key skills and qualifications needed to thrive as a Remote RN Chart Review, and why are they important?
How Can I Get a Remote Job as a Chart Review RN?
The qualifications to get a remote job as a chart review nurse include a nursing degree, a nursing license, and experience using medical records and coding systems. You can start out on this career path by becoming a registered nurse (RN) or a practical nurse (LPN). This process involves earning an associate or bachelor’s degree in nursing and passing the NCLEX-RN licensing exam. It’s essential to have strong communication and analytical skills, attention to detail, and a reliable computer with internet access to work from home. Earning certification from the American Association of Medical Audit Specialists or the American Academy of Professional Coders is a plus.
What is a Remote RN Chart Review?
What is the difference between Remote Rn Chart Review vs Remote LPN Chart Review?
| Aspect | Remote Rn Chart Review | Remote LPN Chart Review |
|---|---|---|
| Credentials | Registered Nurse (RN) license | Licensed Practical Nurse (LPN) license |
| Work Environment | Healthcare facilities, insurance companies, telehealth | Similar settings, often with more limited scope |
| Job Responsibilities | Comprehensive chart review, complex case analysis | Basic chart review, documentation verification |
Remote Rn Chart Review and Remote LPN Chart Review both involve reviewing patient records remotely. However, RNs typically handle more complex cases requiring a broader scope of practice and higher credentials, while LPNs focus on more routine documentation tasks. Both roles are essential in healthcare documentation and insurance claims, but RNs generally have more advanced responsibilities and qualifications.
What are some common challenges faced by Remote RN Chart Review nurses, and how can they be overcome?

Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 9 days ago
CareOregon rating
8.3
Based on 9 frontline employees who took The Breakroom Quiz
125th of 300 rated insurance
Job description
The Registered Nurse - Utilization Management I is responsible for supporting specific utilization management (UM) program functions within the Clinical Operations department. UM program functions include Benefit Management, Benefit Review, Appeals and Grievances and Health Related Services (HRS). Together they support the healthcare needs of members, determine the best medically appropriate services, and apply clinical-based criteria for decision-making while managing medical expenses.
Estimated Hiring Range:
$102,330.00 - $125,070.00
Bonus Target:
Bonus - SIP Target, 5% Annual
Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
Essential Responsibilities
General Duties
- Communicate with members and/or providers in a professional manner and in accordance with State and Federal requirements as needed to complete requests.
- Maintain confidentiality of all discussions, records, and other data in connection with quality management activities according to professional standards.
- Refer members to care coordination per policies and procedures.
- Maintain accurate and complete documentation.
- Collaborate with Medical Directors to determine medical necessity and appropriateness of care for benefits requested and/or rendered.
- Work with clinical support staff to ensure service requests, authorizations and/or grievances are managed in accordance with state and federal guidelines.
- Identify and refer potential quality of care issues for peer review.
- Ensure that authorization decisions are based on organizational policy and state and federal coverage rules.
- Gather and submit documents for third party case review; this includes all documentation and follow-up activities.
- Issue denial notices based on established unit protocols and state and/or federal requirements.
- Assist with periodic audits, general quality management and improvement activities, and other regulatory activities as needed.
- Foster collaboration with teams across the Clinical Operations department to ensure work and goals are met.
- Meet or exceed department production, timelines, and quality standards established for level I.
- May participate in departmental workgroups or projects as assigned.
- Support testing for system updates and implementations as assigned.
- May help train new staff and teammates as assigned.
- Cross train in additional functional focus areas as assigned.
Duties Specific to Functional Focus Area
- Benefit Management
- Review provider pre-service requests and determine benefit coverage according to Medicare, Medicaid and/or organizational guidelines.
- Benefit Review
- Determine appropriate level of care and length of stay for inpatient members to include hospitals, skilled nursing facilities, long term acute care hospitals, inpatient rehabilitation hospitals, and respite care programs.
- Review inpatient admission for re-insurance clinical reporting.
- Appeals and Grievance
- Assemble evidence and build clinical cases for administrative hearings or Independent Review Entity (IRE) reviews.
- Function as a CareOregon representative in administrative hearings.
- Assist with the analysis and summary of data for written reports and public presentations as needed.
- Communicate with members, providers, health plan administrators to manage grievances and appeals and provide case status updates as needed.
- Investigate and use clinical judgement to identify quality of care or safety issues and present findings to an oversight committee.
- Health Related Services
- Review provider and member submitted HRSN and Flexible Services requests and determine benefit eligibility according to Medicaid and/or organizational guidelines.
Experience and/or Education
Required
- Current unrestricted Oregon RN license
- Minimum 2 years RN experience [OR 1 year RN experience AND 3 years' experience in healthcare setting role(s) such as billing, coding, medical assistant, etc.]
Preferred
- More than 1 year RN experience
- Healthcare utilization management experience in Prior Authorization UM
- Experience with Medicaid and/or Medicare utilization management
Knowledge, Skills and Abilities Required
Knowledge
- Knowledge of Medicaid health plan and Medicare benefits
- Knowledge of applicable DMAP rules and regulations
- Knowledge of ICD-10, CPT, and HCPCS codes
- Familiarity with the principles of utilization management
- Familiarity with healthcare documentation systems
Skills and Abilities
- General computer skills including use of Microsoft Office applications and internet search functions
- Ability to use review criteria in accordance with departmental policies
- Ability to adhere to HIPAA regulations e.g., maintaining confidentiality of protected health information
- Ability to interpret and apply complex policies and procedures
- Ability to review work for accuracy
- Ability to independently prioritize work
- Ability to use critical thinking and problem-solving skills
- Strong spoken and written communication skills
- Strong interpersonal and customer service skills
- Ability to work effectively with diverse individuals and groups
- Ability to learn, focus, understand, and evaluate information and determine appropriate actions
- Ability to accept direction and feedback, as well as tolerate and manage stress
- Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
- Ability to hear and speak clearly for at least 3-6 hours/day
Working Conditions
Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure
Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.
Work Location: Work from home
We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
We are an equal opportunity employer
CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.
What CareOregon employees say
Pay
Benefits
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About CareOregon
Sourced by ZipRecruiter
Industry
Insurance services
Company size
1,001 - 5,000 Employees
Headquarters location
Portland, OR, US
Year founded
1994