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Remote Rn Critical Access Jobs in Oregon (NOW HIRING)

Curana Health, Inc.

RN Clinical Quality Coordinator

Summary The Quality Registered Nurse (RN) is responsible for overseeing clinical quality, clinic ... Primarily remote or hybrid, with periodic travel to clinic sites as needed * Collaborative, fast ...

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Remote Rn Critical Access information

What is the difference between Remote Rn Critical Access vs Remote Rn Hospital?

AspectRemote Rn Critical AccessRemote Rn Hospital
Work EnvironmentPrimarily rural, small critical access hospitalsUrban or suburban hospitals, larger facilities
CertificationsRN license, possibly critical access or rural health certificationsRN license, hospital-specific certifications
Job FocusEmergency, acute care in rural settingsGeneral hospital care, specialized units
Employer UsageCritical access hospitals, rural health clinicsLarge hospitals, healthcare systems

Remote Rn Critical Access nurses work mainly in rural, small hospitals focusing on acute and emergency care, often requiring rural health certifications. Remote Rn Hospital nurses serve in larger, urban hospitals with diverse specialties. The roles differ mainly in work environment and patient care scope, but both require RN licensure and healthcare experience.

What are popular job titles related to Remote Rn Critical Access jobs in Oregon? For Remote Rn Critical Access jobs in Oregon, the most frequently searched job titles are:
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Remote Rn Critical Access jobs near you

Remote Home Health RN - Medical Claims Reviewer

Broadway Ventures

Remote

Other

Posted 11 days ago

Job description

Job Type: Full-time (40 hours/week)
Schedule: Monday-Friday, 8:00 AM - 5:00 PM

Max Salary: W-2 ($60,000-$63,000)

Location: Remote (U.S. - Work from home)
Remote Work Requirements: High-speed internet (non-satellite) and a private, lockable home office
Equipment: You will be provided with all necessary equipment to perform your job effectively, including but not limited to a desktop computer, dual monitors, a headset, an ethernet cable, and additional accessories as needed.

About the Role

We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to assess medical necessity, appropriateness, and reimbursement eligibility while documenting decisions in accordance with regulatory and organizational requirements.

Key Responsibilities
  • Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
  • Assess payment determinations using clinical information and established guidelines.
  • Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
  • Provide clear, well-documented rationales for service approvals or denials.
  • Educate internal and external teams on medical review processes, coverage determinations, and coding requirements.
  • Support quality control activities to meet corporate and team objectives.
  • Provide guidance to LPN team members and support non-clinical staff through training and discussions.
  • Assist with special projects and additional responsibilities as assigned.
Minimum QualificationsLicensure:
  • Active, unrestricted RN license in the U.S. and in the state of hire
    OR
  • Active compact multistate RN license (as defined by the Nurse Licensure Compact).
Education:
  • Associate Degree in Nursing
    OR
  • Graduate of an accredited School of Nursing.
Experience:
  • Two years of clinical experience plus at least two years in one of the following:
    • Home Health
    • Utilization/Medical Review
    • Quality Assurance
Skills & Competencies:
  • Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical settings.
  • Ability to interpret and apply medical review criteria and clinical guidelines.
  • Proficiency in Microsoft Office and word processing software.
  • Strong analytical, organizational, and decision-making skills.
  • Ability to work independently while managing priorities effectively.
  • Excellent customer service, communication, and critical thinking skills.
  • Ability to handle confidential information with discretion.
Preferred Qualifications
  • Three years of clinical nursing experience in Home Health, Utilization Review, Medical Review, or Quality Assurance (strongly preferred).
  • Proficiency in using multiple screens and software programs simultaneously.

If you are a detail-oriented RN with a passion for medical review, we encourage you to apply!

Apply