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Remote Rn Field Case Manager Jobs in Maryland (NOW HIRING)

RELI GROUP INC

Medical Review Nurse III

Baltimore, MD · Remote

... Registered Nursing program. * A Bachelor's Degree in Nursing (BSN) or other related field is ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

... Registered Nursing program. * A Bachelor's Degree in Nursing (BSN) or other related field is ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...

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All JobsRn Field Case JobsRemote Rn Field Case Manager JobsRemote Rn Field Case Manager Jobs in Maryland

Remote Rn Field Case Manager information

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

AspectRemote Rn Field Case ManagerRemote Rn Utilization Review Nurse
CertificationsRN license, case management certification often preferredRN license, certification in utilization review or case management beneficial
Work EnvironmentField-based, visiting patients and providers remotelyOffice-based, reviewing cases and medical records remotely
Employer & Industry UsageInsurance companies, workers' comp, healthcare providersInsurance companies, managed care organizations, healthcare payers
Common Search & ComparisonRemote Rn Field Case Manager vs Remote Rn Utilization Review Nurse

The Remote Rn Field Case Manager primarily conducts patient visits and manages cases in the field, while the Remote Rn Utilization Review Nurse focuses on reviewing medical necessity and appropriateness of care remotely. Both roles require RN licensure and related certifications, but differ in work environment and daily responsibilities.

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Remote Rn Field Case Manager jobs near you

DRG Coder, Registered Nurse

Pivotal Placement Services

Baltimore, MD • Remote

$95K - $105K/yr

Full-time

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

Job description

DRG Coder, Registered Nurse

📍 Remote | Full-Time | 🏥 Healthcare | Clinical Documentation & Coding

About the Role

We are seeking an experienced DRG Coder / Clinical Auditor (RN) to conduct comprehensive DRG quality and validation audits of inpatient medical records. This role is critical in ensuring accurate DRG assignment, strong clinical documentation support, and compliance with Medicare and CMS regulations. The ideal candidate is highly analytical, clinically strong, and comfortable working independently in a production-driven audit environment.

You will play a key role in improving coding accuracy, reimbursement integrity, and regulatory compliance while providing clear, defensible audit findings.

Key ResponsibilitiesDRG Validation & Chart Review
  • Perform in-depth DRG quality audits of inpatient medical records.
  • Validate DRG assignments against clinical documentation and coding guidelines.
  • Identify missed opportunities, discrepancies, and documentation gaps impacting reimbursement.
Clinical Documentation Review
  • Evaluate physician documentation to ensure clinical indicators appropriately support assigned diagnoses and procedures.
  • Apply strong clinical judgment to assess severity of illness, risk of mortality, and DRG impact.
Audit & Compliance
  • Ensure compliance with Medicare, CMS, and payer-specific documentation and coding requirements.
  • Identify trends, risks, and improvement opportunities related to DRG accuracy and quality.
  • Support organizational initiatives focused on audit accuracy, compliance, and revenue integrity.
Coding Expertise
  • Apply extensive hands-on knowledge of ICD-10-CM and ICD-10-PCS, Coding Clinic guidance, and Official Coding Guidelines.
  • Utilize MS-DRG and APR-DRG methodologies when reviewing and validating records.
Communication & Reporting
  • Document audit findings clearly, concisely, and professionally.
  • Communicate results and rationale effectively to internal stakeholders as required.
Additional Duties
  • Support other documentation, coding, and audit-related activities as assigned.
Required QualificationsLicensure
  • Active Registered Nurse (RN) license required
    (Non-RN candidates will not be considered)
Experience
  • Minimum of 2 years of recent DRG quality auditing experience in a hospital or health plan setting.
  • Extensive hands-on inpatient ICD-10-CM and ICD-10-PCS coding experience required.
Certifications
  • National coding certification required (AHIMA or AAPC).
  • CCS, CIC, or equivalent strongly preferred.
Technical Knowledge
  • Proficiency in Medicare and CMS documentation and coding guidelines.
  • Strong understanding of MS-DRG and APR-DRG methodologies.
  • Advanced familiarity with Coding Clinic citations and Official Coding Guidelines.
Soft Skills
  • Exceptional attention to detail and analytical accuracy.
  • Strong critical thinking and problem-solving skills.
  • Clear, professional written and verbal communication.
  • Ability to work independently in a fast-paced, production-driven environment.
Tools
  • Proficient in Microsoft Office Suite (Excel, Word, Outlook).
Compensation

💵 Pay Range: $90,000 – $104,841

Compensation is based on location, experience, qualifications, and internal equity. Final compensation may vary following the interview and assessment process.

Who We Are

Headquartered in Central Florida, Pivotal Placement Services is a full-service national workforce solutions firm specializing in healthcare talent—from frontline staff to executive leadership—in both clinical and non-clinical roles. We deliver customer-focused staffing solutions through Direct Placement and MSP/VMS partnerships nationwide.