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Remote Rn Government Jobs in Washington, PA (NOW HIRING)

DataAnnotation

Registered Nurse - AI Trainer

Pittsburgh, PA · Remote

$50 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...

DataAnnotation

RN - AI Trainer

Pittsburgh, PA · Remote

$50 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...

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Remote Rn Government information

What is a Remote RN Government job?

A Remote RN Government job is a nursing position that allows registered nurses to work from home or a remote location while serving government agencies. Responsibilities may include telehealth services, case management, utilization review, or public health initiatives. These roles typically support federal, state, or local government healthcare programs such as Veterans Affairs, Medicaid, or public health departments. Remote RNs use technology to assess, educate, and support patients while ensuring compliance with government healthcare regulations.

What types of patients and responsibilities can a Remote RN Government typically expect to manage?

Remote RN Government positions often involve supporting diverse patient populations, such as veterans, underserved communities, or individuals enrolled in public health programs. Daily duties include conducting virtual patient assessments, coordinating care plans, providing health education, and ensuring adherence to government health policies. RNs may also collaborate with case managers, social workers, and public health officials remotely. This role demands the ability to manage a varied caseload efficiently while maintaining thorough documentation and clear communication with patients and colleagues.

What are the key skills and qualifications needed to thrive in the Remote Rn Government position, and why are they important?

To thrive as a Remote RN Government, you need an active registered nurse license, thorough clinical knowledge, and experience working within government regulations or public health frameworks. Familiarity with government healthcare systems, secure telemedicine platforms, and compliance standards (such as HIPAA) is essential. Strong self-motivation, clear communication, and time management skills are vital for working independently while collaborating virtually with multidisciplinary teams. These competencies ensure high-quality patient care, regulatory compliance, and effective remote collaboration in a government healthcare setting.

What are popular job titles related to Remote Rn Government jobs in Washington, PA? For Remote Rn Government jobs in Washington, PA, the most frequently searched job titles are:
What job categories do people searching Remote Rn Government jobs in Washington, PA look for? The top searched job categories for Remote Rn Government jobs in Washington, PA are:
What cities near Washington, PA are hiring for Remote Rn Government jobs? Cities near Washington, PA with the most Remote Rn Government job openings:
Remote Rn Government jobs near you
Infographic showing various Remote Rn Government job openings in Washington, PA as of July 2026, with employment types broken down into 89% Full Time, 8% Part Time, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution.
Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Medical Assistance Expert)

Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Medical Assistance Expert)

The CKHobbie Group

Pittsburgh, PA • On-site, Remote

$40 - $42/hr

Full-time

PTO

Posted 18 days ago

Job description


Are you a registered nurse ready to take your career in an exciting newdirection-one where your expertise truly makes a difference? JoinPennsylvania's premier Quality Improvement Organization and step into adynamic role focused on advocacy and program integrity through compliance management. Here, you'll champion the needs of vulnerable populations,safeguard the quality of care, and influence healthcare outcomes on ameaningful scale. Enjoy the freedom of working from home, theflexibility and autonomy to manage your workday, and the opportunity forcontinuous professional growth-all while being part of a passionate,mission-driven team dedicated to improving healthcare across theCommonwealth.
In this rewarding role, you'll use your clinical knowledge outside ofthe traditional bedside setting to review and audit claims, supportprogram integrity initiatives, and advocate for beneficiaries across theCommonwealth. You'll enjoy the flexibility of working from home, theautonomy to manage your work, and meaningful opportunities forprofessional growth-all while contributing to a mission that trulymatters.
What You'll Do
  • Conduct clinical reviews and ensure quality, appropriateness, and compliance with healthcare standards
  • Support program integrity efforts by identifying trends, risks, and opportunities for improvement
  • Advocate for beneficiaries, with a strong focus on protecting and improving care for vulnerable populations
  • Apply nursing judgment to analyze medical records, documentation, and billing data
  • Collaborate with interdisciplinary teams, providers, and stakeholders to promote best practices
  • Contribute to quality improvement initiatives that strengthen healthcare delivery across Pennsylvania

What We're Looking For
  • Active, unrestricted Registered Nurse (RN) license
  • Strong clinical background with the ability to apply nursing judgment analytically
  • Interest in advocacy, quality improvement, and healthcare program integrity
  • Excellent written and verbal communication skills
  • Ability to work independently while managing multiple priorities
  • Comfort with technology and electronic medical records

Experience in utilization review, case management, quality improvement, compliance, or claims review is a plus-but not required.
Why Join Us
  • Mission-driven work with Pennsylvania's leading Quality Improvement Organization
  • Make a real impact on healthcare quality and outcomes for vulnerable populations
  • Remote work - enjoy the convenience and balance of working from home
  • Autonomy and flexibility in how you manage your workday
  • Advocacy-focused role that values your nursing voice and expertise
  • Career development opportunities to grow beyond traditional nursing roles
  • Supportive, collaborative team culture committed to excellence and integrity

If you're a registered nurse seeking purpose-driven work,professional growth, and the flexibility to balance your life andcareer-this is your opportunity. Apply today and help shape the future of healthcare quality in Pennsylvania.
Requirements
Be available as a full-time consultant, approximately 37.5 hours per week;
• Possess a current license to practice as a Registered Nurse issued by the Pennsylvania
State Board of Nursing; or possess a non-renewable temporary practice permit issued
by the Pennsylvania State Board of Nursing. Resources possessing non-renewable
temporary practice permits must obtain licensing as a Registered Nurse within the
one-year period as defined by the Pennsylvania State Board of Nursing;
• Possess a documented work history of three (3) or more years of professional
experience with medical assistance, health care services or human services or any
equivalent combination of experience and training;
• Possess basic computer skills, including familiarity with Microsoft Office programs.
Principal Duties and Responsibilities (RN - Utilization Review / Program Integrity)
  • Conduct clinical utilization reviews by evaluating medical records, treatment plans, and supporting documentation to determine medical necessity, appropriateness, quality, and level of care in accordance with Medical Assistance (MA) program requirements.
  • Apply nursing judgment and evidence-based clinical standards to ensure MA recipients receive safe, appropriate, and high-quality care while supporting program integrity and regulatory compliance.
  • Assess provider billing and documentation to verify compliance with MA policies and identify potential fraud, waste, or abuse.
  • Review clinical documentation submitted through electronic provider portals, telephone communications, fax, and U.S. mail, ensuring completeness and accuracy for utilization determinations.
  • Make authorization determinations by approving, modifying, or denying service requests within RN scope of practice, or refer cases to physician advisors for secondary medical review when medical necessity or level of care is unclear.
  • Collaborate with physician/medical consultants to support peer-to-peer reviews and facilitate discussions with ordering providers regarding clinical justification, appropriate care settings, and service coverage.
  • Accurately document utilization review decisions and clinical rationale in electronic systems, generating authorization notices, denial letters, reason codes, and appeal rights in compliance with regulatory standards.
  • Participate in retrospective, concurrent, and prospective utilization reviews, including re-evaluations of previously denied services upon request by providers or facilities.
  • Review and prepare appeal cases by analyzing medical records, developing exhibits and correspondence, and providing testimony at administrative hearings using knowledge of MA regulations, utilization management principles, and appeal processes.
  • Interpret MA policies, regulations, and utilization management guidelines for internal staff, providers, and stakeholders through consultation, meetings, and educational sessions.
  • Engage in interdisciplinary collaboration with internal departments, medical consultants, legal staff, and external stakeholders to support consistent and defensible utilization determinations.
  • Maintain ongoing professional development through continuing education, conferences, and review of current medical literature to remain current with standards of care, clinical guidelines, and utilization review best practices.
  • Provide cross-coverage in other program areas as needed, maintaining competency through training and updates to ensure continuity of program operations.
  • Respond to inquiries from recipients, providers, legislators, legal offices, and external agencies to explain utilization decisions, coverage policies, and administrative processes.
  • Maintain accurate case records and documentation in accordance with MA regulations, accreditation standards, and organizational policies.
  • Perform related duties and special projects as assigned, with expectations and performance standards communicated for each assignment.
  • When required, work at Department-designated locations. The primary duty location is Pittsburgh, PA, where appropriate workspace, technology, and resources will be provided to support assigned responsibilities.

Benefits
Attractive Compensation plan.Holiday and Vacation program.

Apply