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Remote Rn Insurance Jobs in Fall River, MA (NOW HIRING)

Ourhrconnect

Medical Review Supervisor

Carolina, RI · On-site +1

Active, unrestricted RN licensure from the United States and in the state of hire, OR active ... Life Insurance * Paid Time Off (PTO) * On-site cafeterias and fitness centers in major locations

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Showing results 21-40

All JobsRn Insurance JobsRemote Rn Insurance JobsRemote Rn Insurance Jobs in Fall River, MA

Remote Rn Insurance information

See Fall River, MA salary details

$7

$42

$72

How much do remote rn insurance jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for remote rn insurance in Fall River, MA is $42.41, according to ZipRecruiter salary data. Most workers in this role earn between $31.63 and $50.19 per hour, depending on experience, location, and employer.

What is a Remote RN Insurance nurse?

A Remote RN Insurance nurse is a registered nurse who works with insurance companies to review medical claims, assess patient care needs, and help determine the medical necessity of treatments—often from a home office. Their responsibilities may include case management, utilization review, and providing telephonic support to patients or healthcare providers. This role requires strong clinical experience, excellent communication skills, and the ability to analyze medical records and insurance policies. Working remotely, these nurses help ensure patients receive appropriate care while also managing healthcare costs for insurance providers.

What are the key skills and qualifications needed to thrive as a Remote RN Insurance nurse?

To thrive as a Remote RN Insurance Nurse, you need an active RN license, a strong grasp of clinical practice, and experience in case management or utilization review. Familiarity with claims processing systems, telehealth platforms, and knowledge of medical coding (ICD-10, CPT) are typically required, along with certifications like CCM or URAC being advantageous. Exceptional communication, critical thinking, and time management skills help you collaborate with patients, providers, and insurance teams effectively. These competencies ensure accurate assessments, efficient case handling, and high-quality service in a remote, compliance-driven environment.

What are some common challenges faced by Remote RN Insurance professionals, and how can they be managed effectively?

Remote RN Insurance professionals often encounter challenges such as managing a high volume of case reviews, maintaining clear communication with both patients and insurance teams, and staying updated with changing insurance policies and regulations. To manage these challenges, it’s important to develop strong organizational skills, utilize effective digital communication tools, and participate in ongoing training. Engaging with a supportive team and seeking mentorship within the organization can also help in adapting to the remote environment and ensuring quality outcomes.

What is the difference between Remote Rn Insurance vs Remote Rn Case Manager?

AspectRemote Rn InsuranceRemote Rn Case Manager
CertificationsRN license, insurance knowledgeRN license, case management certification
Work EnvironmentInsurance companies, telehealthHealthcare facilities, telehealth
Employer & IndustryInsurance providers, telehealth companiesHospitals, insurance companies, healthcare agencies

Remote Rn Insurance focuses on assessing insurance claims and policy coverage, while Remote Rn Case Managers coordinate patient care plans. Both roles require RN licensure and involve telehealth work, but their primary responsibilities and employer settings differ.

What are popular job titles related to Remote Rn Insurance jobs in Fall River, MA?

For Remote Rn Insurance jobs in Fall River, MA, the most frequently searched job titles are:

What job categories do people searching Remote Rn Insurance jobs in Fall River, MA look for?

The top searched job categories for Remote Rn Insurance jobs in Fall River, MA are:

What cities near Fall River, MA are hiring for Remote Rn Insurance jobs?

Cities near Fall River, MA with the most Remote Rn Insurance job openings:

Remote Rn Insurance jobs near you
Infographic showing various Remote Rn Insurance job openings in Fall River, MA as of August 2026, with employment types broken down into 62% Full Time, 13% Part Time, and 25% Contract. Highlights an 100% Remote job distribution, with an average salary of $88,205 per year, or $42.4 per hour.

Senior Medical Reviewer (Behavioral Health Focused)

Ourhrconnect

Carolina, RI • Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 18 days ago

Job description


Summary
 We are currently hiring for a Senior Medical Reviewer to join BlueCross BlueShield of South Carolina. In this role as a Senior Medical Reviewer, you will act as Team Lead for specialty programs, medical review, utilization management, and case management areas by providing assistance and support to unit supervisor/manager by giving direction/guidance/training to staff and ensure appropriate levels of healthcare services are provided.
Our ideal candidate will possess the following experience:
- Four years of recent clinical experience in a defined Behavioral Health specialty area. Specialty areas include: Serious Mental Illness (SMI), Trauma and Post-Traumatic Stress Disorder, Substance Use Disorders (SUD), Child and Adolescent Behavioral Health, and Cognitive Disorders. Or, 4 years of Behavioral Health utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical.
Description
 

Location:

This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm and will be fully remote in SC. Our ideal candidate must reside in South Carolina and may be required to report on-site occassionally, and will oversee member-facing patient visits by team members within SC.

What You'll Do:

  • Functions as team leader/senior-level Medical Reviewer. Provides leadership/guidance/direction/training to staff. Maintains working knowledge of unit functions and ability to interpret to new hires, department interworkings and workflow. Acts as resource for staff/external entities troubleshooting as well as resolving issues. Keeps manager informed of any problems/issues that need resolving.

  • Assists management with monitoring workflow and workloads (including reassignment of work to meet timelines, redirecting work intake source to balance workloads), reporting, and addressing aging issues.

  • Participates in departmental quality reviews. Follows process to ensure quality plan is adhered to and communicated to all parties. Gives/receives feedback regarding medical review decision making and technical claims processing issues. Ensures that quality work instructions/forms/documents are developed/revised as needed.

  • Provides quality service and communicates effectively with external/internal customers in response to inquiries. Obtains information from internal departments, providers, government, and/or private agencies, etc. to resolve discrepancies/problems.

  • Participates in compliance initiatives and other directed activities. Participates/oversees special projects as requested by management.

To Qualify for This Position, You'll Need the Following:

  • Required Education: Associates in a job-related field

  • Degree Equivalency: Graduate of Accredited School of Nursing

  • Required Work Experience: 4 years clinical, OR, 2 years clinical and 2 years medical review/utilization review, OR, combination of health plan, clinical, and business experience totaling 4 years.

  • Required Skills and Abilities: Working knowledge of managed care and various forms of health care delivery systems.

  • Strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience.

  • Knowledge of specific criteria/protocol sets and the use of the same.

  • Working knowledge of word processing and spreadsheet software.

  • Ability to work independently, prioritize effectively, and make sound decisions.

  • Good judgment skills.

  • Demonstrated customer service, organizational, and presentation skills.

  • Demonstrated proficiency in spelling, punctuation, and grammar skills.

  • Demonstrated oral and written communication skills.

  • Ability to persuade, negotiate, or influence others.

  • Analytical or critical thinking skills.

  • Ability to handle confidential or sensitive information with discretion.

  • Ability to lead/direct/motivate others.

  • Required Software and Tools: Microsoft Office.

  • Required Licenses and Certificates: If RN, active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact NLC), OR active, unrestricted licensure/certification from the United States and in the state of hire in specialty area as required by hiring division/area.

We Prefer That You Have the Following:

  • Preferred Experience: 4 years of Behavioral Health clinical experience as RN, LISW-CP, LMSW, or LPC.

  • Experience with care coordination and case management process for High-Risk and Intensive Case Management levels of Behavioral Health.

  • Knowledge of Managed Care regulations/policies/instructions/provisions.

  • Experience with South Carolina Behavioral Health resources related to supports/services and referral linkage.

  • Working knowledge of Microsoft Teams, Word, PowerPoint OneNote, Excel, Outlook, Tableau, OR other spreadsheet/database software.

  • Preferred Education: Bachelor's degree- Nursing or Graduate of Accredited School of Nursing.

  • Preferred Skills and Abilities: Knowledge of database software. Knowledge of Medicare regulations/policies/instructions/provisions. Knowledge of home health, and/or system/processing procedures for medical review.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

  • Subsidized health plans, dental and vision coverage

  • 401k retirement savings plan with company match

  • Life Insurance

  • Paid Time Off (PTO)

  • On-site cafeterias and fitness centers in major locations

  • Education Assistance

  • Service Recognition

  • National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.comor call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's moreinformation.

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