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

Enlyte

Telephonic Case Manager

Carolina, RI · Remote

$74K - $86K/yr

S. RN Compact license required URAC-recognized certification in case management (CCM, CDMS, CRC ... and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a ...

Ourhrconnect

Analyst, Appeals

Carolina, RI · On-site +1

An active, unrestricted RN license 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 Sep 10, 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 September 2026, with employment types broken down into 77% Full Time, 6% Part Time, and 17% Contract. Highlights an 100% Remote job distribution, with an average salary of $88,205 per year, or $42.4 per hour.

RN Medical Reviewer II - Palmetto GBA

Carolina, RI • On-site, Remote

Ourhrconnect
See more jobs at Ourhrconnectexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 13 days ago

Job description


Summary
 Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices.
Description
 

Logistics:

Palmetto GBA- one of BlueCross BlueShield's South Carolina subsidiary companies.

Centers for Medicare and Medicaid Services (CMS) Requirements: Certain divisions within BlueCross BlueShield of South Carolina require CMS (Centers for Medicare and Medicaid Services) residency that requires employees to have lived in the US for at least three (3) out of the last five (5) years. This is a business requirement - government contracts, not an HR requirement. In the spirit of transparency, if we extend an offer and discover during the background check process that you have not been in the US for at least three (3) years, you will fail background, and the offer will be rescinded.

Location:

  • This position is full-time salaried position Monday-Friday in a typical home office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM ET. It may be necessary, given the business need, to occasionally work additional hours.

  • You must have high-speed (non-satellite) internet service and a private home office to work from home.

  • Training classes will start on 10/12/2026. Unfortunately, no time off during training will be permitted.

  • Preferred candidates will live in South Carolina or Alabama.

What You'll Do:

  • Perform medical claim reviews for one or more of the following: claims for medically complex services, services that require preauthorization/predetermination, requests for appeal or reconsideration, referrals for potential fraud and/or abuse, and correct coding for claims/operations. Make reasonable payment determinations based on clinical medical information and established criteria/protocol sets or clinical guidelines.

  • Determines medical necessity, appropriateness, and/or reasonableness and necessity for coverage and reimbursement. Monitor process's timeliness in accordance with contractor standards. Document medical rationale to justify payment or denial of services and/or supplies. Educate internal and external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines.

  • Participate in quality control activities supporting corporate and team-based objectives. Provide guidance, direction, and input as needed to LPN team members. Provide education to non-medical staff through discussions, team meetings, classroom participation, and feedback. Assist with special projects and specialty duties and responsibilities as assigned by management.

To Qualify for This Position, You'll Need:

  • License: Active RN licensure in state hired, OR, active compact multistate RN license as defined by the Nurse Licensure Compact (NLC).

  • Education:Associate degree - Nursing OR Graduate of an accredited School of Nursing.

  • Work Experience: Two years of clinical experience as an RN.

  • Skills and Abilities: Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated oral and written communication skills. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.

  • Software and Tools:Microsoft Office.

What We Prefer You Have:

  • Work Experience: Five years of varied RN nursing experience to include: Medical/Utilization Review, Quality Assurance, Emergency, Critical Care, or Medical/Surgical experience, strongly preferred. Medicare or claims experience a plus.

  • Software and Tools: Ability to use multiple Windows-based programs simultaneously.

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.

Palmetto GBA

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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