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

Compass Group

REMOTE DIETITIAN

Plymouth, MA · Remote

$83K/yr

With more than 31,000 dedicated team members, including 1,600 registered dietitians and 1,200 ... Medical, Dental, Vision, Life Insurance/AD, Disability Insurance, Commuter Benefits, Employee ...

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All 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 Jun 20, 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 are the key skills and qualifications needed to thrive as a Remote RN Insurance Nurse, and why are they important?

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 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 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 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 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

Senior Medical Review Director - Stop Loss Focus

Ourhrconnect

Carolina, RI • Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 29 days ago

Job description


Summary
 Lead, organize, and develop staff in administration of the Medical Review and Prior Authorization programs for commercial stop loss programs.This role Directs and oversees the Medical Review and Prior Authorization programs ensuring performance expectations, compliance standards, workload issues, quality control, training and maintaining effective staffing levels and budgetary limits. Works collaboratively with owned division and program partners in the development and implementation of an efficient and effective Medical Review Strategy, including the integration of policy and education, that optimizes critical Medical Review cycle times. Serves as the Medical Review and Prior Authorization liaison between internal and external stakeholders.
Description
 

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose:

Lead, organize, and develop staff in administration of the Medical Review and Prior Authorization programs for commercial stop loss programs.This role Directs and oversees the Medical Review and Prior Authorization programs ensuring performance expectations, compliance standards, workload issues, quality control, training and maintaining effective staffing levels and budgetary limits. Works collaboratively with owned division and program partners in the development and implementation of an efficient and effective Medical Review Strategy, including the integration of policy and education, that optimizes critical Medical Review cycle times. Serves as the Medical Review and Prior Authorization liaison between internal and external stakeholders.

Logistics:

https://www.companionlife.com/ - one of BlueCross BlueShield of South Carolina's subsidiary companies.

Location:

This is a remote position. Typical work hours are from 8:30am - 5pm, Monday through Friday.

What You'll Do:

  • Ensure system/operational compliance with CMS directives. Establish, guide and analyze the effectiveness of Medical Review and Prior Authorization operations against benchmarks that are developed as measures of success. Analyze performance trends and develop new/modified work processes to improve overall operations quality/timeliness/customer satisfaction/financial outcomes. Direct/develop/evaluate/motivate subordinates to achieve and maintain production and quality standards ensuring area review decisions are accurate and all associates are well informed and trained on contract process work instructions.
  • Directs and oversees the development of the Medical Review and Prior Authorization Program strategy and error rate reduction plans based on the findings.
  • Develop and implement the Medical Review Programs strategic plan with goals supportive of the corporate strategic plan. Manage budget to ensure cost effectives and performance quality. Serve as the liaison and maintain proactive working relationship with CMS and other Medicare program leadership as needed by contract.
  • Investigate and resolve action items assigned by executive management. Resolve priority level problems from providers, beneficiaries, and CMS.

To Qualify For This Position, You'll Need The Following:

  • Required Education: Bachelor's in a job related field
  • Required Work Experience: 10 years healthcare program management, utilization/case management, or medical review management or equivalent military experience in grade E4 or above.
  • Required Skills and Abilities: Excellent verbal and written communication skills. Excellent organizational, customer service, analytical or critical thinking skills. Excellent presentation skills. Good judgment skills. Ability to persuade, negotiate, or influence others. Ability to evaluate existing processes and develop ways to streamline procedures. Strong organizational, analytical, communication, and decision-making skills. Knowledge of budget preparation and management. Ability to handle difficult situations. Ability to easily adapt to change.
  • Required Software and Other Tools: Microsoft Office. Knowledge of medical systems software.
  • Required Licenses and Certificates: If RN, active RN licensure in state hired.

We Prefer That You Have The Following:

  • Preferred Work Experience: 8 years of commercial/ self-funded program management, utilization/case management, or medical review management or equivalent military experience grade E4 or above. May be concurrent. 5 years of Stop Loss experience.
  • Preferred Skills and Abilities: In-depth knowledge of the Medicare Medical Review and Prior Authorization program. Knowledge of pricing large stop loss claims in coordination with other clinical staff and underwriting teams. Excellent decision making and problem solving. Demonstrated knowledge of developing, monitoring, and overseeing budgets. Working and managing cost containment vendors, and managing and negotiating associated contracts. Developing of medical policies and guidelines for general underwriter organizations. Extensive knowledge of cell and gene therapy & impact to future health care costs and quality.
  • Preferred Licenses and Certificates: American Society for Quality Certification.

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.

Pay Range Transparency:

Range Minimum: $122,441.00

Range Midpoint: $180,746.00

Range Maximum:$239,051.00

Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.

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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