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Remote Rn Medical Record Review Jobs (NOW HIRING)

TEEMA Group

REMOTE RN - Quality Review

Phoenix, AZ · Remote

$42 - $43.50/hr

Review medical records to identify potential quality, safety, and utilization concerns * Conduct ... Active, unrestricted license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) * ...

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site +1

$34.73 - $45.15/hr

Performs medical record review for severity of illness and intensity of service; liaison function ... Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ...

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

Perform automated and complex medical record and claim reviews to make coverage determinations ... Registered Nurse, with a current unobstructed license to practice nursing in the United States.

RELI GROUP INC

Medical Review Nurse III

Baltimore, MD · Remote

Perform automated and complex medical record and claim reviews to make coverage determinations ... Registered Nurse, with a current unobstructed license to practice nursing in the United States.

Guideway Care

Clinical Operations Manager

AL · Remote

This role involves managing a team of remote registered nurses who provide triage services to ... Access to the electronic medical record (EMR) system may require the use of your personal mobile ...

Solvet

RN - Registered Nurse

Springfield, VA · On-site +1

Responsibilities * Review TSA employee and applicant medical records and electronic medical ... Remote work ? Initial training at TSA Headquarters in Springfield, VA (local travel required)

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Remote Rn Medical Record Review information

What is the difference between Remote Rn Medical Record Review vs Remote Rn Chart Review?

AspectRemote Rn Medical Record ReviewRemote Rn Chart Review
CertificationsRN license, possibly certifications in medical record reviewRN license, similar certifications
Work EnvironmentReviewing medical records remotely for legal, insurance, or compliance purposesAnalyzing and summarizing patient charts for healthcare providers or research
Industry UsageLegal, insurance, healthcare complianceHealthcare providers, research institutions, quality assurance

Remote Rn Medical Record Review involves evaluating medical records for legal, insurance, or compliance purposes, focusing on accuracy and completeness. Remote Rn Chart Review typically involves analyzing patient charts for clinical or research insights. While both roles require RN licensure and similar skills, their primary focus and industry applications differ slightly.

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Infographic showing various Remote Rn Medical Record Review job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 78% Full Time, 14% Part Time, and 7% Contract. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution.
Medicaid Medical Review RN (Medical Reviewer III)

Medicaid Medical Review RN (Medical Reviewer III)

CoventBridge Group

Remote

$65K - $70K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 16 days ago

CoventBridge Group rating

6.7

Company rating: 6.7 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

301st of 487 rated business services

Job description

Overview
Medicaid Medical Review RN (Medical Reviewer III) - REMOTE
The Medicaid Medical Review RN (Medical Reviewer III) will primarily be responsible for conducting clinical reviews of medical records during the course of fraud investigations or other program integrity initiatives such as requests for information or in support of proactive data analysis efforts. In addition, this position applies Medicare and Medicaid guidelines in making clinical determinations as to the appropriateness of payment coverage.
In assuming this position, you will be a critical contributor to meeting CoventBridge Integrity System's objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.
This position will report directly to the Medical Review Supervisor and will work in our Grove City, OH office. If not local, remotely from a home office.
At this time, CoventBridge is not considering candidates who require visa sponsorship, currently or in the future, including but not limited to H-1B, H-2B, E-3, TN, O-1, F-1 (OPT/CPT, or J-1 Visa Statuses.)
Responsibilities/ Requirements
Responsibilities:
  • Reviews information contained in Standard Claims Processing System files (e.g., claims history, provider files) to determine provider billing patterns and to detect potentially fraudulent or abusive billing practices or vulnerabilities in Medicare or Medicaid payment policies
  • Utilizes extensive knowledge of medical terminology, ICD-9-CM, ICD-10-CM HCPCS Level II and CPT coding along with analysis and processing of Medicare claims. Utilizes Medicare/Medicaid and Contractor guidelines for coverage determinations
  • Coordinates and compiles the written Investigative Summary Report to the PI Investigator upon completion of the records review
  • Incorporates leadership and communication skills to work with physicians and other health professionals as well as external regulatory agencies and law enforcement personnel
  • Provides training to UPIC staff on medical terminology, reading medical records, and policy interpretation
  • Provides expert witness testimony as required
  • Completes assignments in a manner that meets or exceeds the quality assurance goal of 98% accuracy
  • Maintains chain of custody on all documents and follows all confidentiality and security guidelines
  • Performs other duties as assigned by the Medical Review Supervisor that contribute to UPIC goals and objectives and comply with the Program Integrity Manual and Statement of Work guidelines and CMS directives and regulations

Requirements:
  • 2 years minimum experience with a state Medicaid agency or Managed Care Organization focused in Medicaid
  • 2 years minimum of working knowledge of ICD 10-CM/CPT coding experience
  • 4 years minimum experience auditing claims history or provider files to determine if the claim was payable and if any signed of fraud, waste or abuse are noted
  • Knowledge of, and the ability to correctly identify, Medicare and Medicaid coverage guidelines
  • Advance knowledge of medical terminology and experience in the analysis and processing of Medicare claims, utilization review/ quality assurance procedures, ICD 10-CM and CPT coding, Medicare coverage guidelines and payment methodologies (i.e., Correct Coding Initiative, DRG's, Prospective Payment Systems and Ambulatory Surgical center), NCPCP and other types of prescription drug claims
  • Ability to read Medicaid claims, both paper and electronic, and a basic knowledge of Medicaid is required
  • Should possess excellent verbal and written communication skills with an ability to write professional summary reports
  • Knowledge of and ability to use Microsoft Word, Excel, and Internet applications
  • Able to efficiently organize and manage workload and assignments
  • Must have and maintain a valid driver' license for the state of residence as on-site audits are part of the role as a nurse reviewer

Educational/Experience Qualifications:
  • Graduate from an accredited school of nursing and have an active license as a Registered Nurse (RN) required
  • Preference given to BSN or higher prepared nurses with recent medical review claims experience in Medicare or Medicaid reviews

Benefits
  • Medical, Dental, Vision plans
  • Life, LTD and STD paid by the employer
  • 401(k) with company match up to 4%
  • Paid Time Off and company paid holidays
  • Tuition assistance after 1 year of service

The salary range for this role is $65,000 to $70,000 annually. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
About Us:
CoventBridge Integrity Systems delivers investigative services, technology, and expertise that help healthcare and government organizations protect critical programs, strengthen oversight, and address fraud, waste, abuse, and operational risk.
CoventBridge Integrity Systems is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics and maintains a drug-free workplace.
CoventBridge Integrity Systems is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge Integrity Systems will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com.

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