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Work From Home Rn Medical Record Review Jobs (NOW HIRING)

ePATHUSA Inc

Medical Review Nurse

VA · Remote

$76K - $97K/yr

Seeking Registered Nurse for fully remote role to perform complex medical record and claim reviews ... from a variety of provider types. * Minimum of 2 (two) years' experience in the medical review ...

VIVA USA INC

HEDIS Review Nurse

Chicago, IL · On-site +1

$31.25 - $41.25/hr

The review nurse is responsible for medical record abstractions and overreads during the annual ... Registered Nurse (RN)/ Licensed Practical Nurse (LPN) with unrestricted license 2 years' HEDIS ...

VIVA

HEDIS Review Nurse

$31 - $41/hr

The review nurse is responsible for medical record abstractions and overreads during the annual ... Registered Nurse (RN)/ Licensed Practical Nurse (LPN) with unrestricted license 2 years' HEDIS ...

Managed Staffing

HEDIS Reviewer

MI · Remote

$44 - $45/hr

HEDIS Reviewer - Work From Home (Michigan Only) Location: Remote - Must reside in Michigan (MI) Schedule: Monday - Friday, 8:00 AM - 5:00 PM Job Summary: HEDIS Reviewer III (Medical Record Review ...

BrightStar Care API

Registered Nurse Case Manager

Join a leader in the home health care and medical staffing industry. If providing compassionate ... Non-skilled work in member's homes to prevent hospital readmission * Teaching and helping members ...

CES, LLC

Medical Review Nurse III

Saint Augustine, FL · Remote

Primarily responsible for conducting clinical reviews of medical records during the course of fraud ... None Office Equipment (if a WFH position): * A locking cabinet and/or desk appropriate for storing ...

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

At RELI Group, our work is grounded in purpose. We partner with government agencies to solve ... Perform automated and complex medical record and claim reviews to make coverage determinations ...

RELI GROUP INC

Medical Review Nurse III

Baltimore, MD · Remote

At RELI Group, our work is grounded in purpose. We partner with government agencies to solve ... Perform automated and complex medical record and claim reviews to make coverage determinations ...

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Work From Home Rn Medical Record Review information

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How much do work from home rn medical record review jobs pay per hour?

As of Sep 14, 2026, the average hourly pay for work from home rn medical record review in the United States is $44.91, according to ZipRecruiter salary data. Most workers in this role earn between $34.38 and $53.37 per hour, depending on experience, location, and employer.

What is a Work From Home RN Medical Record Review?

A Work From Home RN Medical Record Review is a registered nurse (RN) who evaluates and analyzes patients’ medical records remotely, often for insurance companies, healthcare organizations, or legal purposes. Their primary responsibilities include reviewing documentation for accuracy, completeness, and compliance with regulations or clinical guidelines. This role requires a strong understanding of medical terminology, clinical practices, and confidentiality standards. It allows nurses to leverage their clinical expertise in a non-bedside, remote setting, providing flexibility and work-life balance.

What are the key skills and qualifications needed to thrive as a Work From Home RN Medical Record Review?

To thrive as a Work From Home RN Medical Record Review, you need a current RN license, strong clinical knowledge, and experience with medical documentation and chart review. Familiarity with electronic health records (EHRs), coding systems like ICD-10, and utilization management software is typically expected. Attention to detail, critical thinking, and effective written communication help ensure accuracy and clarity in remote documentation. These skills are vital for maintaining compliance, supporting quality assurance, and ensuring the integrity of patient records in a remote work environment.

What are some common challenges faced by Work From Home RN Medical Record Reviewers, and how can they be managed?

Work From Home RN Medical Record Reviewers often face challenges such as managing distractions in a home environment, maintaining data security, and meeting productivity targets without in-person supervision. To overcome these, it's important to set up a dedicated workspace, follow strict privacy protocols, and use time management techniques to stay focused. Regular communication with your team and utilizing secure digital platforms can also help ensure accuracy and compliance in your reviews.

What is the difference between Work From Home Rn Medical Record Review vs Work From Home Medical Coding Specialist?

AspectWork From Home Rn Medical Record ReviewWork From Home Medical Coding Specialist
CredentialsRegistered Nurse (RN) licenseMedical coding certification (CPC, CCS, etc.)
Work EnvironmentHome-based, reviewing patient recordsHome-based, coding medical procedures and diagnoses
Industry UsageHealthcare, insurance, legal casesHealthcare, insurance billing
Common Search/ComparisonYesYes

Both roles are remote healthcare positions requiring specialized certifications. The RN Medical Record Review focuses on evaluating patient records for accuracy and compliance, while the Medical Coding Specialist assigns codes for billing and documentation. Understanding these differences helps job seekers find the right remote healthcare role that matches their credentials and career goals.

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Work From Home Rn Medical Record Review jobs near you
Infographic showing various Work From Home Rn Medical Record Review job openings in the United States as of September 2026, with employment types broken down into 88% Full Time, and 12% Contract. Highlights an 100% Remote job distribution, with an average salary of $93,419 per year, or $44.9 per hour.

Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Medical Assistance- Med Surg Hos

Harrisburg, PA • On-site, Remote

The CKHobbie Group
Recruiting and Staffing Services • 11 - 50 employees
Learn more about The CKHobbie Groupexternal

$40 - $42/hr

Full-time

PTO

Re-posted 8 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.
Are you a registered nurse ready to take your career in an excitingnew direction-one where your expertise creates real, lasting impact?Join Pennsylvania's premier Quality Improvement Organization and play a vital role in protecting healthcare quality, advocating forvulnerable populations, and ensuring the integrity of criticalhealthcare programs.
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 - Medical Assistance Inpatient Utilization Review & Discharge Planning)
  • Conduct clinical utilization reviews for medical-surgical inpatient hospitalizations under the Medical Assistance (MA) Program by evaluating medical records, admission criteria, continued stay indicators, and treatment plans to determine medical necessity, appropriateness, and level of care.
  • Apply registered nursing clinical judgment and evidence-based medical-surgical standards to ensure MA beneficiaries receive safe, effective, and timely inpatient care consistent with MA coverage requirements and regulatory guidelines.
  • Perform prospective, concurrent, and retrospective reviews of inpatient admissions to assess appropriate level of care (e.g., inpatient vs. observation), length of stay, and readiness for discharge.
  • Evaluate discharge planning documentation to ensure timely, safe, and effective transitions of care, including coordination of post-acute services such as home health, durable medical equipment (DME), skilled nursing facility (SNF), rehabilitation, behavioral health follow-up, and community-based supports.
  • Assess provider documentation and hospital billing to ensure compliance with MA policies, inpatient reimbursement rules, and discharge planning requirements, and identify potential fraud, waste, or abuse.
  • Review clinical documentation submitted through electronic medical records, provider portals, telephone communications, fax, and U.S. mail to support utilization and discharge determinations.
  • Make authorization determinations within RN scope of practice by approving, modifying, or denying inpatient stays and post-acute services, or referring cases to physician advisors when medical necessity, level of care, or discharge disposition is unclear.
  • Collaborate with physician/medical consultants and hospital care teams to support peer-to-peer discussions regarding continued stay criteria, discharge readiness, and appropriate post-discharge level of care.
  • Document utilization review findings, clinical rationale, and discharge planning decisions in electronic systems, generating authorization notifications, denial letters, reason codes, and appeal information in compliance with MA regulations.
  • Conduct re-reviews and reconsiderations of inpatient and post-acute service decisions upon request by hospitals, providers, or facilities, in collaboration with physician/medical consultants as needed.
  • Review and prepare appeal cases related to inpatient admissions, continued stays, and discharge determinations by analyzing medical records, preparing case summaries and exhibits, and providing testimony at administrative hearings using knowledge of MA regulations and appeal procedures.
  • Interpret MA inpatient and discharge planning policies, regulations, and utilization management guidelines for hospital staff, providers, and internal stakeholders through consultation, education, and meetings.
  • Participate in interdisciplinary collaboration with hospitals, post-acute providers, medical consultants, social services, legal staff, and program leadership to support patient-centered, compliant, and efficient transitions of care.
  • Maintain professional competence through continuing education and review of current medical-surgical and care transition literature to remain current with standards of care, utilization review best practices, and regulatory changes.
  • Provide cross-coverage in other MA program areas as needed, maintaining working knowledge through training and updates to support continuity of program operations.
  • Respond to inquiries and correspondence from beneficiaries, providers, legislators, legal offices, and external agencies to explain inpatient coverage decisions, discharge planning requirements, and administrative processes.
  • Maintain accurate case documentation and records in accordance with MA regulations, accreditation standards, and organizational policies.
  • Perform related duties and special projects as assigned, with expectations and performance standards communicated at the time of assignment.
  • When required, work at Department-designated locations. The primary work location is Harrisburg, PA, where appropriate workspace, technology, and resources will be provided to support assigned responsibilities.

Benefits
Attractive Compensation plan.Holiday and Vacation program.

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