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Work From Home Rn Risk Management Jobs in Pittsburgh, PA

HMG Careers

Work From Home Sales Specialist

Dawson, PA · Remote

$69K/yr

What We Offer * Remote, work-from-home career * Average first-year earnings of $69K through ... Ongoing training and mentorship from experienced managers * High-quality leads provided with no ...

HMG Careers

Work From Home Sales Specialist

Weirton, WV · Remote

$69K/yr

What We Offer * Remote, work-from-home career * Average first-year earnings of $69K through ... Ongoing training and mentorship from experienced managers * High-quality leads provided with no ...

HMG Careers

Work From Home Sales Specialist

Butler, PA · Remote

$69K/yr

What We Offer * Remote, work-from-home career * Average first-year earnings of $69K through ... Ongoing training and mentorship from experienced managers * High-quality leads provided with no ...

HMG Careers

Work From Home Sales Specialist

Plum, PA · Remote

$69K/yr

What We Offer * Remote, work-from-home career * Average first-year earnings of $69K through ... Ongoing training and mentorship from experienced managers * High-quality leads provided with no ...

HMG Careers

Work From Home Sales Specialist

Oakdale, PA · Remote

$69K/yr

What We Offer * Remote, work-from-home career * Average first-year earnings of $69K through ... Ongoing training and mentorship from experienced managers * High-quality leads provided with no ...

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Work From Home Rn Risk Management information

See Pittsburgh, PA salary details

$42.2K

$100.7K

$162.6K

How much do work from home rn risk management jobs pay per year?

As of Jun 15, 2026, the average yearly pay for work from home rn risk management in Pittsburgh, PA is $100,678.00, according to ZipRecruiter salary data. Most workers in this role earn between $70,400.00 and $128,100.00 per year, depending on experience, location, and employer.

Can risk managers work remotely?

Risk managers can often work remotely, especially in roles that involve data analysis, reporting, and communication. Many organizations allow risk management professionals to perform their duties from home using digital tools and secure networks, though some positions may require on-site presence for meetings or inspections.

What does a typical day look like for a Work From Home RN in Risk Management?

As a Work From Home RN in Risk Management, your day may involve reviewing incident reports, conducting virtual root cause analyses, monitoring compliance with safety policies, and collaborating remotely with clinical and administrative teams. You’ll spend much of your time using risk management software, attending video meetings, and documenting findings or recommendations. The role often requires balancing project deadlines with real-time incident response, so self-motivation and organizational skills are key. While you’ll work independently, regular communication with other healthcare professionals ensures patient safety and successful risk mitigation.

How to make an extra $2000 a month as a nurse?

Work From Home Rn Risk Management professionals can increase income by taking on additional freelance or consulting projects, leveraging specialized skills such as compliance, documentation, or telehealth. Gaining certifications like Certified Risk Manager (CRM) or Certified Professional in Healthcare Quality (CPHQ) can also open opportunities for higher-paying roles or side gigs in healthcare risk management. Flexibility and strong communication skills are essential for managing multiple projects remotely.

What are the key skills and qualifications needed to thrive in the Work From Home Rn Risk Management position, and why are they important?

To thrive as a Work From Home RN in Risk Management, you need a current RN license, experience in clinical nursing, and a solid understanding of healthcare compliance, quality improvement, and risk assessment processes. Familiarity with risk management platforms, electronic health records (EHRs), and certification such as CPHRM (Certified Professional in Healthcare Risk Management) is often valued. Excellent communication, critical thinking, and time management skills help set candidates apart in remote environments. These competencies are vital for effectively identifying, analyzing, and mitigating healthcare risks to ensure patient safety and legal compliance from a remote setting.

How to make $300,000 as a nurse online?

Work From Home Rn Risk Management professionals can increase earnings by specializing in areas like telehealth, consulting, or risk assessment, which often command higher pay. Building expertise, obtaining relevant certifications, and leveraging platforms for freelance or consulting work can help reach higher income levels, including $300,000 annually.

How can I make 2000 a week working from home?

Work From Home Rn Risk Management professionals can increase earnings by gaining specialized certifications, such as Certified Risk Management Professional, and building experience in remote risk assessment and compliance. Earning $2000 weekly typically requires working multiple clients or projects, setting competitive rates, and efficiently managing time and tasks in a remote environment.

What is a Work From Home RN Risk Management job?

A Work From Home RN Risk Management job involves assessing and mitigating risks related to patient care, medical procedures, and regulatory compliance. These nurses review patient records, analyze trends, and ensure healthcare policies are followed to prevent legal or safety issues. They often collaborate with healthcare teams and insurance providers to manage claims and improve patient outcomes. This role requires strong analytical skills, attention to detail, and experience in clinical nursing and healthcare regulations.

What are popular job titles related to Work From Home Rn Risk Management jobs in Pittsburgh, PA? For Work From Home Rn Risk Management jobs in Pittsburgh, PA, the most frequently searched job titles are:
What job categories do people searching Work From Home Rn Risk Management jobs in Pittsburgh, PA look for? The top searched job categories for Work From Home Rn Risk Management jobs in Pittsburgh, PA are:
What cities near Pittsburgh, PA are hiring for Work From Home Rn Risk Management jobs? Cities near Pittsburgh, PA with the most Work From Home Rn Risk Management job openings:
Work From Home Rn Risk Management jobs near you

Remote/Hybrid Registered Nurse (RN) - Advocacy & Program Integrity (Medical Assistance Expert)

The CKHobbie Group

Pittsburgh, PA • Remote

Other

PTO

Posted 25 days ago

Job description

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.
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 - Utilization Review / Program Integrity)
  • Conduct clinical utilization reviews by evaluating medical records, treatment plans, and supporting documentation to determine medical necessity, appropriateness, quality, and level of care in accordance with Medical Assistance (MA) program requirements.
  • Apply nursing judgment and evidence-based clinical standards to ensure MA recipients receive safe, appropriate, and high-quality care while supporting program integrity and regulatory compliance.
  • Assess provider billing and documentation to verify compliance with MA policies and identify potential fraud, waste, or abuse.
  • Review clinical documentation submitted through electronic provider portals, telephone communications, fax, and U.S. mail, ensuring completeness and accuracy for utilization determinations.
  • Make authorization determinations by approving, modifying, or denying service requests within RN scope of practice, or refer cases to physician advisors for secondary medical review when medical necessity or level of care is unclear.
  • Collaborate with physician/medical consultants to support peer-to-peer reviews and facilitate discussions with ordering providers regarding clinical justification, appropriate care settings, and service coverage.
  • Accurately document utilization review decisions and clinical rationale in electronic systems, generating authorization notices, denial letters, reason codes, and appeal rights in compliance with regulatory standards.
  • Participate in retrospective, concurrent, and prospective utilization reviews, including re-evaluations of previously denied services upon request by providers or facilities.
  • Review and prepare appeal cases by analyzing medical records, developing exhibits and correspondence, and providing testimony at administrative hearings using knowledge of MA regulations, utilization management principles, and appeal processes.
  • Interpret MA policies, regulations, and utilization management guidelines for internal staff, providers, and stakeholders through consultation, meetings, and educational sessions.
  • Engage in interdisciplinary collaboration with internal departments, medical consultants, legal staff, and external stakeholders to support consistent and defensible utilization determinations.
  • Maintain ongoing professional development through continuing education, conferences, and review of current medical literature to remain current with standards of care, clinical guidelines, and utilization review best practices.
  • Provide cross-coverage in other program areas as needed, maintaining competency through training and updates to ensure continuity of program operations.
  • Respond to inquiries from recipients, providers, legislators, legal offices, and external agencies to explain utilization decisions, coverage policies, and administrative processes.
  • Maintain accurate case records and documentation in accordance with MA regulations, accreditation standards, and organizational policies.
  • Perform related duties and special projects as assigned, with expectations and performance standards communicated for each assignment.
  • When required, work at Department-designated locations. The primary duty location is Pittsburgh, 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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