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Sarah Jenkins
Remote Medical Review Nurse jobs in the United States
Job type
Min. salary, $/year
Level
Healthcare providers across the country continue to seek compliance-focused nursing talent, and medical review nurse remote jobs are expanding quickly nationwide. With 500+ open positions now available, organizations are eager to hire a medical review nurse capable of handling cases throughout the USA. This growing need highlights the value of experienced clinical reviewers in today’s healthcare system.
Candidates for this role typically hold an active RN license, strong clinical judgment, and solid experience in case evaluation, utilization management, and regulatory compliance. Attention to detail, familiarity with ICD-10 coding, and excellent communication skills help these professionals collaborate effectively with multidisciplinary teams. Analytical thinking and the ability to interpret complex documentation set top applicants apart in this competitive field, especially for remote medical review nurse positions that demand independent judgment.
Work arrangements for this position typically involve secure digital case management systems, allowing professionals to evaluate records and maintain quality standards from home offices nationwide. As telehealth and virtual care expand, demand for remote medical review nurse vacancies continues to rise across the USA, reflecting a broader shift toward flexible healthcare staffing models.
If you’re ready to advance your career while enjoying the flexibility of home-based work, now is the time to explore available opportunities. Global Work AI connects dedicated candidates with employers seeking to hire a medical review nurse for rewarding remote roles. Take the next step toward a flexible, impactful nursing career today.
Sedgwick
Perform clinical assessments and evaluate patient conditions, including treatment utilization and compliance. Collaborate with physicians, claims examiners, and other parties to negotiate care levels.
remote, United States$63k – $65k/yrFull TimeJunior (<2 years)
Providence
Conduct prospective, retrospective, and concurrent utilization reviews for Southern CA ministries. Perform clinical reviews and assess medical records daily during admissions for all payers as required by health plans.
remote, CA, United StatesPart TimeJunior (<2 years)
Centene Corporation
Analyze prior authorization requests for medical necessity and appropriate care levels. Collaborate with healthcare providers and teams to ensure timely service reviews. Document and maintain clinical information in health management systems, ensuring compliance with regulations.
remote, TX, United States$54k – $98k/yrFull TimeJunior (<2 years)
CareSource
Process medical necessity reviews for healthcare service authorization, assist with discharge planning, and coordinate care for members. Engage with medical directors for clinical expertise, monitor healthcare service delivery, and refer quality issues to Quality Improvement.
remote, MA, United States$75k – $121k/yrFull TimeMiddle (2-4 years)
Peraton
Conduct medical record reviews and apply clinical judgment to claim payment decisions. Perform research on medical claims data to identify issues and support fraud investigations.
remote, United States$51k – $82k/yrFull TimeJunior (<2 years)
Conduent
Conduct in-home assessments for Medicaid applicants, evaluate client needs, and gather information for eligibility determinations.
remote, LA, United States$39k/yrFull TimeEntry with Degree
Connecticut Children's
Conducts utilization reviews for assigned patients, ensuring compliance with medical necessity guidelines. Performs concurrent and retrospective clinical reviews, documents resource utilization, and collaborates with healthcare teams to optimize patient care.
remote, CT, United StatesFull TimeMiddle (2-4 years)
HJ Staffing
Conduct Peer-to-Peer (P2P) reviews with treating physicians regarding authorization requests. Analyze clinical documentation and evaluate medical necessity and level of care. Apply CMS Medicare Advantage requirements and clinical criteria. Document P2P discussions and maintain HIPAA compliance.
remote, United StatesFull TimeLead / Manager
Mindrift
Evaluate clinical EHR vignettes for accuracy and completeness, assess clinical reasoning quality, and score benchmark items based on established criteria. Conduct independent blind reads and participate in physician adjudication to ensure quality and correctness of clinical cases.
remote, United States$101k/yrPart TimeJunior (<2 years)
CommunityCare
Conduct clinical reviews of utilization requests for outpatient, inpatient, and post-acute services. Determine medical necessity using clinical review criteria and document review determinations.
remote, OK, United StatesFull TimeMiddle (2-4 years)
Oscar Health
Conduct medical reviews to determine appropriateness of inpatient, outpatient, and pharmacy services. Document decisions in workflow tools, ensuring clarity for members. Engage in peer-to-peer discussions with providers to clarify clinical information and explain review outcomes.
remote, United States$275k/yrFull TimeSenior (5+ years)
BlueCross BlueShield of South Carolina
Perform medical reviews using clinical information and established guidelines. Document decisions and provide support for medical claims and utilization practices. Educate staff on medical reviews and participate in quality control activities.
remote, United StatesFull TimeJunior (<2 years)
UnitedHealth Group
Conduct coverage reviews based on member plan benefits and coverage review policies, rendering coverage determinations. Document clinical review findings and engage in peer-to-peer discussions with providers.
remote, United States$249k – $373k/yrFull TimeDirector
Gainwell Technologies LLC
Coordinate and perform appeal-related duties, including analyzing and responding to provider appeals. Review documentation to ensure all aspects of the appeal are addressed accurately. Prepare case files and summaries for hearings, and participate in virtual and on-site hearings.
remote, United States$69k – $99k/yrFull TimeSenior (5+ years)
Acentra Health, LLC
Review medical records against criteria to determine appropriateness, ensuring accuracy and timeliness. Assess and manage daily workload, collaborating with supervisors on quality monitoring and improvement plans. Serve as a liaison for providers and address customer service issues.
remote, United States$57k – $71k/yrFull TimeMiddle (2-4 years)
Amerihealth Caritas
Evaluate medical necessity for inpatient and outpatient services, ensuring compliance with clinical guidelines and regulations. Review provider requests, gather medical documentation, and make determinations based on clinical criteria.
remote, United StatesFull TimeMiddle (2-4 years)
Virginia Information Technologies Agency
Review and develop mortality case summaries for individuals receiving DBHDS services, focusing on medical records and related documents. Analyze sequences of events leading to deaths and identify contributing factors.
remote, WY, United States$70k – $91k/yrFull TimeJunior (<2 years)
The IMA Group
Review medical records for disability, workers’ compensation, and insurance-related cases. Summarize clinical information into structured reports, identify key findings and gaps in documentation, and prepare case summaries for physician review.
remote, United States$90k – $120k/yrFull TimeMiddle (2-4 years)Acentra Health, LLC
Review medical records against criteria to determine appropriateness. Ensure accuracy and timeliness of reviews, manage daily workload, and monitor quality. Serve as a resource for nurse reviewers and liaise with providers for customer service issues.
remote, United States$57k – $79k/yrFull TimeJunior (<2 years)Peraton
Conduct medical record reviews and apply clinical judgment to claim payment decisions. Perform research on medical claims data to identify issues and support fraud investigations.
remote, United States$66k – $106k/yrFull TimeSenior (5+ years)
Humana
Conduct inpatient medical necessity reviews based on national guidelines and regulations. Analyze complex hospital cases and deliver utilization management determinations. Communicate with external providers to obtain clinical information and discuss review outcomes.
remote, United States$224k – $313k/yrFull TimeDirector
Prolific Academic Ltd
Complete expert registration and medical-credential verification through Prolific’s onboarding process. If qualified, apply experience in utilization review, utilization management, or physician clinical review to paid research and AI-related tasks.
remote, United States$262k/yrFull TimeJunior (<2 years)
AltaMed
Review authorization requests from various health plans, approving them per delegation responsibilities. Process denials using standard language and post recommendations in the authorization platform. Identify high-risk populations and refer them to case management programs.
remote, Montebello, CA, United States$249k – $311k/yrFull TimeJunior (<2 years)
SCAN Health Insurance
Review and analyze complex healthcare claims from a medical perspective. Conduct audits of medical claims, identify documentation needs, and interpret CMS guidelines.
remote, CA, United States$79k – $113k/yrFull TimeMiddle (2-4 years)
ChenMed
Conduct utilization management reviews for assigned territories, establishing 2-3 cases daily across multiple markets. Attend health plan and local team calls, and participate in weekly PCP and SNF meetings. Advise other physician reviewers and engage in process and quality improvement initiatives.
remote, United States$205k – $293k/yrFull TimeJunior (<2 years)Peraton
Conduct medical record reviews and apply clinical judgment to claim payment decisions. Perform research on medical claims data to identify issues and support fraud investigations.
remote, United States$51k – $82k/yrFull TimeSenior (5+ years)
ePathUSA
Perform complex medical record and claim reviews for Medicare Part A and B, making coverage determinations based on policies and guidelines. Evaluate AI-assisted processes for compliance and support Program Integrity reviews to detect fraud, waste, and abuse.
remote, IA, United States$77k – $97k/yrFull TimeMiddle (2-4 years)
Dane Street, LLC
Ensure timely completion and accuracy of physician reports, evaluating quality against client standards. Communicate with clients and physicians to clarify report questions and gather necessary information.
remote, United StatesFull TimeEntry with Degree
Medica
Conduct medical record reviews and clinical quality audits to ensure compliance with quality standards. Collect and validate clinical documentation, prepare audit findings, and support quality programs through data abstraction.
remote, AR, United States$70k – $105k/yrFull TimeSenior (5+ years)
RediMinds, Inc
Review incoming case files for completeness and accuracy, validate system-generated summaries, quality-check clinicians’ written reviews, and perform final quality assurance on determination letters.
remote, United StatesFull TimeJunior (<2 years)ChenMed
Oversee Utilization Management (UM) cases, establishing 2-3 cases daily across assigned markets. Attend health plan and local calls, and participate in weekly PCP and SNF meetings. Advise other physician reviewers and engage in process and quality improvement initiatives.
remote, United States$205k – $293k/yrFull TimeJunior (<2 years)
Machinify
Perform medical claims audit reviews for inpatient and outpatient services, applying medical review guidelines. Document findings and generate audit letters. Support findings during appeals and collaborate with the audit team to identify vulnerabilities.
remote, United StatesFull TimeSenior (5+ years)
All Care To You
Review authorization requests for medical necessity, documenting all steps in the authorization system. Process requests within established time frames, utilizing CMS and Health Plan criteria. Conduct retrospective reviews and refer cases to the Medical Director as needed.
remote, United StatesFull TimeSenior (5+ years)
CoventBridge Integrity Systems
Conduct clinical reviews of medical records for fraud investigations and program integrity initiatives. Analyze claims history and provider files to detect fraudulent billing practices.
remote, OH, United States$78k – $85k/yrFull TimeMiddle (2-4 years)
COMAGINE HEALTH
Conduct clinical reviews for medical necessity, appropriateness, and quality of healthcare services. Evaluate service requests against established clinical criteria and collaborate with clinical teams and physician consultants.
remote, IA, United StatesFull TimeSenior (5+ years)
NTT DATA Services
Conduct clinical reviews of medical records to evaluate medical necessity for appeals. Prepare detailed case reviews and recommendations for Medical Directors. Ensure compliance with regulations and standards while maintaining accurate appeal records.
remote, FL, United States$76k/yrFull TimeMiddle (2-4 years)
Tristar Insurance
Perform Workers’ Compensation utilization review including prospective, concurrent, expedited, and retrospective reviews to assess medical necessity. Evaluate treatment requests against clinical information and guidelines, referring to Peer Physicians as needed.
remote, United States$82k – $88k/yrFull TimeJunior (<2 years)
GARDAWORLD FEDERAL SERVICES LLC
Review applicant medical records against US Government contract medical requirements. Submit medical review documents accurately and timely, maintain confidentiality of medical records, and interpret medical examination results.
remote, United StatesFull TimeLead / ManagerGainwell Technologies LLC
Perform clinical reviews of medical records to assess medical necessity and appropriateness of care. Document review decisions and rationale, determine approvals, and process consultant decisions.
remote, United States$78k – $88k/yrFull TimeSenior (5+ years)Machinify
Perform medical claims audit reviews for government clients, ensuring compliance with medical review guidelines. Document findings, generate audit letters, and support findings during appeals. Collaborate with the audit team to identify vulnerabilities and improve medical policies.
remote, United StatesFull TimeSenior (5+ years)10,000,000+ more jobs available!
