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Sarah Jenkins
Remote Nurse Reviewer jobs in the United States
Job type
Min. salary, $/year
Level
Healthcare organizations across the USA need skilled nurse reviewers to support utilization review, quality assurance, and compliance programs. With 500+ open positions available, nurse reviewer remote jobs let experienced clinicians work from anywhere while evaluating clinical cases for accuracy. Demand for this remote role remains strong as payers streamline case management.
Successful candidates hold an active RN license and bring hands-on experience with utilization review, medical necessity criteria, and case management systems. Employers value professionals who interpret clinical documentation, apply InterQual or MCG guidelines, and communicate findings clearly. Strong analytical skills and independent judgment help candidates stand out among nurse reviewer vacancies.
Remote work is now standard for this profession, with employers nationwide offering flexible schedules and virtual onboarding. The shift toward telehealth and remote case management keeps these roles among the most sought-after in clinical operations. Many organizations now hire a nurse reviewer who can work independently using digital collaboration tools.
If you're ready for a flexible, remote career that puts your clinical expertise to work, now is a great time to explore new opportunities. Global Work AI connects skilled clinicians with organizations seeking a dedicated nurse reviewer, making it simple to find a role that fits your goals. Discover more opportunities waiting for you today.
GuideWell Source
Review and analyze complex healthcare claims for medical necessity and appropriateness of care. Conduct clinical reviews, interpret CMS guidelines, and identify issues such as overpayment or fraud. Provide guidance to team members and develop recommendations for corrective actions.
remote, AL, United StatesFull TimeJunior (<2 years)
CareSource
Process medical necessity reviews for behavioral health services, assist with discharge planning, and coordinate care for members. Engage with medical directors for clinical expertise, maintain knowledge of regulations, and refer quality issues to Quality Improvement.
remote, MA, United States$75k – $121k/yrFull TimeMiddle (2-4 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)Health Plan of San Joaquin/Mountain Valley Health Plan
Conduct concurrent reviews of inpatient activities, ensuring compliance with care plans and regulatory requirements. Collaborate with providers to resolve care issues, make recommendations for transfers and discharge planning, and document activities in HPSJ systems.
remote, CA, United StatesFull TimeMiddle (2-4 years)
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)
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)
MICHIGAN PEER REVIEW ORGANIZATION
Conduct objective peer reviews of clinical cases, determining medical necessity and quality of care. Ensure decisions align with current standards of practice and submit reviews using provided IT systems in a timely manner.
remote, United StatesFull TimeSenior (5+ years)
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)
Revitalize Home Healthcare
Review OASIS-E2 assessments for accuracy and consistency before submission. Confirm alignment of OASIS, visit notes, therapy evaluations, and medication profiles. Verify ICD-10 coding and PDGM accuracy, providing actionable feedback to clinicians.
remote, FL, United States$81k – $91k/yrPart TimeJunior (<2 years)
WNS Global Services
Conduct concurrent inpatient utilization reviews using InterQual criteria to assess medical necessity for admissions and continued stays. Collaborate with clinical teams to gather information and support level-of-care decisions.
remote, United States$75k/yrFull TimeJunior (<2 years)
WellSky
Review acute and post-acute authorization requests and medical records for medical necessity. Manage medical necessity denials from notification to resolution, ensuring compliance with clinical guidelines.
remote, United StatesFull TimeMiddle (2-4 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)
MedReview
Lead complex clinical validation reviews and provide final determinations on disputed findings. Manage physician-level appeals and conduct peer-to-peer discussions. Ensure compliance with CMS regulations and support quality assurance activities.
remote, United States$240k – $250k/yrFull TimeSenior (5+ 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)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)
Dane Street, LLC
Evaluate medical records, provide clinical summaries, engage in peer communications, and respond to client inquiries. Conduct thorough reviews of clinical cases in Reproductive Endocrinology/Infertility. Maintain proper credentialing and ensure timely delivery of assessments and reports.
remote, United StatesFull TimeSenior (5+ years)
company
Coordinate and monitor utilization of physical health services, ensuring compliance with standards. Perform clinical reviews to assess appropriateness of services, document utilization management activities, and advocate for members.
remote, NY, United States$62k – $118k/yrFull TimeLead / Manager
Excellus BCBS
Coordinate and monitor utilization of physical health services, ensuring compliance with standards. Perform clinical reviews to assess appropriateness of services, document utilization management activities, and advocate for members.
remote, NY, United States$62k – $118k/yrFull TimeMiddle (2-4 years)
SmartLight Analytics
Analyze hospital claims and itemized bills for accuracy, identifying billing errors and DRG misassignments. Review high-cost claims to detect overpayments and negotiate adjustments with claims administrators. Prepare documentation to support claim adjustments and track disputes through resolution.
remote, Plano, TX, United StatesFull TimeSenior (5+ 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)
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)
Slingshot AI
Review anonymized conversations with Ash to assess its handling of key moments in mental health support. Provide clinical judgment on what Ash should do, potential pitfalls, and reasoning behind decisions.
remote, United States$202k – $282k/yrPart TimeLead / Manager
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)
Osmosis
Collaborate with multidisciplinary teams to create and curate content on emerging medical technologies. Review and assess the impact of technologies on medical practice and patient care. Provide feedback throughout the content development cycle and ensure content accuracy.
remote, United States$91k – $111k/yrPart TimeJunior (<2 years)Osmosis
Collaborate with multidisciplinary teams to create and curate content on emerging medical technologies. Review and assess the impact of technologies on medical practice and patient care. Provide feedback throughout the content development cycle and ensure content accuracy.
remote, United States$91k – $111k/yrPart 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)
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)
PruittHealth
Conduct evaluations, assessments, and treatments per individualized care plans. Ensure timely and accurate documentation and records. Adhere to established policies and procedures related to nursing practice. Maintain continuity of patient care in a home health setting.
remote, GA, United StatesFull TimeJunior (<2 years)PruittHealth
Conduct evaluations, assessments, and treatments per individualized care plans. Ensure timely and accurate documentation and records. Adhere to established policies and procedures related to nursing practice. Maintain continuity of patient care in a home health setting.
remote, GA, United StatesPart TimeJunior (<2 years)Gainwell Technologies LLC
Coordinate and perform all 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$95k – $110k/yrFull TimeLead / Manager
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)Gainwell 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)10,000,000+ more jobs available!
