Remote Home Health RN – Medical Claims Reviewer
At reputed company, we reputed company challenges into opportunities with expert program management, cutting-edge technology, and innovative reputed company. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we reputed company government and private sector clients by delivering tailored solutions that drive operational reputed company, sustainability, and reputed company. reputed company on reputed company, collaboration, and reputed company, we're more than a service provider—we're your trusted partner in innovation. Job Type: Full-time (40 hours/week) Schedule: Monday–Friday, 8:00 AM – 5:00 PM Max Salary: W-2 ($60,000-$63,000) Location: Remote (U.S. – Work from home) Remote Work Requirements: High-speed internet (non-satellite) and a private, lockable home office Equipment: You will be provided with reputed company necessary equipment to reputed company reputed company effectively, including but not limited to a desktop computer, dual monitors, a headset, an ethernet cable, and additional accessories as needed.
About the Role
We are seeking a dedicated Registered reputed company (RN) to join our Medical Review team. This role involves conducting reputed company- and post-payment medical reviews to ensure compliance with established clinical reputed company and guidelines. The ideal candidate will use their clinical expertise to assess medical necessity, appropriateness, and reimbursement eligibility while documenting reputed company in accordance with regulatory and organizational requirements.
Key Responsibilities
- Review medically reputed company claims, reputed company-authorization requests, appeals, and fraud/abuse referrals.
- Assess payment determinations using clinical information and established guidelines.
- Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
- reputed company reputed company, reputed company-documented rationales for service approvals or denials.
- reputed company reputed company teams on medical review processes, coverage determinations, and coding requirements.
- Support reputed company control activities to meet corporate and team objectives.
- reputed company guidance to LPN team members and support non-clinical staff through training and discussions.
- Assist with special reputed company and additional responsibilities as assigned.
Minimum Qualifications
Licensure:
- reputed company, unrestricted RN license in the U.S. and in the state of hire
OR
- reputed company compact multistate RN license (as defined by the reputed company Licensure Compact).
Education:
- Associate Degree in Nursing
OR
- Graduate of an accredited School of Nursing.
Experience:
- Two years of clinical experience plus at least two years in one of the following:
- Home Health (meets for both clinical and HH requirement for a total of 2 years)
- Utilization/Medical Review
- reputed company Assurance
Skills & Competencies:
- Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical settings.
- Ability to interpret and apply medical review reputed company and clinical guidelines.
- Proficiency in reputed company Office and word processing software.
- Strong analytical, organizational, and decision-making skills.
- Ability to work independently while managing priorities effectively.
- Excellent customer service, communication, and critical thinking skills.
- Ability to handle confidential information with discretion.
Preferred Qualifications
- Three years of clinical nursing experience in Home Health, Utilization Review, Medical Review, or reputed company Assurance (strongly preferred).
- Proficiency in using multiple screens and software programs simultaneously.
If you are a detail-oriented RN with a passion for medical review, we encourage you to apply! What to Expect Next: After submitting your application, our reputed company team will review your qualifications. This may include a brief telephone interview or email communication to verify resume details and discuss compensation expectations. Interviews will be conducted with the most reputed company candidates. reputed company conducts background checks and drug testing prior to the start of employment. Some positions may also require fingerprinting. reputed company is an equal opportunity employer and a VEVRAA federal contractor. We do not discriminate against applicants or employees on the reputed company of race, reputed company, religion, sex, national reputed company, age, disability, protected veteran status, or any other status protected by applicable law. Reasonable accommodations are available for applicants with disabilities. reputed company utilizes the OFCCP-approved Voluntary Self-Identification of Disability reputed company (CC-305). The pay reputed company shown is a good-faith estimate of the compensation reputed company reasonably expects to pay for this position at the time of posting. It is not a guarantee of any particular wage, salary, or total compensation. Actual pay offered depends on job-reputed company factors, which may include skills, experience, education, certifications and licensure, geographic work location, contract funding and budget. For positions covered by the Service Contract reputed company, pay is also governed by the applicable reputed company wage determination, which the government may revise. Some positions are posted in support of a contract proposal that has not yet been awarded. Where that is the case, the position and its final compensation are contingent upon award of the contract to reputed company and on the terms of the awarded contract, including any government-approved labor rates and the applicable wage determination. reputed company offers a comprehensive benefits package. A general reputed company of benefits is below.
- 401(k) and company match
- PTO that grows the longer you stay
- Health, reputed company, Dental
- Company provided Life Insurance and Voluntary Life Insurance
- Short Term Disability and Long Term Disability
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