Remote Medical Review Nurse

Introduction: Help Drive Clinical Excellence from Anywhere

Are you a seasoned nursing professional with a passion for clinical integrity and patient advocacy? As a Remote Medical Review Nurse, you will have the opportunity to make a real impact without stepping into a traditional healthcare setting. This role offers the perfect blend of purpose, flexibility, and career growth. If you’re energized by evidence-based practice, healthcare quality assurance, and working autonomously in a tech-enabled environment, we invite you to apply and shape your future with us.

About the Role: Purpose Meets Professional Growth

In this pivotal position, you’ll be responsible for reviewing medical records, treatment plans, and clinical documentation to assess the validity and clinical justification for services. Your expertise will ensure healthcare decisions are fair, well-informed, and align with clinical standards. The position calls for precision, clinical judgment, and the ability to work independently while maintaining collaborative relationships with interdisciplinary teams. This is more than just a job—it’s a platform for continuous growth and meaningful contribution to patient care quality.

Key Responsibilities: Uphold Standards, Improve Outcomes

Core Duties

• Analyze patient documentation for compliance with regulatory guidelines and payer criteria
• Evaluate treatment plans and care delivery against evidence-based standards
• Draft clear, concise medical reviews and determinations
• Collaborate with physicians, case managers, and compliance teams to ensure accurate decision-making
• Monitor trends and identify opportunities for care improvement and utilization effectiveness
• Participate in peer review processes and internal quality assurance audits
• Remain current on healthcare regulations, coding updates, and review protocols

Work Environment: Empowerment and Flexibility Combined

This fully remote position supports a balanced and productive lifestyle. You’ll enjoy autonomy in your daily workflow, with access to collaborative digital tools, clinical databases, and expert guidance when needed. Expect a culture of mutual respect, innovation, and continuous professional support. Whether you’re working from a home office or traveling temporarily, this role adapts to your lifestyle while maintaining high standards of clinical accountability.

Technology & Tools: Enabling Clinical Precision Remotely

We believe that high-quality care review starts with top-tier resources. You will work with secure EHR systems, medical coding platforms, AI-powered clinical support tools, and HIPAA-compliant communication channels. These tools are designed to optimize efficiency and accuracy in every stage of the medical review process. Familiarity with platforms like Epic, InterQual, or MCG will enhance your performance, though comprehensive onboarding and training are provided.

Qualifications: Experience That Drives Impact

Required Credentials and Expertise

• Active, unrestricted RN license in your practicing state
• Minimum of five years of clinical nursing experience, ideally in acute care or utilization management
• At least two years in a medical review, case management, or clinical documentation role
• Strong understanding of ICD-10, CPT codes, and clinical review criteria such as InterQual or MCG
• Proficiency with EHR systems and remote communication tools
• Exceptional analytical thinking, clinical writing, and decision-making skills
• Ability to work independently and meet regulatory deadlines without direct supervision

What You’ll Gain: Growth, Balance, and Recognition

This opportunity is designed for professionals who seek advancement without compromising personal wellness. You’ll benefit from:

Professional Benefits

• A flexible remote schedule with supportive digital infrastructure
• Opportunities to lead internal improvement initiatives
• Access to certifications, continuing education, and leadership training
• A values-driven organization focused on outcomes and innovation
• Recognition for your contributions to equitable and accurate healthcare delivery

Compensation and Benefits

This role offers an annual salary of $87,949, along with a comprehensive suite of benefits, including medical coverage, leave allowances, continuing education stipends, and performance-based bonuses. You’ll also gain access to mentorship programs and long-term career development pathways that align with your ambitions.

Join a Mission That Matters

In an era where healthcare decisions affect millions, your expertise can create ripples of positive change. As a Remote Medical Review Nurse, you will be the clinical voice advocating for quality, fairness, and better outcomes. Whether you’re looking to expand your nursing career into health policy, compliance, or virtual care leadership, this position provides the foundation to make that leap.

Call to Action: Apply Today and Make Your Impact Count

If you're a detail-oriented RN seeking to elevate healthcare from behind the scenes, we want to hear from you. Take the next step and join a dedicated team that values integrity, empowers individual growth, and redefines what it means to care—virtually and impactfully. Your future in clinical excellence starts here.