Remote Medical Review RN

Make an Impact as a Remote Medical Review RN

Are you ready to take charge of your future and contribute your clinical expertise in a way that drives change? As a Remote Medical Review RN, you will have the opportunity to combine the power of nursing knowledge with the efficiency of digital platforms, serving as a key contributor to enhancing the precision, compliance, and quality of healthcare decisions across a growing network. This is more than just a work-from-home role—it's your chance to help shape the future of healthcare, one case at a time, from the comfort of your space.

About the Role

In this position, you’ll be the go-to expert for clinical documentation review, ensuring that healthcare services align with evidence-based practices, payer guidelines, and quality standards. As part of a forward-thinking team committed to accountability and results, your analytical skills and nursing judgment will have a direct impact on patient outcomes and cost-effective care delivery. Imagine impacting lives and outcomes while working in a role designed to honor your skills and fuel your career growth.

Key Responsibilities

Clinical Evaluation and Documentation

• Thoroughly assess clinical documentation to ensure it supports the level of care provided
• Evaluate medical necessity and appropriateness of treatments using evidence-based guidelines.
• Interpret patient histories, test results, and physician notes to validate medical decisions.

Compliance and Standards

• Apply regulatory requirements and payer-specific criteria to each review
• Maintain up-to-date knowledge of federal, state, and accreditation regulations
• Document findings concisely and accurately in compliance with organizational protocols

Interdisciplinary Communication

• Collaborate with physicians, case managers, and external auditors for clarification and additional insight.
• Provide clinical recommendations when discrepancies arise
• Support the development of internal guidelines and peer review strategies

Quality Enhancement

• Identify opportunities to reduce unnecessary procedures or duplicate services.
• Participate in process improvement initiatives to enhance review efficiency and quality.
• Offer feedback to leadership on trends that may impact service delivery

Work Environment and Team Culture

Joining this fully remote role means stepping into a supportive, collaborative culture that values innovation, transparency, and continuous learning. Our virtual team spans multiple regions and thrives on trust, communication, and a shared purpose. You’ll be backed by experienced peers who are passionate about quality healthcare and who believe in uplifting each other through challenges and wins alike. You’re not just logging in; you’re stepping into a dynamic, digital-first care team dedicated to real-world results.

Tools and Technology

To help you stay focused and efficient, you’ll use:

• Advanced Electronic Medical Records (EMR) systems
• AI-enhanced review platforms for intelligent case routing
• Secure communication tools to facilitate real-time collaboration
• Cloud-based dashboards for streamlined documentation and reporting

Your onboarding includes in-depth training on all systems, ongoing tech support, and access to a library of resources that empower you to stay sharp and efficient while reviewing each case with confidence.

What You Bring to the Table

Required Qualifications

• Current and valid RN licensure without limitations within the U.S.
• At least three years of hands-on experience in a clinical nursing setting, preferably in acute care or case management
• Deep understanding of clinical guidelines, utilization review, and care coordination principles

Preferred Experience

• Prior experience in medical review, utilization management, or audit-based roles
• Proficiency in interpreting ICD-10 and CPT codes
• Familiarity with Milliman or InterQual criteria

Key Competencies

• Strong clinical judgment and critical thinking
• Ability to navigate complex medical records with precision
• Excellent written and verbal communication
• Exceptionally detail-oriented and skilled at managing time-sensitive tasks in a fast-paced environment

Perks That Make a Difference

We know that meaningful work deserves meaningful benefits. Here's what you can expect:

• Competitive annual salary of $115,632
• Generous paid time off and flexible scheduling
• 100% remote work setup with equipment provided
• Comprehensive health, dental, and vision insurance
• Continuing education reimbursement and professional development resources
• Performance bonuses and career advancement paths

This is your moment to make a difference in a role that honors both your passion and expertise. Whether you’re looking for more work-life balance or a position that leverages your skills in new ways, this opportunity is designed to elevate your nursing career.

Growth and Development Opportunities

We believe in rewarding ambition and nurturing excellence. As a Remote Medical Review RN, you'll have:

• Ongoing mentorship from industry leaders
• Access to peer forums and clinical knowledge exchanges
• Opportunities to specialize in high-impact clinical areas
• Pathways to leadership roles and specialized certifications

As the organization continues to grow, so do your possibilities. We celebrate success and encourage your professional journey at every stage.

Who This Role Is Perfect For

This position is ideal for an experienced RN who thrives in a structured, analytical environment and wants to stay clinically connected while enjoying the autonomy of remote work. If you're driven by quality, inspired by data-driven outcomes, and ready to be part of a purpose-driven team, you'll feel right at home here.

Your Next Big Opportunity Awaits—Apply Now!

Why wait to make an impact? Step into a role where your voice matters, your expertise is valued, and your contributions lead to better healthcare every day. Take charge of your future and join a mission that moves healthcare forward with intelligence, compassion, and clinical excellence.

The future of care is remote, and it's calling for professionals like you. Apply now to become a Remote Medical Review RN and bring your best to every case—from anywhere.