Remote Medicare RN Specialist

Make an Impact from Anywhere

Are you ready to take charge of your future while shaping the health outcomes of Medicare recipients nationwide? We’re on the lookout for an experienced Remote Medicare RN Specialist who brings deep clinical expertise, policy awareness, and a passion for meaningful change. If you’re seeking a dynamic remote position where your insights can influence care decisions and compliance, this is your next big opportunity.

How You’ll Drive Purpose and Progress

Primary Responsibilities

• Review and analyze Medicare clinical documentation to ensure regulatory compliance.
• Interpret CMS guidelines and apply appropriate coverage criteria.
• Work alongside diverse clinical departments to craft individualized patient strategies aligned with Medicare standards.
• Deliver case evaluations with timeliness and accuracy to support patient outcomes.
• Identify and flag documentation gaps that may impact claim approvals or reimbursements.
• Communicate effectively with providers to clarify or obtain needed information.
• Stay current with Medicare updates and proactively apply new knowledge to day-to-day work.

Role in Organizational Growth

As the healthcare landscape rapidly evolves, this role is crucial in guiding policy adherence and strengthening reimbursement strategies. You’ll help ensure our team remains at the forefront of Medicare compliance, making you a vital force in the company's forward momentum.

Work From Home, Work With Purpose

Remote Work Environment

Take advantage of the freedom and autonomy offered by a remote role while staying deeply connected with a collaborative team. You'll have the tools and support to thrive, no matter where you are:

• HIPAA-compliant virtual workspaces
• Regular video check-ins with colleagues and leadership
• Structured onboarding and ongoing mentorship

Tools and Technology You’ll Use

• Medicare claims review software
• Secure cloud-based EHR systems
• CMS regulations databases
• Internal dashboards for case progress tracking
• Video conferencing tools for virtual rounds and training

What You Bring to the Table

Qualifications & Experience

• Active RN license with multistate eligibility (required)
• Minimum of 3 years in clinical nursing, with at least 1 year in Medicare case review or utilization management
• Deep understanding of CMS regulations and Medicare Advantage plans
• Familiarity with ICD-10 coding and healthcare documentation standards
• Strong analytical mindset and confident decision-making skills
• Excellent written and verbal communication
• Proficiency in remote collaboration tools

Bonus Skills (Not Required, but Valued)

• Credential in healthcare quality management, such as CPHQ or equivalent
• Prior experience with Medicare audits or appeals
• Bilingual capabilities

Exciting Benefits & Perks

Take your career to the next level while enjoying perks designed for balance, growth, and satisfaction:

• Competitive salary: ★★ $126,742 annually ★★
• Generous PTO and flexible scheduling
• Health, dental, and vision coverage from day one
• Wellness stipends for home office upgrades
• Career coaching and leadership development tracks
• Company-sponsored continuing education and certifications
• Recognition programs and employee spotlights

Culture That Energizes and Elevates

Company Ethos

We’re a team of mission-driven healthcare professionals who believe in equitable access, clinical integrity, and the power of remote collaboration. Innovation is our backbone, and we celebrate wins as a community, whether it’s a small breakthrough or a significant organizational milestone.

Inclusion and Belonging

Everyone deserves to feel seen, heard, and supported. We prioritize inclusion not just in language but in daily practice, creating a workplace where individuality powers collective success.

Growth Starts Here

Joining us means stepping into a career path filled with potential. From clinical leadership opportunities to cross-functional project involvement, your journey doesn’t stop at job satisfaction—it expands into professional evolution. We’ll invest in you through:

• Personalized development plans
• Access to industry thought leaders
• Participation in national remote healthcare symposiums

Your Next Big Opportunity Awaits—Apply Now!

If you’re passionate about Medicare policy, clinical excellence, and empowering patients through remote care, we want to hear from you. Seize the chance to contribute to something greater, all while enjoying the work-from-home lifestyle that suits your life and goals.

Apply now and make your impact where it matters most!