Remote Nurse Reviewer for Medicare and Medicaid

Step Into a Role That Matters

Imagine a position where your clinical experience powers smarter healthcare decisions for millions. As a Remote Nurse Reviewer for Medicare and Medicaid, you won’t just review documentation—you’ll help define the integrity of healthcare services nationwide. This role is about using your judgment, insight, and compassion to navigate the complexities of federal and state medical review programs from wherever you are. If you’ve been waiting to apply your nursing expertise in a creative, analytical way without stepping into a hospital, your time has arrived.

Key Responsibilities and Core Functions

Lead With Purpose

• Evaluate clinical documentation to determine medical necessity, appropriateness, and compliance with Medicare and Medicaid regulations
• Use evidence-based criteria to review pre-authorization, post-payment audits, and appeal cases
• Coordinate seamlessly with cross-functional teams and healthcare partners to clarify ambiguous documentation and support claim resolution

Shape the System

• Identify trends and gaps in documentation that may lead to denials or overpayments
• Draft reports and clinical rationales to support findings in audit reviews and policy updates
• Offer insights on improving provider education, documentation quality, and regulatory compliance

Communicate With Confidence

• Deliver concise, defensible written analyses that uphold federal standards
• Participate in virtual case review discussions and contribute to clinical quality assurance processes
• Engage with providers, peers, and compliance teams through remote collaboration tools

Remote Work Environment and Team Culture

Fully Remote & Fully Empowered

Ditch the commute and gain back your time. This position is 100% remote, designed for nurses who thrive in digital environments and prefer meaningful, flexible work. Whether you live in a bustling city or a quiet rural town, your contributions will echo across state lines.

Supportive Culture

You'll be part of a virtual team that values accuracy, collaboration, and continuous learning. Every voice matters, and every insight has the power to improve the healthcare system.

Technology and Resources Provided

Technology That Works For You

• Secure EHR platforms for reviewing and documenting clinical findings
• AI-assisted screening tools to identify red flags and patterns efficiently
• Integrated communication systems for cross-team coordination

Resources for Precision

• Access to Medicare/Medicaid guidelines, CMS manuals, and state-specific regulations
• Digital libraries with evidence-based medical review criteria (InterQual, MCG)
• Clinical education modules to stay current with policy and practice

Required Qualifications and Preferred Skills

Core Qualifications

• Active RN license (multi-state or compact preferred)
• Minimum 3 years of clinical nursing experience, preferably in case management, utilization review, or audit
• Familiarity with Medicare and Medicaid regulations and clinical coding (ICD-10, CPT)

Bonus Skills

• Experience in health insurance, managed care, or third-party medical review
• Excellent written communication and analytical thinking
• Tech-savvy with comfort in EMR/EHR platforms and digital documentation tools

Competitive Compensation and Exciting Benefits

Perks That Go Beyond Pay

• Annual Salary: $80,251 (fully remote)
• Flexible scheduling to balance work and life
• Generous PTO, wellness stipends, and virtual ergonomic support
• Online learning courses and professional development resources
• Mission-driven environment with real impact on healthcare outcomes

Company Mission and Industry Impact

A Mission That Moves Healthcare Forward

This company was born out of a bold idea: that medical expertise and advanced technology can come together to drive smarter, more compassionate healthcare. By uniting clinical intelligence with scalable digital solutions, we’ve built a system that values both patients and professionals. As a Remote Nurse Reviewer, you help us uphold that mission every day by ensuring accuracy, fairness, and quality in coverage decisions.

Application Process and Career Growth

Your Next Step

If you're a creative, detail-obsessed nurse who thrives in a digitally connected world, this is your moment. Your clinical judgment will be heard, respected, and amplified. You'll help drive policies that shape care for millions, all while building a career with depth and flexibility.

Apply Now — Your Future Is Calling

Join a team that’s changing the narrative around healthcare audits. Take your career beyond the bedside and into the world of healthcare innovation.

Your next big opportunity awaits—apply now!