Calabria Group- REMOTE Registered Nurse - Clinical Review

Progressive Technology; Philippines; Remote; Full time

Benefits offered by this job

Health, dental, and vision insurance

Paid time off and paid holidays

Ongoing professional development opportunities

Job summary

A healthcare innovation company is seeking a Registered Nurse (RN) to join their remote Clinical Review team. This non-clinical position will evaluate medical records and pre-authorization requests. Ideal candidates will have an active RN license in the U.S. and at least three years of clinical experience. Enjoy competitive compensation, health insurance, and a fully remote work environment.

Qualifications

• Active and unrestricted RN license in the U.S.
• 3 years of clinical nursing experience, preferably in acute care.
• Proven knowledge of clinical care standards and medical necessity criteria.

Responsibilities

• Conduct clinical reviews of medical records and pre-authorization requests.
• Ensure adherence to regulations related to healthcare reviews.
• Document review findings clearly and concisely.

Skills

Critical thinking

Organizational skills

Communication skills

Computer literacy

Education

RN license in the United States

Tools

EMRs

Microsoft Office Suite

Clinical review platforms

Job description

Job Summary

Progressive Technology, in partnership with the Calabria Group, is seeking a highly motivated and experienced Registered Nurse (RN) to join our remote Clinical Review team. This is a non-clinical position focusing on the evaluation of medical records, pre-authorization requests, and clinical documentation to ensure quality care, compliance with medical policies, and appropriate utilization of healthcare services. This is an excellent opportunity for RNs seeking a transition from bedside care to a dynamic, remote work environment.

Key Responsibilities

• Conduct clinical reviews of medical records and pre-authorization requests to determine medical necessity and appropriateness of care.

• Apply clinical knowledge, judgment, and established guidelines to review complex cases efficiently and accurately.

• Communicate with physicians, healthcare providers, and internal teams to clarify or obtain additional medical documentation.

• Ensure adherence to all federal and state regulations, as well as internal policies related to healthcare reviews and medical necessity.

• Document review findings and decisions in the appropriate system in a clear and concise manner.

• Participate in peer reviews and interdepartmental meetings to support continuous improvement efforts.

• Provide subject matter expertise to support appeals, denials, and audit processes.

• Maintain confidentiality and adhere to HIPAA and company-specific security protocols at all times.

Required Skills and Qualifications

• Active and unrestricted Registered Nurse (RN) license in the United States.

• Proven knowledge of clinical care standards, medical necessity criteria, and utilization management principles.

• Proficient in interpreting clinical notes, treatment plans, and diagnostic reports.

• Exceptional critical thinking, organizational, and decision-making skills.

• Excellent verbal and written communication skills.

• High level of comfort working independently in a remote environment with minimal supervision.

• Strong computer literacy, including proficiency with EMRs, Microsoft Office Suite, and clinical review platforms.

Experience

• Minimum of 3 years of clinical nursing experience, preferably in acute care, case management, or utilization review.

• Prior experience in clinical review, utilization management, or insurance-related roles is highly desirable.

• Experience with healthcare documentation standards, insurance authorizations, and managed care processes.

Working Hours

• Monday to Friday, 8:00 AM – 5:00 PM (your local time zone).

• No weekends or on-call shifts.

• Flexibility may be required depending on workflow or regional review timelines.

Knowledge, Skills, and Abilities

• Strong clinical acumen with the ability to evaluate the appropriateness of care.

• Deep understanding of medical terminology, ICD-10, CPT coding, and evidence-based clinical guidelines.

• Familiarity with NCQA, URAC, and CMS standards.

• Ability to work in a fast-paced, deadline-driven environment.

• Effective time management and multitasking abilities in a virtual setting.

Benefits

• Competitive hourly or salaried compensation (depending on contract).

• 100% Remote – work from anywhere in the U.S.

• Health, dental, and vision insurance (eligibility based on employment type).

• Paid time off and paid holidays (where applicable).

• Ongoing professional development opportunities.

• Supportive and collaborative team environment.

Why Join Us

At Progressive Technology, Calabria Group, we are committed to innovation in healthcare and excellence in clinical review. As part of our remote RN team, you will play a vital role in ensuring patients receive the right care at the right time while enjoying the flexibility and freedom of remote work. Join a forward-thinking organization where your nursing skills make a difference behind the scenes—and beyond the bedside.

How to Apply

Ready to bring your nursing expertise into a dynamic, non-clinical role?
Please submit your updated resume and cover letter to our recruitment team or apply directly through our careers portal. Shortlisted candidates will be contacted for a virtual interview.