Medical Claim Review Nurse

MedNational Staffing; Long Beach (CA); Remote; USD 60,000 - 80,000; Full time

Job summary

Join a leading staffing company as a Clinical Claims Review RN. This remote position focuses on ensuring quality in medical claims and auditing processes. Ideal candidates will have an active RN license and substantial clinical experience to help maintain compliance with healthcare standards. Flexibility across U.S. time zones makes this role a great fit for detail-oriented professionals seeking impact in patient care.

Benefits

Benefits Available

Qualifications

• Active RN license required.
• 3+ years clinical nursing experience preferred.
• Experience with medical claims review or utilization management is a plus.

Responsibilities

• Review medical records and claims for accuracy.
• Conduct retrospective audits and ensure compliance with guidelines.
• Collaborate with Medical Directors and support Utilization Management teams.

Skills

Attention to detail

Documentation skills

Critical thinking

Education

Active, unrestricted RN license

3+ years clinical nursing experience

Job description

Clinical Claims Review RN – Remote | $41.98 / hrThis is a 6-month contract (Benefits Available). Possible Temp-To-Perm.Are you a detail-oriented RN with a passion for clinical accuracy and quality patient care? Join our team as a Clinical Claims Review Nurse and help ensure the integrity of our medical claims and appeals processes.In this role, you'll :

• Review medical records and claims to determine medical necessity and coding accuracy
• Conduct retrospective audits including DRG Validation, Level of Care, and Readmission reviews
• Collaborate with Medical Directors and serve as a resource to Utilization Management teams
• Ensure compliance with federal / state regulations and Molina policy guidelines

Requirements :

• Active, unrestricted RN license
• 3+ years clinical nursing experience
• Experience with medical claims review, auditing, or utilization management preferred
• Familiarity with MCG / InterQual or willingness to train
• Excellent documentation and critical thinking skills

Location : Remote, with flexibility across U.S. time zones

Pay : $41.98 / hour

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