Remote RN: Clinical Records Review & QA

Managed Medical Review Organization; Eagle (ID); Remote; USD 70,000 - 95,000; Full time

Job summary

Managed Medical Review Organization is seeking a skilled registered nurse for a remote, home-office role. The position emphasizes telephonic/customer service, accurate documentation, and clinical review duties without face-to-face patient contact.

The role requires 12 pm–8 pm EST, Monday–Friday, with rotating on-call coverage on weekends/holidays. Remote work is supported, with residency in specified states and prior experience in insurance review essential.

Qualifications

• Current unrestricted RN state license.
• Graduate from an accredited School of Nursing with BSN or ADN.
• Strong computer and documentation skills.
• Minimum 2 years in healthcare insurance, appeals/grievances, UR or QA.
• Ability to work independently and maintain confidentiality.
• Effective communication with physicians, colleagues and clients.
• Strong verbal and written communication skills.
• Must be able to work 12 pm - 8 pm EST, Mon-Fri with rotating on-call weekends/holidays.

Responsibilities

• Verify conflicts of interest per policy.
• Review medical records and applicable review questions.
• Maintain communication with Physician Reviewer during review.
• Verify Physician Reviewer credentials per policy.
• Communicate delays with referring party as required.
• Discuss and review training material with Physician Reviewers.
• Maintain external reviews documentation per state requirements.
• Document all required case activities in W5.
• Input Physician Reviewer costs and client charges into W5.
• Quality review rough draft HCR reports for quality and compliance.
• Remediate quality issues identified with Physician Reviewer.
• Assist in selecting evidence-based criteria supporting rationale.
• Perform final review of HCR reports for client submission.
• Participate in orientation/training programs.
• Participate in Quality Improvement Committee/projects.
• Address ongoing quality issues with Quality Department.

Skills

Communication skills

Independent worker

Telehealth experience

Documentation accuracy

Education

RN license in good standing

BSN or ADN

Job description

Managed Medical Review Organization is seeking a skilled registered nurse for a remote, home-office role. The position emphasizes telephonic/customer service, accurate documentation, and clinical review duties without face-to-face patient contact.

The role requires 12 pm–8 pm EST, Monday–Friday, with rotating on-call coverage on weekends/holidays. Remote work is supported, with residency in specified states and prior experience in insurance review essential.