Remote RN Medical Reviewer II — Claims & Coverage

Palmetto GBA, LLC; Northern (KY); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health plans

401k

Life Insurance

Paid Time Off

Job summary

Palmetto GBA is seeking a Remote RN Medical Reviewer II to perform medical reviews and support claims decisions. Responsibilities include evaluating medical necessity, applying established guidelines, and documenting rationale.

Training begins on 12/7/2026 with a Monday–Friday schedule in a home-office environment. Ideal candidates will have active RN licensure, an associate degree in nursing, and at least two years of RN experience.

Qualifications

• Active RN licensure in state hired or compact multistate recognition.
• Associate degree in Nursing or graduate of an accredited School of Nursing.
• Two years of clinical RN experience required.

Responsibilities

• Perform medical claim reviews using criteria and guidelines.
• Determine medical necessity and reimbursement appropriateness.
• Document medical rationale for decisions and educate staff.
• Support quality control and team-based objectives.

Skills

RN licensure

Independent work

Decision making

Communication skills

Analytical thinking

Word processing

Education

Associate degree - Nursing

Graduate of accredited School of Nursing

Tools

Microsoft Office

Windows-based programs

Job description

Palmetto GBA is seeking a Remote RN Medical Reviewer II to perform medical reviews and support claims decisions. Responsibilities include evaluating medical necessity, applying established guidelines, and documenting rationale.

Training begins on 12/7/2026 with a Monday–Friday schedule in a home-office environment. Ideal candidates will have active RN licensure, an associate degree in nursing, and at least two years of RN experience.