Medical Review Nurse Analyst
$68,000–$70,000 year
Remote · Texas, United States or Illinois, United States
Job Summary
Medical Review Nurse Analyst conducts clinical reviews of medical records to determine medical necessity and ensure compliant reimbursement under Medicare guidelines; reviews claims, educates providers on billing/documentation requirements, and supports CMS regulations and program integrity. Requires RN license (BSN/ASN), 1+ year clinical experience, strong communication, and familiarity with medical record review and coding; remote work available in specified US states. Benefits include remote work options, performance bonuses, 401(k) matching, health/dental/telehealth, and professional development.
Required Qualifications
- Associate’s (ASN) or Bachelor’s Degree in Nursing (BSN)
- Active RN license, applicable to state of practice in good standing
- 1 or more years of clinical experience in a healthcare setting (hospital, homecare, skilled nursing, etc.)
- Excellent written and verbal communication skills
- Strong attention to detail and organizational skills
- Basic knowledge and understanding of medical/clinical review processes
- Solid computer skills with experience with MS Outlook, Teams, OneNote, Word, and Excel
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