Remote utilization review nurse jobs in Bayonne, New JerseyCreate job alerts

Job Description Role Overview We’re seeking experienced Utility Management Nurses to support a client’s healthcare product development by leveraging expertise in insurance coding and hospital revenue management workflows. This role involves collaborating with hospital systems to align medical documentation with insurance policies, ensuring accurate coding and optimal reimbursement outcomes. Key Responsibilities * Insurance Coding & Revenue Cycle Alignment: Review, audit, and optimize insurance coding practices across hospital systems to ensure compliance and maximize reimbursement accuracy. * Workflow Analysis: Evaluate existing revenue management workflows and recommend improvements tailored to client’s AI-driven documentation tools. * Clinical Data Interpretation: Translate complex clinical notes into standardized coding formats (ICD-10, CPT, HCPCS) aligned with payer policies. * Policy Matching: Assess coding accuracy against insurance guidelines and payer documentation requirements. * Product Development Collaboration: Work closely with client’s engineering and product teams to refine AI models that automate or assist with medical coding and documentation. * Compliance & Quality Assurance: Ensure alignment with HIPAA, CMS, and payer-specific coding regulations. Required Qualifications * Licensure: Registered Nurse (RN) or equivalent clinical background. * Experience: Minimum 3–5 years in medical coding, clinical documentation improvement (CDI), or revenue cycle management. * Certifications: CPC, CCS, or CRC certification preferred. * Domain Expertise: Familiarity with hospital billing systems, payer policy interpretation, and coding audit procedures. * Analytical Skills: Strong understanding of clinical documentation standards and payer logic. * Tech Savvy: Comfortable working with EHR systems (Epic, Cerner, Meditech) and documentation review software. Preferred Qualifications * Experience working within hospital revenue integrity teams or insurance utilization management. * Exposure to AI-powered healthcare documentation tools or automated coding systems. * Ability to identify and flag edge cases or policy exceptions in automated workflows. * Strong collaboration skills with cross-functional (engineering, compliance, and data) teams. Engagement Model • Contract / Part-time (Remote/In person) — Flexible hours with collaboration during U.S. business hours. In person in San Francisco is a plus

Role Overview We’re seeking experienced Utility Management Nurses to support a client’s healthcare product development by leveraging expertise in insurance coding and hospital revenue management workflows. This role involves collaborating with hospital systems to align medical documentation with insurance policies, ensuring accurate coding and optimal reimbursement outcomes. ### Key Responsibilities - Insurance Coding & Revenue Cycle Alignment: Review, audit, and optimize insurance coding practices across hospital systems to ensure compliance and maximize reimbursement accuracy. - Workflow Analysis: Evaluate existing revenue management workflows and recommend improvements tailored to client’s AI-driven documentation tools. - Clinical Data Interpretation: Translate complex clinical notes into standardized coding formats (ICD-10, CPT, HCPCS) aligned with payer policies. - Policy Matching: Assess coding accuracy against insurance guidelines and payer documentation requirements. - Product Development Collaboration: Work closely with client’s engineering and product teams to refine AI models that automate or assist with medical coding and documentation. - Compliance & Quality Assurance: Ensure alignment with HIPAA, CMS, and payer-specific coding regulations. ### Required Qualifications - Licensure: Registered Nurse (RN) or equivalent clinical background. - Experience: Minimum 3–5 years in medical coding, clinical documentation improvement (CDI), or revenue cycle management. - Certifications: CPC, CCS, or CRC certification preferred. - Domain Expertise: Familiarity with hospital billing systems, payer policy interpretation, and coding audit procedures. - Analytical Skills: Strong understanding of clinical documentation standards and payer logic. - Tech Savvy: Comfortable working with EHR systems (Epic, Cerner, Meditech) and documentation review software. ### Preferred Qualifications - Experience working within hospital revenue integrity teams or insurance utilization management. - Exposure to AI-powered healthcare documentation tools or automated coding systems. - Ability to identify and flag edge cases or policy exceptions in automated workflows. - Strong collaboration skills with cross-functional (engineering, compliance, and data) teams. ### Engagement Model - Contract / Part-time (Remote/In person) — Flexible hours with collaboration during U.S. business hours. In person in San Francisco is a plus

Job Description Registered Nurse / Clinical Editor / Proofer - Remote, New York State (#25297) • Location: Remote, • Employment Type: Full-time, • Hourly Rate: $45/hr About Greenlife Healthcare Staffing: Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals. Position Overview: We are seeking a detail-oriented Registered Nurse with strong editorial skills to review NYS Dispute Resolution and External Review determinations. This remote position combines clinical expertise with editorial precision to ensure accurate, compliant, and professionally presented case documents while improving team performance through error tracking and staff training. Why Join Us? • Work Schedule: Full-time, Remote. Sunday to Thursday (9:00 AM - 5:30 PM), • Professional Growth: Gain valuable experience in healthcare policy and medical editing, • Impactful Work: Ensure accuracy and compliance in state healthcare dispute resolutions Key Responsibilities: This individual will review all NYS Dispute Resolution and External Review determinations for accuracy of decisions, mathematical determinations, content, grammar, punctuation, and state-required conventions. They will utilize their clinical knowledge and editorial skills to produce a final, clean copy for each case determination. They will track errors and retrain clinical and administrative staff to mitigate production errors. • Conduct a thorough review of pre-final dispute determinations using checklist tools., • Make clinical and mathematical edits to responses using provided case documentation, as necessary., • Consult with team members and supervisors as necessary to improve the final product., • Complete edits check of content, references, grammar, spelling, and punctuation before release of final product., • Maintain tracking and trending of errors and use findings to analyze areas of concern and highlight areas of improvement., • Will provide technical assistance and conduct/participate in staff huddles., • Other activities as may be deemed necessary Greenlife Healthcare Staffing - Empowering Healthcare Professionals, Enriching Lives Requirements Qualifications: • Education: Baccalaureate degree in Nursing or a graduate of an approved RN program, • Licensure: Active New York State RN license, • Experience:, • Must have a minimum of 2 years of experience in an acute care facility, preferably in medicine/surgery or special care units, and one to 3 years of experience in acute care utilization review., • Must have post-graduate studies demonstrating proficiency in writing, editing, and proofing skills., • Technical Skills: Must have knowledge and experience with electronic medical records, including coding, quality, and clinical charting., • Soft Skills: Must have the ability to oversee, problem-solve, and work collaboratively with peers, medical, analytical, and administrative support staff., • Competitive Compensation: Earn $45 per hour, • Comprehensive Benefits:, • Vacation Leave, • 6 Major Paid Holidays per year, • 5 Sick Days (40 Hours) subject to the provisions of NYS Paid Sick Leave Act, • License Reimbursement after 1 year of employment, • Health insurance is subject to plan eligibility requirements, • 401k Matching eligibility after 1 year of employment, • Benefits from Paychex, such as Payactiv, • GLHS is a great company to work for: 93% retention of employees 2 years+, Google reviews, great company culture, etc.

RN- Utilization Review Nurse. Inpatient - Full Time - 100% Remote Opportunity -. VillageCare is loo Nurse, Medical Director, Healthcare, RN.

A national health services organization seeks a Clinical Review Nurse for Prior Authorization to analyze medical necessity of services. The role is remote, requiring an active New York nursing license and 2-4 years of relevant experience.

Manage the utilization review process, ensuring that healthcare services are medically necessary, appropriate, and cost-effective. Manage the supervision of clinical Utilization Management (UM) staff. Track and evaluate data related to utilization patterns, identifying trends, and developing strateg