Nurse Remote Medical Review Specialist id-19114
UnityPoint Health is seeking a dedicated and experienced Nurse Remote Medical Review Specialist to join our team. In this fully remote position, you will be responsible for reviewing medical records and documentation, ensuring the accuracy and compliance of healthcare claims, and working collaboratively with healthcare providers to improve patient outcomes. Your expertise will contribute directly to the quality of care provided to our patients.
As part of UnityPoint Health, one of the nation's leading healthcare providers, you’ll work within a supportive, innovative, and compassionate environment.
Responsibilities:
- Review and analyze medical records and documentation for compliance with healthcare regulations.
- Perform accurate and thorough medical reviews to ensure medical necessity and appropriateness of services provided.
- Collaborate with providers, case managers, and other healthcare professionals to resolve any discrepancies or issues with claims.
- Provide timely and detailed feedback regarding documentation requirements and clinical coding.
- Assist in the development and maintenance of policies and procedures related to medical review.
- Support initiatives aimed at improving care quality and patient safety.
- Stay up-to-date with medical trends, billing practices, and insurance policies.
- Communicate effectively with both clinical and administrative teams to resolve claims and improve patient care processes.
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Requirements:
- Active Registered Nurse (RN) license in good standing.
- Minimum of 3 years of clinical nursing experience (preferably in case management, utilization review, or related fields).
- Previous experience in medical review, chart auditing, or health insurance claims review is highly desirable.
- Strong understanding of healthcare regulations, coding, billing, and insurance processes.
- Excellent communication, problem-solving, and organizational skills.
- Proficiency in using electronic health records (EHR) and Microsoft Office Suite.
- Ability to work independently in a remote setting with minimal supervision.
- Strong attention to detail and accuracy.
- Ability to maintain confidentiality and work in compliance with HIPAA regulations.
Benefits:
- Competitive salary with opportunities for advancement.
- Generous paid time off (PTO) and holiday pay.
- 401(k) with company matching.
- Employee wellness programs and resources.
- Tuition reimbursement and professional development opportunities.
- Work-from-home flexibility with a focus on work-life balance.
- Comprehensive paid orientation and ongoing training programs.
Health Insurance:
- Health, dental, and vision coverage options.
- Prescription drug coverage.
- Health savings account (HSA) and flexible spending account (FSA) options.
- Employee assistance program (EAP) to support mental health and well-being.
- Life insurance and long-term disability coverage.
Why Join Us?
At UnityPoint Health, we believe in providing compassionate, high-quality care to every patient, and we treat our team with the same level of respect and care. Joining us means you’ll have access to opportunities for professional growth, a supportive work environment, and a chance to make a meaningful impact on patient outcomes. We value diversity, equity, and inclusion and strive to create a workplace where all employees feel valued and appreciated.
How to Apply:
If you are ready to take the next step in your career and join a leading healthcare organization, apply today! Simply click the "Apply Now" button to submit your resume and cover letter for consideration. We look forward to hearing from you!
