Senior Nurse Reviewer

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Senior Nurse Reviewer based in the United States.

Make a meaningful impact on healthcare quality and claims accuracy by applying your clinical expertise to complex medical reviews. As a Senior Nurse Reviewer, you will evaluate medical records, healthcare claims, itemized medical bills, and UB-04 forms to ensure accurate billing and appropriate levels of care.

You will use clinical judgment and established criteria to assess medical necessity, validate charges, and support compliance with applicable policies and industry standards. In addition to conducting detailed reviews, you will help develop other reviewers through mentoring, training, and feedback.

This remote opportunity combines clinical analysis, utilization review, and claims auditing in a collaborative, quality-focused environment. You will also benefit from opportunities for professional development and a flexible work environment.