Clinical Review Nurse I – Medicare Part B

Clinical Review Nurse I – Medicare Part B — remote position open now. Apply today.

Remote Clinical Review Nurse I – Medicare Part B. full time. Open to candidates in Remote. Apply now.

About the Role

Anticipated End Date:

Position Title:

Job Description:

Clinical Review Nurse I – Medicare Part B

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Key Responsibilities

• Part B Medicare background is strongly preferred.
• Prior experience with claims review of Medicare is preferred.
• Requires AS in nursing and minimum of 1 year of clinical background; or any combination of education and experience, which would provide an equivalent background.
• Experience in surgical services and ICU is strongly preferred.
• Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials.
• Coding certification or background with medical coding is a plus.
• Part B Nurse Claims is strongly preferred.
• The capable of comprehend medical policies and apply criteria effectively to make informed medical review decisions, while also communicating those decisions clearly and concisely.
• This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.
• Proficient in basic math calculations with percentages.
• BS in nursing is preferred.
• Current unrestricted RN license required.

Frequently Asked Questions

Is this Clinical Review Nurse I – Medicare Part B role remote?
Yes — 100% remote. Work from anywhere in Remote.

Employment type for this Clinical Review Nurse I – Medicare Part B job?
full time. Ideal for remote professionals.

How to apply?
Click Apply Now above. Rolling interviews.

Submit your application today — this won't stay open long.