Clinical Review Nurse — Remote

Job overview

The Clinical Review Nurse — Remote role is fully remote. Compensation is not specified. ARC Group describes these as direct-hire, full-time positions and is recruiting for multiple openings. The nurse reviews health claims and medical records to determine medical necessity, coverage, service levels, and appropriateness of care under applicable policies and accepted standards. The work supports accurate claims review and may also include provider education, corrective-action recommendations, claims processing, and special projects depending on assignment.

What you'll do

• Review and analyze complex pre- and post-payment healthcare claims, including prior authorization
• interpret and apply CMS guidelines
• assess medical necessity, utilization, coverage, and appropriateness of care
• identify provider concerns and potential overpayment or fraud and abuse
• and, depending on assignment, educate providers, recommend or implement corrective action, process claims, or participate in special projects.

What we're looking for

Skills & competencies

clinical review nurse

remote

registered nurse

rn license

medical claims review

prior authorization

medical necessity

cms guidelines

healthcare

arc group

permanent u.s. work authorization

Work arrangement

• Weekend coverage required

Benefits & perks

• The posting describes the positions as direct-hire roles with benefits but does not specify individual benefits.

Why this role

Requires a valid nursing degree, two years of clinical experience, and an unrestricted Registered Nurse (RN) license. Candidates must have permanent U.S. work authorization.

About the employer

ARC Group is hiring for this role. Industry: Employment Placement Agencies. Sector: 56.