Clinical Nurse Reviewer — Remote, Maryland
Compensation
$45 – $60 /hr
Employment type
Full-time
Work setting
On-site
Location
Virginia Beach, VA
Schedule
Day shift
Posted
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Job overview
The Clinical Nurse Reviewer role is remote for candidates based in Maryland. Pay is $45–$60 per hour. Commence’s reviewer role supports healthcare quality and compliance by evaluating records, treatment plans, and procedures. The reviewer assesses medical necessity and care quality, checks documentation against applicable standards, and records findings and recommendations to support coverage determinations, appeals, and regulatory compliance.
What you'll do
- Review patient records for accuracy, completeness, and compliance
- assess care quality and medical necessity
- check provider documentation
- conduct peer reviews
- provide recommendations for coverage determinations and appeals
- document findings in patient management systems
- and stay current with clinical guidelines and regulations.
What we're looking for
- Skills & competencies
- clinical nurse reviewerregistered nurseremotemaryland-basedcommencemedical record reviewutilization reviewquality assurancemedical necessitycoverage determinationsinterqualmilliman care guidelines$45–$60/hractive rn license
- Work arrangement
- Weekend coverage required
Why this role
Remote opportunity for Maryland-based candidates; active state-specific RN license required; familiarity with InterQual or Milliman Care Guidelines is an additional requirement.
About the employer
Commence is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.
Additional details
- Industry sector
- 52
- Industry
- Direct Health and Medical Insurance Carriers
- Occupation code
- 29-1141.00
You'll be redirected to the employer's application page.
Listing ID: 7b33658d-afe6-43d5-b757-b100ef9a4dd0