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Remote Nurse Reviewer Medicaid Medical Necessity Part-Time
Remote / Online - Candidates ideally in
Lancaster, Lancaster County, Pennsylvania, 17622, USA
Listed on 2026-08-05
Lancaster, Lancaster County, Pennsylvania, 17622, USA
Listing for:
Healthcare Quality Strategies, Inc. (HQSI)
Part Time, Remote/Work from Home
position Listed on 2026-08-05
Job specializations:
-
Healthcare
Healthcare Nursing
Job Description & How to Apply Below
Healthcare Quality Strategies, Inc. (HQSI) seeks a Nurse Reviewer for a part-time, remote role (20-30 hours/week). The RN reviews medical necessity and policy compliance for Medicaid claims, applying ICD-10, CPT, and HCPCS coding against Inter Qual/MCG criteria.
The position collaborates with the Team Lead and contract team, ensuring timely reviews, HIPAA/HITECH compliance, and accurate documentation in a centralized database.
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