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Remote RN - Medicare Clinical Review & Utilization
Remote / Online - Candidates ideally in
Ithaca, Tompkins County, New York, 14850, USA
Listed on 2026-08-13
Ithaca, Tompkins County, New York, 14850, USA
Listing for:
First Coast Service Options
Remote/Work from Home
position Listed on 2026-08-13
Job specializations:
-
Healthcare
Healthcare Administration, Healthcare Management
Job Description & How to Apply Below
First Coast Service Options is seeking a Clinical Review Nurse to evaluate medical necessity, coverage, and payment levels for Medicare-related claims. The role applies clinical knowledge to determine the appropriateness of care in line with CMS policies and standards.
The incumbent will review claim data and medical records, identify over payments or potential fraud, and may provide guidance to team members. Strong communication and MS Office skills are essential.
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