Medical Claim Review Nurse | Remote | Washington

Back Medical Claim Review Nurse | Remote | Washington | Contract Business & Care Management Long Beach , California Contract Aug 11, 2026

Walker Healthforce is seeking a Medical Claim Review Nurse with strong appeals review and medical claims experience to support retrospective medical necessity reviews, payment integrity initiatives, and clinical claim validation for Molina Healthcare of Washington
. This is a fully remote contract opportunity.

Start Date: ASAP

Location: Remote – Candidates must reside in Washington

Schedule: Monday-Friday | 8:00 AM-5:00 PM PST

Worker Type: W2 Contract

• Active unrestricted RN license preferred (LPN/LVN accepted)
• 3–5 years of appeals review experience preferred
• Experience performing retrospective medical claims review
• Experience reviewing medical necessity determinations
• Knowledge of ICD-10, CPT, and HCPCS coding
• Billing and coding experience
• Knowledge of state, federal, and third-party regulations
• Strong analytical and critical thinking skills
• Excellent written and verbal communication skills
• Microsoft Office proficiency

• Payment Integrity experience
• DRG validation experience
• Itemized bill review experience
• Managed Care experience
• Experience using PEGA A&G, PEGA UM, or QNXT
• Utilization Management experience

• Perform retrospective clinical reviews of medical claims and appeals
• Validate medical necessity, coding accuracy, and reimbursement
• Review clinical documentation supporting post-claim denials
• Evaluate authorizations, level of care, and billing compliance
• Apply clinical guidelines and regulatory requirements during reviews
• Document review findings accurately within assigned systems
• Collaborate with Medical Directors regarding denial decisions
• Provide clinical support to utilization management and provider appeals
• Participate in payment integrity and coding validation activities
• Maintain productivity, quality, and compliance standards

• Competitive compensation
• Weekly Direct Deposit
• Medical, Dental & Vision benefits
• 401(k) options

• Dedicated healthcare recruiting specialists
• Resume and interview preparation
• Ongoing consultant support throughout your assignment
• Access to opportunities with leading healthcare organizations

Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community. As a certified WMBE, we provide healthcare IT and clinical staffing solutions to hospitals, health systems, and payer organizations nationwide. We are healthcare experts, custom-not commodity—and have been exceeding expectations for nearly 20 years.

Walker Healthforce is an Equal Opportunity Employer committed to fostering a diverse and inclusive workforce. All qualified applicants will receive consideration for employment.