Remote Nursing Jobs: Verified Work-From-Home RN Career Directory

Evaluate inpatient acute admissions, level of care, and surgical length-of-stay using InterQual clinical criteria and CMS Two-Midnight guidelines.

Review ongoing hospitalizations for Medicaid and Medicare Advantage enrollees against Milliman Care Guidelines (MCG) to support safe discharge planning.

Perform forensic chart audits on overturned or disputed medical claims. Prepare comprehensive clinical rationales for medical director dispute arbitration.

Weekend asynchronous chart review for emergency department observation vs inpatient placement. Shift differential applied.

Dedicated California HMO utilization management. Review complex tertiary and quaternary admissions for Northern and Southern California regions.

Review elective orthopedic, bariatric, and cardiovascular outpatient surgical requests against clinical coverage policies for Medicare Advantage members.

Manage inpatient psychiatric, residential treatment, and substance use disorder admissions using ASAM and MCG criteria.

Authorizations and level-of-care determinations for pediatric and adult Medicaid recipients. Ensuring compliance with state health department directives.

Flexible PRN schedule (15-25 hrs/wk). Review retrospective acute hospital claims and write comprehensive medical necessity appeal determinations.

Prepare clinical briefing packets for Medical Director peer-to-peer discussions. Coordinate overturned determinations directly with hospital CFOs.

Coordinate multi-specialty outpatient care for patients with multi-morbid conditions (CHF, COPD, CKD). Formulate individualized clinical care plans.

Navigate solid organ and bone marrow transplant candidates through pre-transplant workup, Center of Excellence selection, and post-transplant recovery.

Provide dedicated telephonic education, chemo side-effect symptom management, and psychosocial support to oncology patients undergoing active therapy.

Telephonic case management for pregnant Medicaid members with preeclampsia, gestational diabetes, and preterm labor risks.

Coordinate transitions from acute hospitals into skilled nursing facilities (SNF) and long-term post-acute care networks using integrated cloud health data.

Remote patient monitoring and telephonic titration guidance for heart failure (HF) and hypertension (HTN) populations.

Coordinate clinical care and home infusion administration for ultra-rare enzyme replacement, hemophilia, and biologic therapies.

Facilitate return-to-work rehabilitation and clinical treatment authorizations for occupational injury claimants across California.

Support families of children with complex congenital anomalies, tracheostomies, and enteral nutrition needs in community settings.

Flexible 20-hour weekly schedule conducting telephonic health risk assessments for newly enrolled dual-eligible Medicare/Medicaid seniors.

Perform rapid inbound symptom triage using standardized Schmitt-Thompson clinical algorithms. Direct callers to emergency, urgent, or home care.

Dedicated evening triage for pediatric parent helplines (5:00 PM - 1:30 AM EST). High shift differential and acute symptom protocol support.

Inbound clinical helpline triage for employer health plans. Provide instant telephonic advice, medication interaction checks, and provider referrals.

Conduct telephonic triage and schedule same-day virtual urgent visits with Kaiser Permanente primary care physicians and specialists.

100% asynchronous clinical message routing. Review incoming patient portal inquiries, lab result notifications, and medication renewal requests.

Select your weekend shifts (12 to 24 hrs/wk). Provide triage coverage for regional health plans using standardized clinical triage protocols.

Provide immediate clinical de-escalation, suicide risk assessment, and acute psychiatric triage for callers in emotional crisis.

Audit automated high-risk biometric alerts from connected glucose meters, pulse oximeters, and cardiac wearables. Reach out to at-risk patients.

First-report-of-injury phone triage for corporate workplaces. Provide immediate first-aid guidance and direct injured workers to occupational clinics.

Provide fluent Spanish/English telephone triage services to diverse Medicaid populations. Differential pay applied for certified bilingual proficiency.

Audit concurrent inpatient medical records to ensure accurate capture of principal diagnoses, CC/MCC comorbidities, and severity of illness (SOI/ROM).

Review outpatient and primary care documentation for accurate Hierarchical Condition Category (HCC) risk adjustment under CMS-HCC models.

100% asynchronous retrospective review of inpatient mortalities and PSI-90 surgical complications to ensure clinical documentation accuracy.

Specialized CDI chart audits for NICU and PICU patient stays. Validate APR-DRG severity of illness and mechanical ventilation capture.

Audit complex CABG, valve replacement, and cardiac stent charts to ensure complete diagnostic specificity of shock and heart failure stages.

Perform pre-bill audits on high-dollar inpatient Medicaid claims to catch missing secondary diagnoses and prevent payer clinical validation denials.

Flexible 15-20 hours weekly. Craft compliant physician queries for Medicare Advantage health plan inpatient audits.

Perform seasonal and year-round NCQA HEDIS medical record abstraction, verifying preventative screenings, diabetic eye exams, and blood pressure controls.

Review prior authorization requests for high-cost oncology, immunology, and specialty pharmacy therapies against FDA labels and clinical pathways.

Audit outpatient physician requests for advanced diagnostic modalities (MRI, CT, PET scans, nuclear cardiology) against clinical appropriateness guidelines.

Review next-generation genomic sequencing (NGS), hereditary cancer panels, and pharmacogenomic testing requests against medical policy.

Review pre-authorizations for skilled home health nursing visits, physical therapy, negative pressure wound therapy (wound VAC), and power mobility devices.

Flexible 25-hour weekly schedule reviewing outpatient physical therapy, occupational therapy, and chiropractic authorization submissions.

Investigate provider disputes on denied prior authorization requests. Re-evaluate medical documentation to determine if overturn criteria are satisfied.

100% asynchronous pre-certification of elective spinal, neurosurgical, and orthopedic surgeries using automated clinical guidelines.