Medical Review Nurse Analyst

About the role

The Medical Review Nurse Analyst conducts clinical reviews of medical records to ensure compliance with Medicare and payer guidelines. This remote position supports providers in accurate billing and appropriate reimbursement while delivering education on current documentation requirements.

Key responsibilities

• Perform detailed reviews of medical records and documentation to determine medical necessity.
• Validate submitted claims for correct coding and compliance with Medicare guidelines.
• Prepare written clinical summaries with clear rationale for approvals, denials, or modifications.
• Educate providers through the Targeted Probe and Educate (TPE) program and monitor their progress.
• Ensure adherence to federal, state, CMS regulations, and company policies.
• Stay current on clinical guidelines, medical policy updates, and industry best practices.

Required profile

• Associate’s or Bachelor’s degree in Nursing (ASN/BSN) with an active RN license in good standing.
• Minimum of one year of clinical experience in a healthcare setting.
• Excellent written and verbal communication skills.
• Strong attention to detail and ability to manage multiple cases.
• Basic knowledge of medical/clinical review processes.

Required skills

• Microsoft Outlook
• Microsoft Teams
• OneNote
• Word
• Excel

What we offer

• Remote work option across approved U.S. states.
• Performance bonus and merit increase opportunities.
• 401(k) retirement plan.
• Competitive salary range of $68,000‑$72,000 per year.