Medical Review Nurse Analyst (RN) – Remote US

About the role

The Medical Review Nurse Analyst (RN) evaluates medical records to determine payment eligibility under TRICARE policy. You will work remotely, reviewing authorizations, appeals, and medical review claims while collaborating with internal teams and external partners.

Key responsibilities

• Review medical documentation to assess compliance with TRICARE policy and evidence‑based guidelines.
• Analyze clinical records for disputed appeals and ensure accurate policy application.
• Verify clinical necessity and completeness for medical review claims.
• Summarize clinical information for second‑level appeal reviews and coordinate with stakeholders.
• Handle escalated or high‑risk cases that require specialized clinical judgment.

Required profile

• U.S. citizenship (DoD restriction).
• Bachelor’s Degree in Nursing (BSN) or equivalent experience.
• Active RN license in the state of practice (or compact license).
• Minimum 3 years of experience in healthcare, health policy, clinical research, or related field.
• Strong critical‑thinking, independent decision‑making, and written/ verbal communication skills.

Required skills

• Proficiency with Microsoft Office suite (Outlook, Word, Excel, OneNote).
• Working knowledge of medical coding systems (ICD‑10, CPT, HCPCS) – preferred.

What we offer

• Competitive salary range $70,000 – $85,000 per year.
• Fully remote work in approved U.S. states.
• Opportunities to work on diverse clinical cases within a federal healthcare program.