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. Working remotely, the analyst collaborates with internal teams, providers, and external partners to ensure accurate, timely, and compliant review outcomes.

Key responsibilities

• Review authorization requests, appeals, and medical review claims for clinical necessity and policy compliance.
• Analyze disputed appeals and provide clear interpretation of medical information.
• Verify supporting documentation for high‑risk or escalated cases.
• Gather, assess, and summarize clinical data for second‑level appeal reviews.
• Maintain detailed records of decisions and communicate findings to stakeholders.

Required profile

• U.S. citizenship due to Department of Defense restrictions.
• BSN or equivalent education and an active RN license (state or compact).
• Minimum three years of experience in healthcare, health policy, clinical research, or a related field.
• Proven ability to conduct research, analyze information, and summarize findings.
• Strong critical‑thinking, organizational, and communication skills.

Required skills

• Microsoft Outlook
• Microsoft Word
• Microsoft Excel
• Microsoft OneNote
• Medical coding knowledge (ICD‑10, CPT, HCPCS)

What we offer

• Salary range $70,000 – $85,000 per year
• Remote work in approved U.S. states
• Opportunity to work with Department of Defense health programs