Medical Reviewer Remote Jobs in Colorado (US)

Full Time Remote Mid Level

Virtual Medical Receptionist / Prior Authorization Specialist

Staffing for Doctors

Medical Reviewer2 days ago

Company Site

Role Description We are seeking a professional and customer-focused Virtual Medical Receptionist / Prior Authorization Specialist to support a busy healthcare practice. This is a patient-facing role requiring excellent communication skills, strong organizational abilities, and experience with medical office workflows. Ideal Candidate - Professional and confident on camera. - Friendly, patient-focused, and service-oriented. - Detail-oriented and highly organized. - Comfortable working in a fast-paced remote environment. - Reliable, proactive, and able to manage multiple responsibilities simultaneously. Key Responsibilities - Serve as the first point of contact for patients via phone and video. - Schedule new and follow-up appointments and manage provider calendars. - Handle inbound and outbound patient communications. - Submit, track, and follow up on prior authorization requests. - Verify insurance eligibility and benefits. - Maintain accurate patient records and documentation. - Coordinate with providers, insurance companies, and patients regarding authorizations and appointments. Qualifications - Fluent English and Spanish communication skills (American-accented English preferred). - Minimum 2 years of experience in a medical office, medical reception, or healthcare administrative role. - Experience with appointment scheduling and patient coordination. - Prior Authorization and Insurance Verification experience strongly preferred. - Comfortable interacting with patients through video and phone platforms. - Strong customer service, multitasking, and organizational skills. - Comfortable using computers, iPads, and healthcare software systems. Requirements - This is a full-time contractor position (40 hours per week). - Pay rate of $6 - $7 per hour depending on skillset and experience. - Schedule is Monday through Friday, from 8 AM to 5 PM US Time. Benefits - If you have a passion for helping patients and experience supporting healthcare operations, we encourage you to apply.

View details: Virtual Medical Receptionist / Prior Authorization Specialist

USA Timezones

$6 - $7 / hour

View details: Nurse Practitioner

Nurse Practitioner

DaVita Kidney Care

Medical Reviewer2 days ago

Full Time Remote Mid LevelTeam 10,001+Since 1994H1B No Sponsor

Company Site LinkedIn

Role Description Are you a Nurse Practitioner ready to transform lives and make a real difference for patients with complex kidney conditions? DaVita IKC is looking for a passionate NP to join our team, helping patients navigate a challenging healthcare system while receiving holistic, integrated care in Baltimore, MD. - Location: REMOTE. Occasional travel for meetings or trainings may be required. - Clinical Care & Evaluation: - Complete Comprehensive Health Evaluations (CHEs) to assess and manage comorbid conditions. - Address medical, social, emotional, and financial needs. - Reduce hospitalizations and improve patient outcomes. - Care Management & Disease Progression: - Manage CKD patients, focusing on slowing disease progression, reducing costs, and preventing readmissions. - Utilize prescriptive authority, medication management, and diagnostic interpretation in collaboration with nephrologists and interdisciplinary teams. - Clinical Leadership: - Lead the clinical team to ensure care coordination aligns with medical treatment plans and addresses both medical and psychosocial needs. - Schedule & Benefits: - Monday–Friday, full-time, with the ability to accommodate patient and nephrology partner availability—flexibility is key. - No nights, weekends, or on-call. - Competitive pay, excellent benefits, CEU/CME reimbursement, paid license renewals, and more. Qualifications - Passion for caring for patients with complex, chronic illnesses. - Willingness to adapt as the program evolves. - Minimum 2 years’ experience as a Nurse Practitioner (NP). - Current, unrestricted NP license in state of practice; DEA license or eligibility within 90 days. - Current CPR/BLS certification. - Valid driver’s license and insurance in the state. - Intermediate computer skills (MS Word, Excel, Outlook). - Strong clinical judgment, autonomous decision-making, and expertise in managing complex comorbidities. - Positive, solution-focused attitude, committed to improving patient and team outcomes. - Home office, high-speed internet, and reliable transportation. Requirements - Experience in Value-Based Care or Population Health, including Medicare Advantage documentation and Health Risk Assessments (preferred). - 5+ years’ experience as a Family NP, Primary Care NP, or in Internal Medicine, Cardiology, Nephrology, or Endocrinology (preferred). - Experience managing population health with a focus on reducing hospitalizations (preferred). - Prior experience with Cerner or similar EHR systems (preferred). Benefits - Competitive total rewards package. - 401k match. - Healthcare coverage. - Broad range of other benefits. Company Description At DaVita, we strive to be a community first and a company second. We want all teammates to experience DaVita as "a place where I belong." Our goal is to embed belonging into everything we do in our Village, so that it becomes part of who we are. We are proud to be an equal opportunity workplace and comply with state and federal affirmative action requirements.

United States

$118K - $150K / year

Arizona Department of Administration

Child Support Specialist Case Reviewer

The Attorney General's Office offers a comprehensive benefits package. For a complete list of benefits provided by The State of Arizona, please visit our benefits page.

Medical Reviewer4 days ago

Full Time Remote Mid LevelTeam 1,001-5,000

Role Description The DES, Division of Child Support Services (DCSS), is seeking an experienced and highly motivated individual to join our team as a Child Support Specialist Case Reviewer with the Administrative Review Unit (ARU). This position is responsible for providing an administrative review of child support cases as assigned pursuant to policy, procedures, federal and state rules, guidelines, and statutory requirements; providing consultative services, technical guidance, and administrative expertise to agency staff during the evaluation of contested actions on administrative enforcement remedies taken statewide. This position may offer the ability to work remotely, within Arizona, based upon the department's business needs and continual meeting of expected performance measures. The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State’s Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance. Job Duties - Conduct a comprehensive review of child support cases when a requestor contests an administrative enforcement action taken by DCSS. - Conduct a comprehensive review of cases when a support recipient contests the distribution/disbursement of support payments as a result of the Quarterly Notice of Collections. - Adhere to strict local, state, and federal time frames in receiving, acknowledging, processing, and resolving requests for administrative reviews. - Request all related documentation needed to support or deny a request for Administrative Review. Qualifications - Strong understanding of child support arrears, past due child support, assigned support, and administrative actions. - Working knowledge of state and federal regulations, rules, and policies governing child support or family law, legal assisting, administrative, and judicial court practices. - Interviewing techniques and investigative procedures. - Computer software applications, i.e., Google Workspace and Adobe. - Assignment of rights, distribution, and disbursement of child support. Requirements - Adhere to strict state and federal timeframes. - Interpret legal or written documents, court orders, and administrative and judicial court practices. - Meet performance measures, manage time and competing priorities; follow set policies and procedures to ensure timeliness, data reliability, and accuracy. - Learn the Arizona Child Support Services automated case management system. Selective Preference(s) - Working knowledge equivalent to one (1) year of child support enforcement, child support arrears, medical, spousal, state-assigned arrears, administrative actions, and court order interpretation. Pre-Employment Requirements - Successfully pass background and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions. - Arizona Level One Fingerprint Clearance Card. - If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements. - All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify). Benefits - Affordable medical, dental, life, and short-term disability insurance plans. - Participation in the Arizona State Retirement System (ASRS) and long-term disability plans. - 10 paid holidays per year. - Paid vacation and sick time. - Paid Parental Leave - Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child. - Deferred compensation plan. - Wellness plans. - Tuition Reimbursement. - Stipend Opportunities. - Infant at Work Program. - Rideshare and Public Transit Subsidy. - Career Advancement & Employee Development Opportunities.

View details: Child Support Specialist Case Reviewer

United States

$41K - $46.8K / year

View details: Medical Review Nurse

Medical Review Nurse

Allstate

Medical Reviewer4 days ago

Full Time Remote Mid LevelTeam 10,001+Since 1931H1B Sponsor

Company Site LinkedIn

Role Description Are you a clinically experienced Registered Nurse looking to apply your expertise beyond direct patient care? As a Medical Review Nurse you will play a critical role in strengthening risk management and improving decision-making across our health and accident products. You’ll use your clinical knowledge to evaluate medical records, guide coverage determinations, and support fair, evidence-based appeal outcomes—directly impacting both business outcomes and member experience. This is an opportunity to bring your clinical judgment, analytical thinking, and passion for quality care into a dynamic, fast-paced environment where your insights drive meaningful results. What You’ll Do - Serve as a trusted clinical expert supporting accident and health lines of business - Review medical records and claims to determine coverage and benefit eligibility - Evaluate medical necessity and appropriateness of care based on evidence-based guidelines - Draft clear, defensible written rationales for coverage and appeal determinations - Analyze medical and claims data to identify trends, risks, and improvement opportunities - Assess medical information to determine current and potential risk exposure for coverage decisions - Interpret and apply policy contract language to ensure consistent, accurate determinations - Synthesize complex data from multiple sources to inform business decisions - Maintain strong productivity and quality in a high-volume, fast-paced environment - Collaborate cross-functionally while demonstrating strong independence and accountability Qualifications - Active Registered Nurse (RN) license - Proven ability to analyze and interpret complex medical information and documentation - Strong clinical judgment and decision-making skills - Excellent written and verbal communication skills Requirements - 5+ years of clinical nursing experience - Experience in health insurance, utilization review, medical claims, or appeals - Familiarity with medical coding systems (CPT, ICD-10, HCPCS) and claims documentation - Experience interpreting insurance policy language and applying it in decision-making - Exposure to data analysis and identifying trends within medical or claims data Key Skills & Strengths - Analytical mindset with strong attention to detail - Ability to translate clinical complexity into clear, actionable insights - Strong problem-solving and critical thinking capabilities - Effective time management and ability to prioritize competing demands - Comfortable working both independently and collaboratively Tools & Expertise - Proficiency in Microsoft Office (Excel, Word, Outlook) - Experience working with medical records, physician notes, and evidence-based clinical studies - Ability to interpret Explanation of Benefits (EOBs) and submitted claims Benefits - Compensation offered for this role is $62,100.00 - $103,950.00 annually and is based on experience and qualifications. - Comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse. - Monthly connectivity reimbursement for employees eligible to work from home.

United States

$62.1K - $104.0K / year

Super-Resolution Visual Quality Reviewer

24-MAG

This opportunity is available through a leading AI-driven work platform.

Medical Reviewer5 days ago

View details: Super-Resolution Visual Quality Reviewer

Role Description We are sharing a specialised part-time consulting opportunity for experienced visual quality professionals with expertise in: - Film - VFX - Rendering - Lighting - Color grading - Cinematography - Professional photography - Artifact detection - Pixel-level review - Super-resolution video evaluation This role supports current and upcoming remote consulting opportunities focused on: - Video sharpening - Upscaling - Super-resolution review - Frame-by-frame visual quality assessment - Artifact detection - Evaluation template development - High-quality project execution Selected professionals will apply a rigorously trained visual eye to assess whether enhanced video outputs hold up at a professional level across: - Detail - Sharpness - Texture - Color - Temporal consistency Qualifications - Fluent English - 7–10 years of experience in high-end visual evaluation across film, visual effects, professional photography, cinematography, rendering, or related fields - Training from a university or program with a highly respected film, visual effects, digital media, or imaging curriculum - Reliable access to a 4K-resolution monitor for precise pixel-level review - Familiarity with AI tools and workflows, including the ability to generate visual samples for testing and comparison - Ability to translate complex visual details into clear, precise language for captions, review notes, and evaluation templates - Ability to work independently in a remote, project-based environment Requirements - VFX supervisor with strong final image quality review experience - Rendering supervisor with experience reviewing dailies and pixel-level output quality - Lighting supervisor, lighting lead, or lighting artist with strong digital video and cinematic motion judgment - Colorist with deep experience in grading, artifact detection, and visual consistency - Director of photography or cinematographer with expertise in framing, sharpness, and high-resolution image detail - Effects artist, surfacing artist, high-end photographer, director, or digital projectionist with a trained eye for final-output quality Nice to Have - Experience reviewing final image quality for film, VFX, animation, games, commercial photography, or high-end video content - Experience with dailies review, color grading, projection review, visual QC, rendering review, or image finishing - Strong understanding of compression artifacts, grain structure, aliasing, noise, softness, texture fidelity, and high-resolution visual detail - Comfort with frame-by-frame review and structured visual evaluation - Experience creating or reviewing visual benchmarks, comparison samples, or expert evaluation templates Benefits - Apply professional visual quality expertise to structured remote evaluation work - Contribute to high-quality review of video sharpening, upscaling, and super-resolution outputs - Work on assignments aligned with your VFX, rendering, lighting, color, cinematography, photography, or projection background - Use your trained eye to identify subtle image-quality issues that matter at a professional level - Remote structure with competitive hourly compensation Contract Details - Independent contractor role - Fully remote with scheduling aligned to PST through EST working hours - Eligible professionals should be based in the United States depending on project needs - Part-time commitment depending on project availability - Competitive rates between $50–$80 per hour depending on expertise and project scope - Weekly payments via Stripe or Wise - Projects may be extended, shortened, or adjusted depending on scope and performance - Work will not involve access to confidential or proprietary information from any employer, client, or institution About the Platform This opportunity is available through 24-MAG LLC. We connect experienced professionals with remote consulting opportunities across technical, evaluation, and project-based workstreams. By submitting this application, you acknowledge that your information may be processed by 24-MAG LLC for recruitment and opportunity matching in accordance with our Privacy Policy: https://www.24-mag.com/privacy-policy

United States

$50 - $80 / hour

PEER REVIEWER - ADDICTION MEDICINE PHYSICIAN

iMPROve Health is Michigan’s Medicare-designated Quality Improvement Organization, dedicated to improving healthcare across the continuum of care using evidence-based, data-driven strategies. We provide medical consulting and review services, along with data analysis, to federal agencies, state Medicaid programs, public health organizations, healthcare facilities, private health plans, and other third-party payers. Our mission is simple: help healthcare get better.

Medical Reviewer6 days ago

View details: PEER REVIEWER - ADDICTION MEDICINE PHYSICIAN

Role Description iMPROve Health is seeking an addiction medicine physician to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis. As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type. Qualifications - Medical License: Must hold an unrestricted medical license in any U.S. state. - Board Certification: Required (if applicable), through a board recognized by: - The American Board of Medical Specialties (ABMS) - The American Osteopathic Association (AOA) - Another nationally recognized board granting certification. - Clinical Experience: - Have at least five (5) years full-time equivalent experience providing direct clinical care to patients. - Have experience providing direct clinical care to patients within the past three (3) years. - Knowledgeable of the issue under review, or of the current, evidence-based clinical guidelines and novel treatments for the medical or behavioral health condition, disease, treatment, or procedure under review. - Have the clinical expertise to manage the medical or behavioral health condition or disease under review. - Must be actively engaged in direct or virtual patient care for at least 20 hours per week. Administrative work does not qualify. Requirements - Reliable Wi-Fi access. - Proficiency with Microsoft Word. - Access to a computer compatible with iMPROve Health’s IT systems. - Must complete the electronic credentialing application and receive organizational approval prior to performing a case review. - Must complete a conflict of interest attestation upon credentialing and prior to performing a case review. - Active hospital medical staff privileges may be required, as applicable. - Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status. - Cannot have current employment or affiliation with any Veterans Affairs (VA) hospital, health care system, or medical center if applying to perform VA-related peer reviews. Benefits - Make a Difference: Use your clinical knowledge to improve the quality of care patients receive. - Professional Recognition: Join a network of highly respected experts in your specialty. - Competitive Compensation: Receive fair pay for your time and expertise. - Protect Standards of Care: Help uphold the integrity of your profession. - Work Remotely: Review cases from the convenience of your home or office.

United States

PEER REVIEWER - PLASTIC SURGEON

Medical Reviewer9 days ago

View details: PEER REVIEWER - PLASTIC SURGEON

Role Description iMPROve Health is seeking a plastic surgeon to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis. As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type. Duties and Responsibilities - Conduct objective, evidence-based peer reviews of clinical cases. - Make final determinations regarding medical necessity and quality of care. - Ensure decisions are fair, unbiased, and aligned with current standards of practice. - Submit reviews in a timely and professional manner using the IT systems provided. Qualifications - Medical License: Must hold an unrestricted medical license in any U.S. state. - Board Certification: Required (if applicable), through a board recognized by: - The American Board of Medical Specialties (ABMS). - The American Osteopathic Association (AOA). - Another nationally recognized board granting certification. - Clinical Experience: - Have at least five (5) years full-time equivalent experience providing direct clinical care to patients. - Have experience providing direct clinical care to patients within the past three (3) years. - Knowledgeable of the issue under review, or of the current, evidence-based clinical guidelines and novel treatments for the medical or behavioral health condition, disease, treatment, or procedure under review. - Have the clinical expertise to manage the medical or behavioral health condition or disease under review. - Must be actively engaged in direct or virtual patient care for at least 20 hours per week. Administrative work does not qualify. Technology Requirements - Reliable Wi-Fi access. - Proficiency with Microsoft Word. - Access to a computer compatible with iMPROve Health’s IT systems. Other Requirements - Must complete the electronic credentialing application and receive organizational approval prior to performing a case review. - Must complete a conflict of interest attestation upon credentialing and prior to performing a case review. - Active hospital medical staff privileges may be required, as applicable. - Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status. - Cannot have current employment or affiliation with any Veterans Affairs (VA) hospital, health care system, or medical center if applying to perform VA-related peer reviews. Benefits - Make a Difference: Use your clinical knowledge to improve the quality of care patients receive. - Professional Recognition: Join a network of highly respected experts in your specialty. - Competitive Compensation: Receive fair pay for your time and expertise. - Protect Standards of Care: Help uphold the integrity of your profession. - Work Remotely: Review cases from the convenience of your home or office.

United States

PEER REVIEWER - ENDOCRINOLOGIST

Medical Reviewer10 days ago

View details: PEER REVIEWER - ENDOCRINOLOGIST

Role Description iMPROve Health is seeking an endocrinologist to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis. As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type. Duties and Responsibilities - Conduct objective, evidence-based peer reviews of clinical cases. - Make final determinations regarding medical necessity and quality of care. - Ensure decisions are fair, unbiased, and aligned with current standards of practice. - Submit reviews in a timely and professional manner using the IT systems provided. Qualifications - Medical License: Must hold an unrestricted medical license in any U.S. state. - Board Certification: Required (if applicable), through a board recognized by: - The American Board of Medical Specialties (ABMS). - The American Osteopathic Association (AOA). - Another nationally recognized board granting certification. - Clinical Experience: - Have at least five (5) years full-time equivalent experience providing direct clinical care to patients. - Have experience providing direct clinical care to patients within the past three (3) years. - Knowledgeable of the issue under review, or of the current, evidence-based clinical guidelines and novel treatments for the medical or behavioral health condition, disease, treatment, or procedure under review. - Have the clinical expertise to manage the medical or behavioral health condition or disease under review. - Must be actively engaged in direct or virtual patient care for at least 20 hours per week. Administrative work does not qualify. Technology Requirements - Reliable Wi-Fi access. - Proficiency with Microsoft Word. - Access to a computer compatible with iMPROve Health’s IT systems. Other Requirements - Must complete the electronic credentialing application and receive organizational approval prior to performing a case review. - Must complete a conflict of interest attestation upon credentialing and prior to performing a case review. - Active hospital medical staff privileges may be required, as applicable. - Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status. - Cannot have current employment or affiliation with any Veterans Affairs (VA) hospital, health care system, or medical center if applying to perform VA-related peer reviews. Benefits - Make a Difference: Use your clinical knowledge to improve the quality of care patients receive. - Professional Recognition: Join a network of highly respected experts in your specialty. - Competitive Compensation: Receive fair pay for your time and expertise. - Protect Standards of Care: Help uphold the integrity of your profession. - Work Remotely: Review cases from the convenience of your home or office.

United States

PEER REVIEWER - OPHTHALMOLOGIST

Medical Reviewer10 days ago

View details: PEER REVIEWER - OPHTHALMOLOGIST

Role Description iMPROve Health is seeking an ophthalmologist to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis. As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type. - Current knowledge of brow ptosis surgery needed. Duties and Responsibilities - Conduct objective, evidence-based peer reviews of clinical cases. - Make final determinations regarding medical necessity and quality of care. - Ensure decisions are fair, unbiased, and aligned with current standards of practice. - Submit reviews in a timely and professional manner using the IT systems provided. Qualifications - Medical License: Must hold an unrestricted medical license in any U.S. state. - Board Certification: Required (if applicable), through a board recognized by: - The American Board of Medical Specialties (ABMS) - The American Osteopathic Association (AOA) - Another nationally recognized board granting certification. - Clinical Experience: - Have at least five (5) years full-time equivalent experience providing direct clinical care to patients. - Have experience providing direct clinical care to patients within the past three (3) years. - Knowledgeable of the issue under review, or of the current, evidence-based clinical guidelines and novel treatments for the medical or behavioral health condition, disease, treatment, or procedure under review. - Have the clinical expertise to manage the medical or behavioral health condition or disease under review. - Must be actively engaged in direct or virtual patient care for at least 20 hours per week. Administrative work does not qualify. Technology Requirements - Reliable Wi-Fi access. - Proficiency with Microsoft Word. - Access to a computer compatible with iMPROve Health’s IT systems. Other Requirements - Must complete the electronic credentialing application and receive organizational approval prior to performing a case review. - Must complete a conflict of interest attestation upon credentialing and prior to performing a case review. - Active hospital medical staff privileges may be required, as applicable. - Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status. - Cannot have current employment or affiliation with any Veterans Affairs (VA) hospital, health care system, or medical center if applying to perform VA-related peer reviews. Benefits - Make a Difference: Use your clinical knowledge to improve the quality of care patients receive. - Professional Recognition: Join a network of highly respected experts in your specialty. - Competitive Compensation: Receive fair pay for your time and expertise. - Protect Standards of Care: Help uphold the integrity of your profession. - Work Remotely: Review cases from the convenience of your home or office. Company Description

United States