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Medical Claim Review Nurse | Remote | Washington | Contract

Walker Healthforce, LLC -
Long Beach, CA

Quick Apply

Job Details

Contract
5 days ago

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance

Qualifications

Regulatory compliance in claims processing
Medical billing compliance checks
State healthcare regulations
Pre-authorization review for utilization management
Productivity software
Insurance claims auditing
Clinical documentation standards
Healthcare claims compliance audits
Healthcare coding investigations
Nursing

Full Job Description

Medical Claim Review Nurse | Remote (Washington) | Contract

Walker Healthforce is seeking a Medical Claim Review Nurse with strong appeals review and medical claims experience to support retrospective medical necessity reviews, payment integrity initiatives, and clinical claim validation for Molina Healthcare of Washington. This is a fully remote contract opportunity.

Start Date: ASAP

Location: Remote – Candidates must reside in Washington

Schedule: Monday–Friday | 8:00 AM–5:00 PM PST

Worker Type: W2 Contract

Core Requirements

Active unrestricted RN license preferred (LPN/LVN accepted)
3–5 years of appeals review experience preferred
Experience performing retrospective medical claims review
Experience reviewing medical necessity determinations
Knowledge of ICD-10, CPT, and HCPCS coding
Billing and coding experience
Knowledge of state, federal, and third-party regulations
Strong analytical and critical thinking skills
Excellent written and verbal communication skills
Microsoft Office proficiency

We Consider It a Bonus If You Also Have

Payment Integrity experience
DRG validation experience
Itemized bill review experience
Managed Care experience
Experience using PEGA A&G, PEGA UM, or QNXT
Utilization Management experience

Job Responsibilities

Perform retrospective clinical reviews of medical claims and appeals
Validate medical necessity, coding accuracy, and reimbursement
Review clinical documentation supporting post-claim denials
Evaluate authorizations, level of care, and billing compliance
Apply clinical guidelines and regulatory requirements during reviews
Document review findings accurately within assigned systems
Collaborate with Medical Directors regarding denial decisions
Provide clinical support to utilization management and provider appeals
Participate in payment integrity and coding validation activities
Maintain productivity, quality, and compliance standards

What We Offer

Competitive compensation
Weekly Direct Deposit
Medical, Dental & Vision benefits
401(k) options

Why Work With Walker?

Dedicated healthcare recruiting specialists
Resume and interview preparation
Ongoing consultant support throughout your assignment
Access to opportunities with leading healthcare organizations

Contact our Recruiting Team today to learn more about this opportunity!

About Us

Walker Healthforce is known as the dominant force of performance, precision, expertise, and integrity in the healthcare consulting community. As a certified WMBE, we provide healthcare IT and clinical staffing solutions to hospitals, health systems, and payer organizations nationwide. We are healthcare experts, custom—not commodity—and have been exceeding expectations for nearly 20 years.

Walker Healthforce is an Equal Opportunity Employer committed to fostering a diverse and inclusive workforce. All qualified applicants will receive consideration for employment.

#IND1

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