🏥 Remote Registered Nurse – Medical Review Specialist

📍 Bexar County, TX Residents Only | Fully Remote
💼 Industry: Defense / Healthcare Compliance
💰 Competitive Salary + Full Benefits Package
🕒 Full-Time | Mon–Fri | No weekends, holidays, or on-call shifts

💡 About Avosys

Avosys Technology is a trusted provider of professional, technological, and management solutions for federal and commercial clients across the U.S. Since 1998, we’ve remained committed to excellence—powered by a team of the industry’s top talent. We’re currently seeking a Registered Nurse – Medical Review Specialist to support Medicare claims review from the comfort of your home.

🩺 What You’ll Do

In this remote role, you’ll review Medicare Part A and B claims to ensure medical necessity and compliance with CMS (Centers for Medicare & Medicaid Services) requirements. You’ll help maintain the integrity of Medicare services while supporting providers with documentation feedback and education.

🔍 Key Responsibilities:

Perform clinical reviews for pre-payment, post-payment, appeals, and prior authorizations
Ensure timely, accurate assessments based on NCDs, LCDs, IOMs, and other CMS documentation
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Provide clear documentation and rationale for approvals, denials, or reductions
Draft review result letters and update electronic systems within CMS deadlines
Conduct provider education sessions, 1-on-1 or in group settings
Escalate cases involving suspected fraud to the appropriate teams
Accurately track all case activity and maintain audit-ready documentation
Collaborate with team leads and participate in ongoing training

✅ Minimum Requirements

Active, unrestricted RN license
Must reside in Bexar County, Texas
U.S. Citizenship required (due to federal contract eligibility)
Minimum of 2 years of clinical experience in direct patient care
Familiarity with evaluating healthcare delivery issues and Medicare regulations
Proficiency with Microsoft Office (Word, Excel, Outlook)
Excellent writing and verbal communication skills

⭐ Preferred Skills

Experience reviewing medical records for CMS or Medicare-related programs
Knowledge of CMS medical necessity requirements (e.g., SSA 1862(a)(1))
Experience in utilization review, case management, or health claims review

🎁 What We Offer

📅 Set schedule: Guaranteed 8-hour weekday shifts
🏖️ Work-life balance: No weekends, holidays, or on-call shifts
💵 Comprehensive benefits:
- Medical, Dental, Vision
- Life Insurance
- Short & Long-Term Disability
- 401(k) retirement plan
👨‍👩‍👧‍👦 Family-first culture: Spend more time with loved ones
🏡 100% Telework (local presence in Bexar County required for compliance)

💼 Additional Information

Telework: Yes (must reside in Bexar County, TX)
Travel: No
Security Clearance: Not required
Background Check: Required
Equal Opportunity Employer: All qualified applicants will be considered regardless of race, color, religion, sex, gender identity, national origin, disability, or veteran status

🚀 Ready to Apply?

If you’re a skilled RN who values flexibility, compliance, and meaningful work in the healthcare sector, apply now to join the Avosys team and support a healthier, more accurate Medicare system.

Entry level Job REMOTE Registered Nurse – Medical Review Specialist-Bexar County, Texas-id-9311