Calabria Group- REMOTE Registered Nurse - Clinical Review

Job Summary Progressive Technology, in partnership with the Calabria Group, is seeking a highly motivated and experienced Registered Nurse (RN) to join our remote Clinical Review team. This is a non-clinical position focusing on the evaluation of medical records, pre-authorization requests, and clinical documentation to ensure quality care, compliance with medical policies, and appropriate utilization of healthcare services. This is an excellent opportunity for RNs seeking a transition from bedside care to a dynamic, remote work environment.

Key Responsibilities

• *

Conduct clinical reviews of medical records and pre-authorization requests to determine medical necessity and appropriateness of care.

• *

Apply clinical knowledge, judgment, and established guidelines to review complex cases efficiently and accurately.

• *

Communicate with physicians, healthcare providers, and internal teams to clarify or obtain additional medical documentation.

• *

Ensure adherence to all federal and state regulations, as well as internal policies related to healthcare reviews and medical necessity.

• *

Document review findings and decisions in the appropriate system in a clear and concise manner.

• *

Participate in peer reviews and interdepartmental meetings to support continuous improvement efforts.

• *

Provide subject matter expertise to support appeals, denials, and audit processes.

• *

Maintain confidentiality and adhere to HIPAA and company-specific security protocols at all times.

• Required Skills and Qualifications
• *

Active and unrestricted Registered Nurse (RN) license in the United States.

• *

Proven knowledge of clinical care standards, medical necessity criteria, and utilization management principles.

• *

Proficient in interpreting clinical notes, treatment plans, and diagnostic reports.

• *

Exceptional critical thinking, organizational, and decision-making skills.

• *

Excellent verbal and written communication skills.

• *

High level of comfort working independently in a remote environment with minimal supervision.

• *

Strong computer literacy, including proficiency with EMRs, Microsoft Office Suite, and clinical review platforms.

• Experience
• *

Minimum of 3 years of clinical nursing experience, preferably in acute care, case management, or utilization review.

• *

Prior experience in clinical review, utilization management, or insurance-related roles is highly desirable.

• *

Experience with healthcare documentation standards, insurance authorizations, and managed care processes.

• Working Hours
• *

Monday to Friday, 8:00 AM – 5:00 PM (your local time zone).

• *

No weekends or on-call shifts.

• *

Flexibility may be required depending on workflow or regional review timelines.

• Knowledge, Skills, and Abilities
• *

Strong clinical acumen with the ability to evaluate the appropriateness of care.

• *

Deep understanding of medical terminology, ICD-10, CPT coding, and evidence-based clinical guidelines.

• *

Familiarity with NCQA, URAC, and CMS standards.

• *

Ability to work in a fast-paced, deadline-driven environment.

• *

Effective time management and multitasking abilities in a virtual setting.

• Benefits
• *

Competitive hourly or salaried compensation (depending on contract).

• *

100% Remote – work from anywhere in the U.S.

• *

Health, dental, and vision insurance (eligibility based on employment type).

• *

Paid time off and paid holidays (where applicable).

• *

Ongoing professional development opportunities.

• *

Supportive and collaborative team environment.

• Why Join Us

At Progressive Technology, Calabria Group, we are committed to innovation in healthcare and excellence in clinical review. As part of our remote RN team, you will play a vital role in ensuring patients receive the right care at the right time while enjoying the flexibility and freedom of remote work. Join a forward-thinking organization where your nursing skills make a difference behind the scenes—and beyond the bedside.

How to Apply

Ready to bring your nursing expertise into a dynamic, non-clinical role? Please submit your updated resume and cover letter to our recruitment team or apply directly through our careers portal. Shortlisted candidates will be contacted for a virtual interview. Apply tot his job Apply To this Job