A remote clinical appeals nurse (also known as a denials and appeals nurse) helps patients get the care they need by serving as patient advocates when claims or services are denied by insurance. Nurses in this career review rejected medical claims. Then, they review the medical evidence to understand if the denial was appropriate. If …
A prior authorization nurse reviews requests for medical treatments, services, or procedures to determine whether they qualify for insurance coverage. The job requires nurses to assess, evaluate, and provide recommendations to help ensure patients receive the services they need. Remote prior authorization nursing is a great option for nurses who want to work from home …
The goal of utilization review (UR) or utilization management (UM) is to ensure patients receive quality care without unnecessary services or expenses. While UR and UM are similar, they focus on different points in the care journey. UR/UM nurses can help patients avoid unnecessary medical tests or procedures. They can also advocate for patients by …
A clinical nurse abstractor reviews patient records for information and metrics that suggest trends, identify healthcare gaps, and pinpoint potential quality issues. The goal of data abstraction is to translate patient information into a format that helps healthcare professionals identify trends and make decisions. This is a tech-heavy role that requires attention to detail and …
Telephone triage nurses apply the nursing process to advise patients about their symptoms or other health questions over the phone or via video call. Other names for this role include advice nurse, telecare nurse, nurse counselor, and remote triage nurse. This article will explore what it takes to work in remote triage, including: What does …
