Remote Rn Jobs in San Diego, CA

Last updated: 4 days ago

Promoted

RN Special Investigations (REMOTE - Southern CA)

Morgan StephensSan Diego, CA, US

$40.00–$42.00 hourly

Remote

Full-time

Job Title : Healthcare - Care Review Clinician I (Temp-to-Perm).Schedule : Monday - Friday, 8 : 00 AM - 5 : 00 PM PST.Location : Remote, but candidate must reside in. Travel Reimbursed at IRS rates.A Manag...Show moreLast updated: 6 days ago

Promoted

BILINGUAL CHRONIC DISEASE MANAGEMENT NURSE (RN-REMOTE CA, AZ, NV, TX, NM)

HealthCHECCA, United States

$38.61–$61.78 hourly

Remote

Full-time

CA RN Required - Bilingual Spanish.SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corpora...Show moreLast updated: 4 days ago

Promoted

RN Auditor - Remote

VirtualVocationsSan Diego, California, United States

Remote

Full-time

A company is looking for a DRG CVA RN Auditor for a remote position.Key Responsibilities : Conduct MS-DRG and APR-DRG coding reviews to verify accuracy and identify overpaymentsPerform clinical codin...Show moreLast updated: 13 days ago

RN-to-BSN Student Rotation

CVS HealthCalifornia, US

Remote

Part-time

This program aims to develop RN-to-BSN students to be ready for the real world.CVS Health accomplishes this goal by not only meeting the academic standards of the school, but by providing students ...Show moreLast updated: 30+ days ago

Promoted

RN CASE MANAGER MATERNITY REMOTE IN SEATTLE WA

Molina HealthcareCA, United States

Remote

Full-time

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, inc...Show moreLast updated: 4 days ago

Complex Case Manager RN - Oncology (Remote)

Highmark HealthCA, Working at Home, California

$106,700.00 yearly

Remote

Full-time

This job has primary ownership and oversight over a specified panel of oncology members that range in health status / severity and clinical needs. The incumbent assesses health management needs of the...Show moreLast updated: 30+ days ago

Case Manager, LVN or RN - Medical Provider Network - Hybrid Remote

Cedars-SinaiCA, United States

Remote

Cedars-Sinai Medical Center has been ranked the #1 hospital in California and #2 hospital in the nation by.Cedars-Sinai was awarded the Advisory Board Company’s Workplace of the Year which is an aw...Show moreLast updated: 30+ days ago

Clinical Program Manager RN •Remote •

ProvidenceCA, United States

$63.66 hourly

Remote

Full-time

Clinical Program Manager RN •Remote •.Candidates residing in AK, WA, MT, OR, CA or TX are encouraged to apply.The Clinical Program Manager Telehealth leads the development of standardized Telehealth...Show moreLast updated: 30+ days ago

Temporary Prior Authorizations Nurse (RN)

The AllianceRemote in California

$51.00–$53.00 hourly

Remote

This is a temporary position and the length of the assignment is estimated to through the summer.The length of the assignment is always dependent on business needs and dates may change.While the as...Show moreLast updated: 30+ days ago

Case Manager, RN (Work from Home)

Bright HealthCalifornia, US

$72,068.00–$108,104.00 yearly

Remote

Our mission is to make healthcare right.We are a value-driven healthcare company committed to providing personalized care to aging and underserved populations. We do this by aligning stakeholders ac...Show moreLast updated: 30+ days ago

Lead Coordinator - Clinical Review, LPN / RN (Remote)

MaximusSan Diego, US

$31.75 hourly

Remote

Full-time

Description & Requirements Maximus is currently hiring a Lead Coordinator - Clinical Review to support the Independent Medical Review (IMR) program. What You Will Receive : • Work / Life...Show moreLast updated: 18 days ago

RN Special Investigations (REMOTE - Southern CA)

Morgan StephensSan Diego, CA, US

6 days ago

Salary

$40.00–$42.00 hourly

Job type

Full-time

Remote

Job description

Job Title : Healthcare - Care Review Clinician I (Temp-to-Perm)

Pay Rate : $40-$42 / hr

Schedule : Monday - Friday, 8 : 00 AM - 5 : 00 PM PST

Location : Remote, but candidate must reside in Southern California and hold a valid CA RN license

Travel Reimbursed at IRS rates

Job Description

A Managed Care Organization is seeking an experienced Registered Nurse (RN) with a strong background in fraud, waste, and abuse investigations to work within the Corporate Special Investigations Unit (SIU). This RN will perform work on behalf of the CA Health Plan, reviewing CLIA certification documentation from non-participating laboratories, contacting both labs and members, and assisting with fraud, waste, and abuse inquiries. The RN may also conduct on-site investigations to validate the presence of proper laboratory equipment and ensure compliance with regulatory standards. This is a temp-to-hire opportunity, with the potential for long-term placement based on performance and business needs.

Key Responsibilities

Review CLIA certification documentation from non-participating laboratories.

Contact non-participating labs and CA Health Plan members regarding documentation compliance.

Report findings to SIU leadership, including suspected fraud, waste, and abuse cases.

Conduct on-site inspections at non-participating laboratories to verify compliance with regulatory standards.

Assist with other referrals to SIU related to fraud, waste, and abuse within the CA Health Plan.

Collaborate with managed care stakeholders to ensure regulatory compliance and proper documentation.

Required Skills & Qualifications

Active CA Registered Nurse (RN) license.

Reside in Southern California (preferred).

Strong background in fraud, waste, and abuse investigations within healthcare.

Hospice experience preferred.

Case management experience preferred.

Ability to analyze documentation for compliance and detect potential fraud.

Strong communication skills to interact with laboratories, members, and healthcare providers.

Ability to travel within California as needed for on-site investigations (expected a few times per year).

Preferred Experience

Prior experience in managed care, SIU, or compliance investigations.

Experience working with healthcare fraud detection units.

Additional Information

This is a temp-to-perm position based on performance and business needs.

Candidates must be detail-oriented, investigative, and highly accountable in fraud investigations.