Nurse Specialist II
Qlarant · United States · US
Utilization Review
Remote
Nurse
Pharmacist
Demand72
Career growth62
Healthcare fit78
Remote potential55
Salary band
USD 58k – 86k
5-year outlook
Stable payer/audit demand is likely, with compensation improving alongside medical review, coding, and Medicare/Medicaid audit experience; exact pay varies by employer and location.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-20
Intelligence details
Flexible work details
- Side income
- Classified as side-income friendly
- Engagement type
- Contract
- Hours
- Variable hours
- Eligible countries
- United States
- Profession fit
- Nurse, Pharmacist
- Rate period
- Annual
Why this was classified this way
- contract
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth considering for nurses seeking payer-side utilization, audit, or fraud/waste/abuse work; less suitable if you want direct patient care or cannot meet the RN and medical-review requirements.
Who should apply
RNs with utilization review, case management, quality, coding, Medicare/Medicaid, claims, or audit exposure; nurses interested in benefit integrity and fraud, waste, and abuse investigations.
CV angle
Frame bedside and clinical experience as evidence of clinical assessment, documentation, and guideline application; highlight medical record review, Medicare/Medicaid knowledge, audit support, case summaries, coding, and communication with investigators.
Skills to highlight
- Medical record review
- Claims review
- Medicare/Medicaid regulations
- Fraud, waste, and abuse detection
- Audit and desk review
- Case documentation and summaries
- Coding knowledge
- Provider and investigator communication
Role summary
A nurse reviewer role performing medical record and claims audits for Medicare, Medicaid, and other claims data to identify potential overpayment, fraud, waste, and abuse, prepare case summaries, and support investigations.
We publish our own intelligence summary, never the full job description. Always confirm details with the employer when you apply.