Remote Utilization Management RN | Clinical Validation
Texas Health Institute
- Remote job
UnitedHealth Group's Optum is seeking an experienced RN for Utilization Management & Clinical Validation. You will review patient records, extract pertinent details, and craft defensible appeal letters using evidence-based literature and coding guidelines. This remote role supports telecommuting from anywhere in the U.S. with flexible scheduling, HIPAA compliance, and opportunities to contribute to enterprise goals while advancing health outcomes. #J-18808-Ljbffr Texas Health Institute
- ...to help millions of people live healthier lives. The Utilization Management and Clinical Validation RN will review patient medical records, extract pertinent... ...process instructions and guidelines. This role is remote from anywhere in the U.S. with an unrestricted RN license...Remote job
- UnitedHealth Group is seeking an Utilization Management & Clinical Validation RN to accurately review medical records and extract case details, crafting defensible appeal letters using evidence-based literature and coding knowledge. You will work from anywhere in the U....Remote jobFlexible hours
$60.2k - $107.4k
...Utilization Management & Clinical Validation RN Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the...SuggestedMinimum wageFull timeWork experience placementLocal area- ...patients. Ensures completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review Specialist as... ...3-4 days for first week. This role will be remote BUT regular meetings/trainings require being...Remote workReliefWeekend work3 days per week
- Comagine Health is seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess medical necessity... ...retrospective reviews. This full-time remote role supports compliant, cost-... ...a Physician Advisor when needed. A valid Alabama RN license and 3+ years of clinical...Remote jobFull timeContract work
- Centene Corp. is seeking a Supervisor, Utilization Management (RN) to lead and supervise our Clinical Review team. This role focuses on ensuring appropriate care for... ...Candidates should possess a nursing degree and a valid California RN license, along with 4+ years of...Remote jobFlexible hours
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays... ...critical role in supporting utilization management operations by conducting... ...This is a 100% remote role, and requires robust... ...Suite, anchored by Cohere Validate™, an AI-driven clinical...Remote workFull timeFlexible hoursShift work- ...Brigham Health Plan is seeking a Registered Nurse to provide clinical review and escalation support for Utilization Management, triaging inquiries and ensuring medical necessity and regulatory compliance. This remote role supports our national network while collaborating...Remote job
$34 - $35 per hour
Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical Nurse - Work from... ...reliability reviews Qualifications RN license in an eNLC (Enhanced Nurse Licensure... ...Review Nurse- Prior Authorization Remote Registered Nurse (Remote Patient...Remote workFull timeWork at officeWork from homeNight shift$72.8k - $130k
...Sr Utilization Management Nurse Optum is a global organization... ...occasional opportunity for remote work based on business... ...details, reviewing clinical information for appropriateness... ...~ Registered Nurse (RN) with a current,... ...to provide proof of a valid, unrestricted Driver's...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- Humana is seeking an experienced Utilization Management Nurse 2 to support medical... ...members. You will use clinical judgment to decide on level... ...providers and members. The role is remote/work-from-home with weekend... ...annually; requires Kentucky RN license, 2+ years clinical...Remote jobWork at officeWork from homeShift work
- ...Description Job Description: Manager of Clinical Utilization Management - Denial... ...CAPosition Type: Hybrid (85% remote, 15% onsite in Northridge,... ...Registered Nursing Program; RN preferred.2. Minimum of five... ...computerized environment.7. Valid CA driver's license and car...Remote workPermanent employmentFull timeTemporary workFlexible hours
$35 - $62.5 per hour
...Clinical DRG RN Auditor $10,000 SIGN ON BONUS FOR EXTERNAL... ...proprietary tools, you will validate ICD-10 diagnosis and... ...overpayments. Utilizing excellent communications... ...requirements Maintain and manage daily case review... ...work independently in a remote environment and...Remote jobHourly payDaily paidMinimum wageFull timeTemporary workPart timeWork experience placementWork at officeLocal areaRelocation package- ...Utilization Manager Registered Nurse (UMRN) Spectrum Healthcare Resources has a need for a Utilization... ...Nurse (UMRN). These will be completely remote positions, working entirely from the... ..., the HCWs must have pertinent clinical experience within the past two (2) years...Remote workFull timeContract workWork at officeWork from homeMonday to Friday
- ...Nurse for a full-time remote position, who will review... ...expertise is needed Utilize CMS guidelines and... ...nursing experience in a clinical setting At least 1 year... ...UM experience in a managed care environment Active, valid, and unrestricted LVN or RN license in California...Remote workFull time
$25k
...Caring Community The Clinical Care Nurse (RN) is a clinic-based... ...reduce avoidable ED utilization, and drive Medicare Advantage... ...City, Patton Ave (Remote), River Hills (Remote... ...chronic disease self-management, particularly in DM,... ...individual to have a valid state driver's...Remote workTemporary workWork at office- A healthcare management organization is seeking a Utilization Management Nurse to oversee health service... ...requires an active LPN/RN license, and candidates should have clinical experience and proficiency... ...benefits package including remote work options. #J-18808-Ljbffr...Remote job
- ...seeks a Registered Nurse to coordinate and manage utilization management for behavioral health services across remote settings in the US. The role emphasizes... ...coordination. The position requires RN license, 2+ years acute clinical experience, and familiarity with...Remote job
- ...Join MES Solutions as a Clinical Quality Assurance Coordinator in a fully remote role. You will utilize your clinical skills to ensure the quality of peer review reports aligns... ...standards. The role requires an active RN/LPN license and a commitment to delivering exceptional...Remote work
- Molina Healthcare seeks an experienced RN to support Arizona Plan clinical member services review processes.... ...AZ RN license and experience with utilization management, prior authorization, and both inpatient and outpatient settings. Remote position, must reside in Arizona,...Remote job
$59.5k - $116.6k
UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services... ...an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate will work...Remote jobWeekend work- A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote jobFlexible hoursWeekend workDay shift
- ...healthcare organization is seeking a Care Manager RN for a remote role primarily serving the state of... ...per diem position involves crucial utilization management activities, ensuring... ...Washington RN license along with 3 years of clinical experience. The role offers...Remote jobHourly payDaily paidDay shift
- Humana seeks a qualified Utilization Management Nurse for National Medicaid Clinical Operations. The role reviews prior authorization requests for inpatient services... ..., Utilization Management. The position requires RN licensure in Illinois (or willingness to obtain) and...Remote job
- CVS Health Corporation is seeking an experienced Registered Nurse (RN) to support our 24/7 Utilization Management operations. This remote role requires clinical expertise to review cases, assess medical necessity, coordinate care and ensure members receive appropriate,...Remote job
$75.3k - $135.4k
Centene Corporation is seeking a Clinical Supervisor to oversee the utilization management team ensuring appropriate care for members. The ideal candidate will supervise... ...experience in a related field, along with an active RN license in California. This position offers a salary...Remote job- Humana is seeking an Utilization Management Nurse, National Medicaid Clinical Operations, to review prior authorization requests for inpatient services. The role requires independent clinical judgment, collaboration with providers, and adherence to Medicaid policies and...Remote job
$2,210 per week
...leader in personalized managed health care, focused... ...Holidays Work-life balance. Remote/hybrid setting (once... ...This individual will utilize clinical knowledge and... ...and claim concerns, and validation of criteria. Communicates... ...but is not limited to RN, LMSW, LMHC. Successful...Remote workFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours- ...Alliance is seeking a Nurse Manager for Utilization Management to supervise daily... ..., ensure standardized clinical care, and supervise staff performance... .... Requirements include RN license, 3+ years in healthcare... ...with UR/case management. Remote work options with occasional...Remote jobContract work
- Comagine Health is seeking a Clinical Utilization Review Nurse (RN) licensed in Alabama to assess medical necessity and quality of care through prospective... ...concurrent, and retrospective reviews. This full-time, remote position supports compliant, cost-effective care aligned...Remote jobFull timeContract work
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