Remote Nurse Reviewer - Utilization & IMR Specialist
Gainwell Technologies
- Remote job
Gainwell Technologies is seeking a Nurse Reviewer to perform clinical reviews to determine if documentation supports the need for the service according to criteria and policies. This role emphasizes accuracy, compliance, and timely decisions within contract-specific review methodologies. The position is home-based across the continental US, with flexible hours and opportunities for ongoing CEU development to maintain RN licensure, plus benefits including health coverage and education support. #J-18808-Ljbffr Gainwell Technologies
$78k - $88k
...are seeking a talented individual for a Nurse Reviewer who will be responsible for performing... ...clinical criteria, coverage policies, and utilization and practice guidelines as defined by... ...of assembling the appeal package for IMR (independent medical review) for physician...Remote workFull timeContract workWork from homeFlexible hoursWeekend work- ...Job Description Job Description Utilities Specialist I - Hybrid - 3 days on site, 2 days WFH... ...account status and current billing. • Review loan documentation to determine utility... ...and/or move about the organization or remote office. The employee is frequently...Remote workFull timeTemporary workWork at officeWork from homeFlexible hours
- ...Expert (SME) - Energized Line Maintenance & Utility Safety Assessment Overview We are... ...timeframe Work Arrangement: Primarily remote with a hybrid component Travel:... ...supporting the assessment team and will: Review current energized work practices against...Remote work
- ...Job Description Job Description Utility Vegetation Management Specialist Who are we? We’re dedicated to the growth of our employees. We... ...vehicle operation and foot patrol of utility power lines; remote locations as well as urban, city environment; physical...Remote workFull time
- Gainwell Technologies LLC is seeking a Senior Nurse Reviewer to perform reviews of medical records, healthcare claims, itemized medical... ...expertise and itemized bill review experience, with potential utilization review responsibilities. Home-based position within the...Remote jobWork from homeFlexible hours
- ...detail-oriented Prior Authorization Specialist to join our national Utilization Management team. In this role,... ...and routing requests to clinical reviewers. You will directly support timely... ...Position Type: Full-Time | 100% Remote Schedule: Monday – Friday, 8:00...Remote workFull timeLive inWork from homeMonday to Friday
$28 per hour
LPN Utilization Management Nurse Reviewer Miami, FL (Work from Home position for FL residents only) Currently seeking an LPN FL licensed Utilization Management... ...LPN clear and active for the state of FL (Required) Work Location: Remote #J-18808-Ljbffr Coastal Care Services, Inc.Remote workHourly payFull timeWork at officeLocal areaWork from homeRelocationHome officeWeekday work- ...Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This remote, part-time role focuses on obtaining and maintaining insurance authorizations, communicating with managed care organizations, and collaborating with clinical teams....Remote workPart timeWeekend work
- ...Northpoint Recovery Holdings, LLC is seeking a licensed Utilization Review Specialist to ensure clinically appropriate care, discharge planning, and cost-effective utilization across the treatment continuum. You will lead reviews of admissions, stays, discharges, and appeals...Remote work
- ...and substance use treatment, the full-time Behavioral Health Utilization Review Specialist will verify benefits, complete prior authorizations, and support medical necessity criteria while working remotely. Key responsibilities Verify insurance benefits, eligibility,...Remote workFull time
- ...Utilization Specialist Part time 20 hours a week then will go to a Full Time Opportunity Location: Central... ...to Orlando or Villages from time to time (remote, but available for onsite meetings) Key Responsibilities Review any new Medicare patients from last 3...Remote workFull timePart time
- ...To support the treatment of addiction and mental health issues, the full-time Remote Utilization Review Specialist will manage pre-authorizations and concurrent reviews, collaborating with case managers and the multidisciplinary treatment team to ensure compliance with...Remote workFull time
- ...Minnesota Adult & Teen Challenge in Minneapolis is seeking a Utilization Review Coordinator to obtain and maintain insurance authorizations for... ...and DHS requirements. Training is provided; initial in-person in Minneapolis with remote work thereafter. #J-18808-Ljbffr...Remote work
- ...Bradford Health Services seeks an experienced Utilization Review Specialist to join our Birmingham-based team. You will evaluate patient records, treatment plans, and clinical data to determine medical necessity and appropriate level of care while ensuring regulatory compliance...Remote work
$30 - $45 per hour
...consulting agency is seeking an Operations Specialist III for a contract opportunity in Long... ...along with experience in Epic EHR and Utilization Review. The selected candidate will perform... ...program metrics. This position is remote and offers a pay range of $30-$45 per...Remote workHourly payContract work- ...and streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will utilize his... ...a cohesive and rewarding environment. This is a fully remote or office/home hybrid position. Your Responsibilities:...Remote workWork at officeFlexible hours
- ...Utilization Review Specialist – Join a Top 1% Workplace Are you looking for a fast-paced clinical role... ...our Olathe corporate office, 3 days remote. What You Will Do Act as the primary... .... Collaborate with physicians, nurses, and therapists to ensure timely and...Remote workWork at office
$24 - $26 per hour
...Utilization Review Specialist – Behavioral Health (Remote) PHP/IOP | Full-Time | Monday–Friday, 9 AM–5 PM ET | $24–$26/hour About the Role Principles Recovery Center (PRC) are hiring a Utilization Review (UR) Specialist to manage insurance authorizations for...Remote workFull timeMonday to Friday- ...Utilization Review (UR) Specialist Location: Open to candidates near Wyomissing PA & Chadds Ford PA (Hybrid / Remote Eligible) Job Type: Full-Time Schedule: Monday - Friday Overview... ...in Healthcare Administration, Nursing, Social Work, Psychology, or related...Remote workFull timeMonday to FridayFlexible hours
- ...Allegheny Health Network seeks an RN Utilization Review professional to obtain pre-certifications... ...of care and timely approvals. This remote role requires PA RN licensure (or multi... ...certification within 5 years, and 2–3 years of nursing experience with 1 year in utilization...Remote work
- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant patient care. The role emphasizes adherence to HIPAA, state and federal regulations, and a strong team-oriented environment...Remote workWork at office
$40k - $50k
...Description Utilization Review Specialist Full-Time- must be able to work a few weekends per month Location: Remote Preferred Residence: Candidates residing in Florida, Tennessee, Texas, Virginia, South Carolina, or New Jersey are strongly encouraged to apply. Job Details...Remote workFull timePart timeWork at officeWeekend work- ...Cleveland Clinic Health System is seeking an experienced Utilization Management RN Reviewer to work remotely with a focus on admission, concurrent and retrospective reviews. The role supports payer communications, data collection, and clinical decision-making to ensure...Remote workWork at office
- Cambia Health Solutions seeks an UM IP Clinical Specialist to review inpatient utilization requests, research information, and coordinate with clinicians to support efficient reviews. The role emphasizes accuracy, timeliness, and adherence to regulatory standards. Work...Remote jobWork from home
- ...Cleveland Clinic is seeking an Utilization Management RN Reviewer to support remote operations from home. The role covers admission and concurrent reviews, and ensures medical necessity criteria are applied to hospital stays and discharges. Qualifications include RN...Remote work
$60k - $70k
...process. Full Time Office/Clerical Remote, Birmingham, AL, US Salary Range:... ...of the journey. We are seeking a Utilization Review Specialist to add to our dynamic team! The Utilization... ...Social Work, Psychology, Counseling, Nursing, Healthcare Administration, Health...Remote workFull timePart timeWork at office$30 - $35 per hour
...Location: Remote Schedule: Monday-Friday 8am-5pm MST Compensation: $30-35/... ...key member of the Northpoint team, the Utilization Review Specialist is a licensed professional who is... ...clinical review with payer as determined by nursing judgment and/or collaboration with...Remote workFull timeTemporary workFor contractorsWork at officeMonday to Friday$65k - $85k
...Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning Potential At Concierge Home Care, we are growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team. This role is ideal for an RN with...Remote workMonday to FridayWeekend workWeekday work$20 - $22 per hour
HKA Enterprises is seeking a Remote Call Center Representative to support a 24/7 facilities, utilities, water, and sanitation customer service operation. This full-time, work-from-home role requires a dedicated home office and reliable internet, with shifts between 12:0...Remote jobHourly payFull timeWork from homeHome officeShift work- CVS Health Corporation is seeking an RN Concurrent Review Nurse to join a remote team delivering inpatient clinical expertise to ensure medically... ...RN license, 5+ years inpatient nursing, and 2+ years in utilization management or discharge planning, with an Associate degree...Remote jobWork from homeMonday to FridayWeekend work
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