Remote RN Utilization Management & Appeals
CareOregon
CareOregon seeks an experienced RN to manage benefit coverage requests, compliance with Medicaid and Medicare guidelines, and collaborate with clinical teams. Candidates must hold an unrestricted Oregon RN license and have a minimum of 2 years of experience. The position offers a work-from-home opportunity and requires excellent communication and problem-solving skills. Join us to support quality care for our members while adhering to state and federal requirements. #J-18808-Ljbffr
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Remote RN Utilization Management & Appeals in Helena, MT vacancy
$50 per hour
...Drips.com is looking for an Appeals RN (Temporary) to handle grievances and appeals effectively. This role requires... ...excellent communication skills and a strong background in utilization management. The position is remote and offers a salary of $50/hr. In this position, you...Remote workTemporary workDrips
New York, NY5 days ago$102.33k - $125.07k
...data in connection with quality management activities according to... ...insurance clinical reporting. Appeals and Grievance Assemble evidence... ...Current unrestricted Oregon RN license. Minimum 2 years RN experience... ...RN experience. Healthcare utilization management experience in the...Remote workWork at officeLocal areaWork from homeFlexible hoursCareOregon
Wausau, WI1 day ago- ...The Peer-to-Peer (P2P) Utilization Review Nurse is an integral... ...Central Utilization Management team, specializing in... ...determinations, supports appeal and reconsideration... ...CONI) processes through RN-to-RN collaboration with... ...and Work Model ~ Remote / Work from Home. ~...Remote workWork from home
Mass General Brigham (Enterprise Services)
Somerville, MA5 days ago - ...CareOregon is seeking a qualified Registered Nurse (RN) to manage member communications and documentation effectively. This role requires a current Oregon RN license and at least two years of RN experience or one year plus three years in a healthcare-related position....Remote work
CareOregon
Madison, WI1 day ago $28.94 - $51.63 per hour
...Wisconsin Psychiatric Association Inc is seeking a Clinical Appeals RN to manage appeals and grievances effectively. This role requires a registered... ..., and ensure compliance with all regulations while working remotely from anywhere in the U.S. Attractive benefits and...Remote workHourly payWork at officeWisconsin Psychiatric Association
Cypress, CA3 days ago- ...Sentara Health Administration, Inc. is seeking an RN Clinician to provide utilization management services in a remote role from Virginia. The ideal candidate must... ...authorization reviews, care coordination, and managing appeals for services denied. In addition to competitive...Remote work
170 Sentara Health Administration, Inc.
Virginia, MN2 days ago - ...CareOregon is seeking a Registered Nurse (RN) for a hybrid position based in Portland, Oregon. This role involves communication with members and providers, maintaining confidentiality, and ensuring compliance with healthcare guidelines. The ideal candidate will hold an...Remote work
CareOregon
Portland, OR1 day ago - ...reviews of medical documentation while working remotely. This role involves managing appeals and validating claims to ensure medical necessity... ...of clinical nursing experience, including utilization review, and a valid RN license in Florida or Kentucky. Strong analytical...Remote workFull time
Molina Healthcare
New York, NY5 days ago $54.1k - $155.54k
...is seeking a Clinical Team Lead to provide leadership and clinical support for a team responsible for Utilization Management Outpatient Appeals. This full-time remote position requires strong nursing experience, effective communication, and problem-solving skills. The...Remote workFull time4062 Aetna Resources, LLC
Hartford, CT1 day ago- ...company based in Newtown Square is seeking a Utilization Management RN Coder. This role involves reviewing patient medical records and composing appeal letters. Candidates must possess an... ...RN license. The position supports remote flexibility, ensuring compliance with healthcare...Remote job
- ...you an experienced Registered Nurse (RN) – Utilization Management / Case Management (Medicare) with a desire... ...review, prior authorizations, appeals, and member care coordination in a fast... ...required (1–6 weeks depending on role) Remote/hybrid flexibility available post-...Remote workContract workLocal area
Talent Software Services
Columbia, SC3 days ago $57.28 - $88.92 per hour
...Description The Care Management Recovery Advocate (CMRA) is responsible... ...of clinically-based appeals between Providence Health and... ...Nursing Department: 7000 UTILIZATION MGMT CA SOCAL Address: CA... ...Torrance Workplace Type: Remote Pay Range: $57.28 - $88.9...Remote workDaily paidMinimum wageShift workProvidence Service
Torrance, CA2 days ago- ...applicable patients as stated in system utilization management plan. Oversees Clinical Review... ...are required as well. This role will be remote but regular meetings/trainings will require... ...and/or clinical support to aid in appeal process. Serves as resource to Case Management...Remote workReliefShift workWeekend work3 days per week
Children's Healthcare of Atlanta
Morgantown, WV1 day ago $153.72k - $230.58k
...healthcare institution in New York is seeking a Director of Pre Appeals Management to lead operational oversight for the pre-appeals... ...Candidates must hold a BSN and have extensive experience in utilization management and appeals. Salary ranges from $153,723 to $230...Remote workMount Sinai Medical Center of Florida
New York, NY2 days ago$116.3k - $264.6k
...Angeles, CA, USA Onsite or Remote Flexible Hybrid... ...at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you'll provide... ...: Current unrestricted RN licensure in CA required... ...misconduct; or have filed an appeal of a finding of...Remote workMonday to FridayFlexible hoursUCLA Health
Los Angeles, CA5 days ago$80k - $90k
...The Medical Review Clinical Appeals Auditor (RN) is responsible for... ...audit activity as assigned by management. Monitors, tracks, and... ...necessary. Experience with utilization management systems or... ...ability to work independently in remote setting with minimum...Remote workFor contractorsImmediate startWork from homeHome officeFlexible hoursShift workThe Rawlings Group
Plantation, FL3 days ago- ...About the Role: Job Summary The Director of Utilization Management (UM) is responsible for leading and managing the Utilization... ...clinical status determination, medical necessity, denials and appeals, and physician education. Review daily, weekly and monthly...Remote workShift workDay shift
Northeast Georgia Health System Inc
United States2 days ago - ...happen at Hopkins. This is a remote position. Our organization... ...supervision of the UM Team Manager, the Utilization Management Specialist performs... ...accredited Nursing Program (RN) or LCSW required, BSN preferred... ..., Care Management, Appeals and/or clinical experience....Remote workWork experience placementWorldwideShift work
Johns Hopkins Medicine
Baltimore, MD1 day ago - ...Truman Medical Centers is seeking a Utilization Management RN for a part-time position working from home. The role involves partnering with interdisciplinary teams to optimize patient care and resources, ensuring compliance with regulatory standards. Applicants should...Remote workPart timeWork from home
Truman Medical Centers
New York, NY2 days ago $57.28 - $88.92 per hour
...Description The Care Management Recovery Advocate (CMRA) is responsible... ...of clinically-based appeals between Providence Health and... ...Nursing Department: 7000 UTILIZATION MGMT CA SOCAL Address: CA... ...Torrance Workplace Type: Remote Pay Range: $57.28 - $88.9...Remote workDaily paidMinimum wageShift work- ...Industrial Asset Management Council, Inc is looking for a Remote RN to join their team. The role requires 2 years of RN experience and Utilization Review expertise, supporting various units in a clinical review capacity. This work-from-home position offers flexible scheduling...Remote workWork from homeFlexible hours
Industrial Asset Management Council
Kansas City, MO1 day ago $102.18k
...Customer Solution Center Appeals and Grievances RN Job Category: Clinical... ...and may provide feedback to management on performance of staff. Ensure... ...in a managed care, utilization management and/or case management... ..., holidays, a hybrid remote schedule, and occasional flexibility...Remote workFull timeShift workWeekend work- ...Job Description Spectrum Healthcare Resources has a potential need for Registered Nurse Utilization Managers (RNUM) . These will be completely remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases, educating patients on appropriate...Remote workFull timeContract workWork at officeWork from homeMonday to Friday
Spectrum Healthcare Resources
Phoenix, AZ2 days ago $71.1k - $97.8k
...leading healthcare organization is seeking a Utilization Management Registered Nurse to support the... ...members. Candidates should hold a Compact RN license and possess over a year of... ...clinical nursing experience. The position is remote with a salary range of $71,100 - $97,80...Remote workHumana
Phoenix, AZ1 day ago$71.1k - $97.8k
...health care organization is seeking a Utilization Management Registered Nurse to help coordinate medical... ...clinical nursing skills within a remote work environment, making care determinations... ...stakeholders. This role requires an RN license and over one year of clinical nursing...Remote workHumana
Kansas City, MO1 day ago$71.1k - $97.8k
...A healthcare organization is seeking a Utilization Management Registered Nurse to support the coordination and documentation of medical services. This remote position requires a valid RN license and clinical experience. Responsibilities include interpreting medical information...Remote workHumana
Wyoming, OH1 day ago$71.1k - $97.8k
...A leading healthcare organization is seeking a Utilization Management Registered Nurse to utilize clinical skills for coordinating care services and documentation. This remote position requires a valid RN license and over a year of relevant clinical experience. The ideal...Remote workHumana
Madison, WI1 day ago$71.1k - $97.8k
...A healthcare organization in the United States seeks a Utilization Management Registered Nurse to coordinate medical services and benefit determinations. This remote position requires a Compact RN license and over one year of clinical experience in a hospital or acute...Remote workHumana
Providence, RI1 day ago- ...Providence is seeking an RN for a remote Utilization Review role. This per diem position involves conducting prospective, retrospective, and... ...clinical expertise and a solid understanding of Utilization Management. The qualified candidate will hold an Associate's Degree...Remote workDaily paid
PROVIDENCE, INC.
Los Angeles, CA1 day ago $71.1k - $97.8k
...company in the United States is seeking a Utilization Management Registered Nurse to utilize clinical... ...determinations. Candidates should possess a Compact RN license and at least one year of clinical experience. The position offers a remote work option and includes a comprehensive...Remote workHumana
Charleston, WV1 day ago
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