Remote Utilization Management Nurse
Humana
- Remote job
Humana is seeking a skilled Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care such as SNF, Home Health, and DME. You will report to the Manager of Utilization Management and collaborate with the One Home/Home Solutions UM team to ensure appropriate care in the right setting. The role requires a compact RN license, 1+ year of clinical RN experience, and a passion for improving member experiences. #J-18808-Ljbffr Humana
- ...Humana is seeking a Utilization Management Nurse to support coordination, documentation, and communication of medical services and benefit determinations... ...make critical patient-care decisions. This full-time, remote position offers a competitive salary and comprehensive...Remote workFull time
- ...CVS Health is seeking a Utilization Management Nurse Consultant for a fully remote position. You will review medical necessity, facilitate discharge planning, and collaborate with providers to support members with complex needs. Qualifications include ADN required,...Remote work
- ...Utilization Management Nurse BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical... ...requirements, and a member's benefit coverage while working remotely. Primary Responsibilities: Performs clinical utilization...Remote workContract workWork at office
- Mass General Brigham Health Plan Holding Company, Inc. seeks a Nurse for utilization review to assess medical necessity and benefit coverage for ACO/HMO/EPO members. Remote with occasional on-site team meetings in Somerville, MA. Strong InterQual/Milliman experience and...Remote work
- ...Utilization Management Registered Nurse (UM RN) We're seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join... ...regulations (LCD/NCD policies). This is a fully remote opportunity requiring discipline, accuracy, and effective...Remote work
$1,600 - $1,800 per week
...NOW HIRING: Registered Nurse - Utilization Management Location: Buckley AFB & Peterson AFB, Colorado Military Health System Compensation... ..., 0730-1630 No weekends, no holidays, no telehealth/remote work Minimum Qualifications ~ U.S. Citizenship...Remote workContract workImmediate startMonday to Friday- ...Utilization Management Department (Fully Remote) Provides health care services regarding admissions, case management, discharge planning and utilization review. Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective...Remote work
$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote The Utilization Management Registered Nurse is responsible for performing utilization review activities in compliance with federal and state regulations, URAC standards, and Guidehealth policies. This role applies...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home$26.01 - $56.14 per hour
...something bigger - helping to simplify health care one person, one family and one community at a time. Registered Nurse (RN) - Utilization Management Remote | Work from Home | 24/7 Operations Are you an experienced Registered Nurse looking to apply your clinical...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeAfternoon shift- ...The Utilization Management (UM) Nurse is a licensed nursing professional responsible for reviewing UM cases and discharge planning activities. The... ...organizations, or patient's home which may be in understaffed/remote areas, in the presence of pets or family members that are...Remote workFull timeWork at office
$36.8 - $49.8 per hour
...Utilization Management Nurse Work from home within Oregon, Washington, Idaho or Utah. Preference will be given to current employees and candidates who reside in Idaho and Utah. Build a career with purpose. Join our Cause to create a person-focused and economically...Remote workFull timeWork at officeImmediate startWork from homeFlexible hours- ...CVS Health is seeking an experienced Utilization Management Nurse Consultant to apply clinical judgment and guidelines to determine appropriate benefits across the continuum of care. This full-time role supports a 24/7 operation, with scheduled weekends, holidays and...Remote workFull timeWeekend workAfternoon shift
- ...CVS Health Corporation in Springfield, IL is hiring a Utilization Management Nurse Consultant to assess and coordinate care, applying clinical criteria to determine coverage and benefits for members. This is a 24/7 operation with weekend, holiday and evening hours....Remote workShift workWeekend workAfternoon shift
$32.01 - $68.55 per hour
## Utilization Management Nurse ConsultantApply: Remote: IL - Work from home: Work At Home-Ohio: Work At Home-Texas: Work At Home-Georgia: Work At Home-West Virginia: Full time: Posted Today: End Date: October 11, 2026 (4 days left to apply): R1047682We’re building a world...Remote workHourly payFull timeTemporary workWork at officeWork from homeMonday to FridayAfternoon shift- Optum is seeking a Registered Nurse with managed care experience to evaluate outpatient services and determine appropriate care in a remote role within the United States. You will translate... ...-functional teams, and supporting utilization management and case management...Remote job
- Cambia Health Solutions, Inc. is seeking a Utilization Management Nurse to join our Clinical Services team. This remote role supports members in Oregon, Washington, Idaho or Utah, conducting prospective, concurrent and retrospective reviews to ensure medical necessity...Remote job
- The Utilization Management Nurse supports the Case Management Department by performing a variety of utilization management functions to promote appropriate... ...rotating weekend coverage Hybrid Position - Primarily remote/work-from-home, with an expectation to be on-site at least...Remote workFull timeWork from homeShift work
$60k
...a LPN/LVN experienced in the managed care payor environment to perform... ...pre-service and post-service utilization reviews and appeals for... ...KNOWLEDGE/SKILLS/ABILITIES The UM Nurse’s responsibilities include... ...opportunities Remote Opportunities We are actively...Remote workTemporary workLocal area- ...Hybrid — 4 days per week in Brighton, MA office; 1 day remote FLSA Status: Exempt About Us BrightonOne is a nonprofit... ...discipline in service to those who served. Position Overview The Nurse Reviewer, Utilization Management performs prospective, concurrent, and retrospective...Remote workFull timeLocal area
- CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote role. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, collaborate with providers to authorize care, and elevate cases when needed...Remote job
- CVS Health is seeking an experienced Registered Nurse for a fully remote Utilization Management Nurse Consultant role. This position is ideal for individuals who thrive in a fast-paced environment and are looking to make a clinical impact without direct patient care. Highlights...Remote job
$29.1 - $62.32 per hour
...simplify health care one person, one family and one community at a time. Position Summary This Utilization Management Nurse Consultant (UMNC) position is 100% remote. As a Utilization Nurse Consultant, you will utilize clinical skills to coordinate, document and...Remote workHourly payFull timeTemporary workWork at officeLocal areaMonday to Friday- Cambia Health Solutions seeks an Utilization Management Nurse to conduct reviews (prospective, concurrent, retrospective) and ensure medical necessity and policy compliance. You will consult with physician advisors and collaborate with interdisciplinary teams to improve...Remote job
- CVS Health is seeking an experienced Utilization Management Nurse Consultant (RN) to evaluate requests for authorization across medical specialties... ...-based review and collaboration with care teams in a remote setting. The position requires active multi-state RN licensure...Remote job
- Cambia Health Solutions is seeking a Utilization Management Nurse to join the Clinical Services team. You will perform prospective, concurrent, and... ..., and the ability to interpret policies. We offer remote work options in several western states, a competitive salary...Remote job
- CVS Health Corporation is seeking a Nurse Consultant to join our Utilization Management team. The role focuses on applying clinical judgment and evidence-based criteria to review inpatient and outpatient services, authorizing care, and escalating cases when needed. The...Remote job
- CVS Health Corporation is seeking a Nurse Consultant to join our Utilization Management team. This remote role reviews inpatient and outpatient services using clinical judgment and evidence-based criteria, collaborates with providers, authorizes care, and elevates cases...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 and requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate...Remote jobWeekend work- CVS Health Corporation is seeking an experienced Registered Nurse to join our Utilization Management team in a fully remote precertification role. Preference is given to Virginia residents or candidates holding Virginia and Compact RN licenses. The position involves reviewing...Remote job
- ...Plan Holding Company, Inc. is seeking a UM Nurse to support network adequacy review and... ...for ACO, HMO, and EPO products. Remote role with occasional onsite meetings in... ...Requires MA RN license and 2-3 years of utilization review experience. You will review authorization...Remote job
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