Remote Utilization Management Nurse RN - Appeals Specialist
Palo Verde Community College District
- Remote job
Optum is seeking a Utilization Management Nurse to accurately review patient medical records and craft defensible appeal letters per process instructions and department guidance. The nurse will complete cases within time expectations, ensure high-quality reviews, and adhere to HIPAA and company policies while supporting OPAS, Optum, and client goals. The role offers a remote work option across the United States and collaborative team environment. #J-18808-Ljbffr Palo Verde Community College District
- UnitedHealth Group's Optum is seeking a Utilization Management Nurse to review patient records and craft defensible appeal letters in accordance with OPAS guidelines. This role... ..., compliant reviews. The position requires an RN license and an associate degree, plus 3+ years...Remote jobMonday to Friday
$60.2k - $107.4k
UnitedHealth Group is looking for an Utilization Management Nurse to review medical records, extract case details, and craft defensible appeal letters. The role emphasizes data extraction... ...an Associate's degree, an unrestricted RN license, 3+ years in bedside nursing, and...Remote job- UnitedHealth Group is hiring a Utilization Management Nurse to accurately review medical records and extract pertinent details for appeal letters. The role supports flexible telecommuting... ...an Associate's degree, an unrestricted RN license in their state, and at least 3 years...Remote jobFlexible hours
- Optum is seeking an Utilization Management Nurse to review patient records and craft defensible appeal letters according to process instructions. You will extract pertinent details... ...in the U.S. with a 40-hour week; requires an RN license, 3+ years bedside nursing in ED/...Remote job
- ...service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and... ...resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license... ...clinical practice and knowledge of Utilization Review Guidelines. The...Remote work
- Spectrum Healthcare Resources is seeking a Utilization Manager Registered Nurse (UMRN) to work entirely remotely from home. The nurse will review cases, educate patients... ...(compact preferred), and at least 2 years of RN UM experience (remote/hybrid preferred). #J-1880...Remote jobWork from homeMonday to Friday
- Providence Health & Services is seeking an Appeals RN in Case Management for a remote, per diem role working 8-hour day shifts. The Care Management Recovery Advocate will manage clinically-based appeals between Providence California Region and outside payers, focusing...Remote jobDaily paidDay shift
$21.68 - $31.08 per hour
...Work Location: This is a fully remote, permanent work-from-home... ...will YOU be doing for us? Utilize internal practices and policies... ...accuracy. Communicate with management and other internal staff on audit... ...of general practices for appeals, complaints, and grievances handling...Remote workHourly payPermanent employmentSecond jobWork at officeWork from homeWeekend work$50k
...Industry: Behavioral Healthcare Management Why consider this job... ...concurrent reviews, and internal utilization review assessments Consult with... ...coordinate urgent/expedited appeals Staff individual cases with medical... ...license (e.g., Registered Nurse, Licensed Practical Nurse,...Remote work$13 - $14 per hour
...hour Job Type: Contract Location: Remote Schedule and Shift: Monday-Thursday... ...health plans requirements related to Utilization Management and authorizations Acts as a... ...information for member and/or provider appeals of denied requests Identifies areas...Remote workHourly payContract workWork at officeShift work$29.7 - $31.8 per hour
...technology-enabled revenue cycle management solutions for health systems... ...The Acute Coding Appeals Specialist integrates medical coding principles... ...the clinical documentation utilized in the decision-making... ...client experiences. This is a remote position; however, candidates...Remote workTemporary workWork at officeLocal area$60.2k - $107.4k
...UnitedHealth Group is seeking a Registered Nurse with at least 3 years of bedside nursing experience to support appeals, data extraction, and HIPAA-compliant communications. This full-time position is remote within the United States and offers a pay range of $60,200 to...Remote workFull timeWork at office- UnitedHealth Group is seeking a qualified Utilization Management Nurse to review patient records and craft appeal letters, ensuring accuracy and compliance. You will support... ...high-quality reviews. Requirements include an RN license, 3+ years bedside nursing in acute care,...Remote jobWork at officeFlexible hours
$60.2k - $107.4k
...Utilization Management Nurse Optum is a global organization that delivers care, aided by technology to help millions of people live healthier... ...from patient medical records; and craft strongly defensible appeal letters per process instructions and the department's/...Remote jobMinimum wageFull timeWork experience placementLocal areaMonday to FridayFlexible hoursWeekend workAfternoon shift$72.8k - $130k
...Sr Utilization Management Nurse Optum is a global organization that delivers care... ...occasional opportunity for remote work based on business needs... ...Qualifications: ~ Registered Nurse (RN) with a current, active,... ..., and/or clinical appeal and guidance reviews ~ Must...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- ...offers industry-leading revenue cycle management services for healthcare providers.... ...manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR... ...rewarding environment. This is a fully remote or office/home hybrid position....Remote workWork at officeFlexible hours
- ...Working remotely in a full-time capacity, the Utilization Management Support Specialist will conduct audits of authorization case work, provide technical support for authorization processing, and assist in resolving quality issues to ensure compliance with service level...Remote workFull timeSecond jobWork at office
- ...Utilization Management Specialist Under general supervision by management, and in collaboration with Medical Directors and other members of the clinical... .... Required License: LCSW, LCMFC, LMHC, LMFT, LCPC or RN. OR RN, then a Bachelor Degree is required. The Master Degree...Remote workContract workLocal area
- ...CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home role in the EST time zone. The position supports... ...management and benefit coordination, requiring an active RN license and hospital experience. Responsibilities include...Remote workWork from home
- ...Utilization Management Specialist The Utilization Management Specialist demonstrates excellent customer... ...payer reviews, contacts, decisions and appeals, and reports trends relative to third... ...positive outcomes. Qualifications RN with current license in State of...Contract workWork at officeLocal areaImmediate start
- ...Summa Health System is seeking a Full-Time Utilization Management Nurse to optimize cost-effective care across the hospital care continuum. The... ...Transitional Care Team and physician advisors, ensuring compliant discharge appeals, and supporting denial review #J-18808-Ljbffr...Full time
- ...talented Team. Job Title: Utilization Management Specialist- 49936-1 Location(s): Remote Job Summary: Utilizing key... ...: ~ Bachelor's Degree in Nursing or an additional 4 years of relevant... ...management experience. ~ RN/LPN state licensing or compact....Remote workWork experience placementWork at office
$58.9k - $80.07k
...The Appeals & Grievances (A&G) unit processes member and non-contracted provider appeals... ...enrollments, Medicare and complete care. Appeals Specialist is the subject matter expert responsible... ...Federal and/or State regulations. They manage their own caseload and is accountable...Remote workTemporary workWork experience placement- Vanderbilt University Medical Center is seeking a Utilization Management professional to ensure accurate certification and complete chart documentation... ...and timely patient throughput. The ideal candidate will have RN qualifications with UR experience, a strong understanding of...Remote job
- Elevance Health is seeking a Utilization Management Representative I to coordinate precertification and prior authorization reviews. This full-time remote role offers flexibility with required in-person training sessions and optional alternate locations within commuting...Remote jobFull timeContract work
- Elevance Health is seeking a hands-on Utilization Management Representative I to coordinate precertification and prior authorization for members. This role supports flexibility with virtual work and required in-person training, while aligning with a hybrid work strategy...Remote job
- ...our service to our vegetation management clients. We’re transparent... ...plans necessary work to meet utility standards Collects data on unit... ...preferred ISA Utility Specialist certification preferred Must... ...patrol of utility power lines; remote locations as well as urban, city...Remote workFull time
$46.76 - $51.76 per hour
...references. Follows NCQA Standards and departmental SOPS to manage member assignments. Conducts research and analysis of... ...internal stakeholders. Nice to Have: Prior experience in utilization management, care management, or payer-side review of ABA services...Remote jobWork at office- ...California is seeking a Registered Nurse for a temporary Utilization Management role. You will ensure prior authorizations... .... Required are an active CA RN license and at least five years in... ...substitute for experience. Hybrid work and remote- interview options are offered. #J-...Remote workTemporary work
- ...CVS Health is seeking a Utilization Management (UM) Nurse Consultant for a fully remote, full-time role open to CST zone candidates. You will coordinate, document, and communicate all aspects of utilization and benefit management, ensuring appropriate care levels within...Remote workFull time
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