Utilization Review Nurse- Remote
$41 - $45.5 per hourMindlance, Inc.
- Remote job
This range is provided by Mindlance. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $41.00/hr - $45.50/hr Direct message the job poster from Mindlance Connecting Top IT Talent with Direct Government Clients Role: Nurse Case Management Senior Analyst Location: Remote (within plan states: IL, TX, NM, OK, MT, TN) Remote only for residents of IL, TX, NM, OK, MT, and TN. License Required: Active, unrestricted RN License Must have MCG/InterQual experience. Job Summary: The Nurse Case Management Senior Analyst is responsible for planning, implementing, coordinating, monitoring, and evaluating healthcare services for members in alignment with physician treatment plans. The role ensures cost-effective, high-quality care and supports members through clinical assessments, health education, and utilization management. Key Responsibilities: Perform clinical assessments to determine member needs. Plan, coordinate, and evaluate care services to support positive health outcomes. Conduct prospective, concurrent, and retrospective reviews for inpatient, rehab, referrals, and select outpatient services. Manage an independent caseload and coordinate all assigned cases. Support program objectives by assessing the effectiveness of alternative care options. Provide health education and utilization management oversight. Address complex issues escalated from junior team members. Complete day-to-day tasks with minimal supervision. Requirements: Active, current, and unrestricted Registered Nurse (RN) license Must have MCG/InterQual experience. Experience in case management, utilization review, or clinical coordination preferred. Strong assessment, planning, and evaluation skills. Ability to work independently and anticipate member needs. Must reside in IL, TX, NM, OK, MT, or TN . About Us: Founded in 1999, Mindlance is a certified diversity business (MBE) and has been ranked one of the fastest growing U.S staffing firms by SIA for ten years. Mindlance has been recognized as one of the consistently best performing partners to industry-leading MSP programs including Kelly, TAPFIN, Allegis, Magnit, Pontoon, Monument, Guidant and Agile-1. As a recruitment-centric talent acquisition company, Mindlance provides Technology, Engineering, Scientific, Clinical Research, Digital, Creative, Marketing, Professional & Call-center staffing as well as Direct Sourcing, RPO, Global Payroll IC management workforce solutions to enterprise clients. With an annual revenue of over $400 million and growing, the Mindlance story is one of calculable achievement, made meaningful by the commitment to keep getting better in a way that is mindful and creates a balance that works for everyone. EEO: Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans. #J-18808-Ljbffr Mindlance, Inc.
- ...TRISTAR Company is seeking an experienced Utilization Review Nurse for a fully remote role across all states. The job focuses on workers’ compensation utilization review—prospective, concurrent, expedited, and retrospective reviews—to determine medical necessity and appropriateness...Remote work
- ...Leave Your Mark is seeking a Registered Nurse for Utilization Review to support a Michigan health plan client from a home-based setting. The role focuses on prospective, concurrent, and retrospective reviews to determine medical necessity, level of care, and length of...Remote workWork from home
- ...Ensemble Health Partners is seeking an experienced RN for Utilization Review to assess medical necessity and optimize hospital and patient care. This remote role involves coordinating with the FCC, care management, and interdisciplinary teams to ensure appropriate level...Remote work
- ...Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will assist patients through the continuum of care in collaboration with the patient’s primary care physician, facility case manager, discharge planner and contracted...Remote work
- ...Centene Corporation is seeking a fully remote Appeals Nurse Reviewer to conduct clinical reviews of medical records and data to determine medical... ...NY RN license (BSN preferred), 2+ years in acute care or utilization management, and knowledge of NCQA and NY Medicaid/...Remote workMonday to Friday
- ...who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage... ...Employee Referral Bonus Program JOB SUMMARY: The Utilization Review Nurse is to assess the medical necessity and quality of healthcare...Remote workFull timeTemporary workLocal area
- ...WNS HealthHelp is seeking a registered nurse to perform concurrent inpatient utilization review using InterQual criteria, supporting medical necessity decisions... ...strong documentation skills, and the ability to operate independently in a remote, US-based #J-18808-LjbffrRemote work
- ...Centene Corp. is seeking a fully remote RN to perform clinical reviews for appeals, evaluating medical necessity based on NCQA standards and applicable... .... The role prefers an active NY license and emphasizes utilization management knowledge. Candidates should have 2+...Remote work
- ...To ensure timely and accurate care decisions, the full-time LVN Utilization Review Nurse will perform clinical reviews for medical necessity and benefit coverage, applying clinical guidelines and policies while working Monday to Friday with rotating Saturday coverage....Remote workFull timeMonday to Friday
- All Care To You is seeking a UM Outpatient Review Nurse to join our Case Management team. This remote role emphasizes clinical review, medical necessity determinations, and collaboration with health plans, providers, and members to support high-quality patient outcomes...Remote job
$89.54k - $136.47k
City/State Norfolk, VA Work Shift First (Days) Overview: Sentara Health is hiring a Remote Utilization Review Registered Nurse. Candidates must reside in the State of Virginia. As an integrated care manager, specializing in Utilization review, the registered nurse...Remote workFull timeTemporary workShift work- ...Gainwell Technologies LLC is seeking a skilled Utilization Review Nurse for a remote role based in the United States. The position reviews medical necessity and appropriateness of services, using InterQual/MCG criteria and contract guidelines, with documentation in management...Remote workContract workFlexible hours
- ...All Jobs Utilization Review Nurse (PRN/Weekend Shift) Fully Remote • FL Description The Utilization Review (UR) Nurse is responsible for conducting admission and continued stay reviews to ensure appropriate utilization of hospital resources and compliance...Remote workDaily paidReliefWork at officeShift workWeekend work
$77.08k - $119.47k
...$119,466.00 Responsible for Utilization Management, Quality Screening... ...Ideal Characteristics Registered nurse with a New York State current... ...applicable to utilization review process. Excellent written and... ...work cannot be done from a remote location. Other Requirements...Remote workShift work- ...We're Hiring: Utilization Review Nurse (RN) – 100% Remote Looking for your next opportunity in Utilization Review? If you're an experienced RN with a strong background in utilization review and a passion for evidence-based care, this is your chance to join a mission-driven...Remote workContract workMonday to Friday
- ...one day in Newark NJ rest of role will be remote This position is responsible for... ...Responsibilities: 1. Conducts on-site reviews at participating provider offices to assess... ...industry. 2. Requires License Practical Nurse License or an active New Jersey Registered...Remote work
$89.07k - $162.8k
...concurrent and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved... ...efficient way.This position is remote but must be willing to travel... ...QualificationsAssociate's degree in Nursing requiredBachelor's degree in...Remote work- ...Franklin, Tennessee-based American Health Partners Inc., seeks a Utilization Review Nurse. You will assess the medical necessity and quality of care,... ...knowledge of InterQual/MCG guidelines and Medicare rules. Remote options are not listed; location is Franklin, TN. #J-1880...Remote work
- ...Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. You will assess inpatient needs, collaborate with the patient's PCP, discharge planner, and contracted providers to ensure safe, cost-effective care.Schedule is Monday...Remote workMonday to Friday
- ...Iconma Portal is seeking a Registered Nurse-Review Analyst for a remote position with a Health Insurance client. You will conduct prospective, concurrent, and retrospective reviews across inpatient, outpatient, ambulatory, and ancillary services to verify medical necessity...Remote work
$40 - $50.48 per hour
...experienced California RN or LVN with strong Utilization Management and inpatient review experience? We’re hiring for a 100% REMOTE opportunity focused on inpatient clinical... ...LVN license Commercial UM background (nurses who possess a fast pace and a sharp sense...Remote workContract workTemporary work$65k - $78k
...Utilization Review Nurse- Remote job at Gainwell Technologies LLC. North Carolina. It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible...Remote workFull timeContract workWork at officeWork from homeFlexible hours- A healthcare provider is seeking a Utilization Review Nurse to coordinate resources and ensure efficient delivery of home health care. This role involves monitoring patient admissions and ongoing care while ensuring adherence to guidelines. The ideal candidate will have...Remote workContract work
- ...Astrana Health is seeking a Utilization Review Nurse with a Texas LVN license to support our Health Services Department in reviewing a high volume... ...weekend and holiday rotation. The position is fully remote and will align with PST hours during probation, transitioning...Remote workTrial periodWeekend work
$41 per hour
...Medical Review Nurse (RN) Remote position, however candidates must reside in the State of TX or State of IL This position is a contract for about 9 months. Pay: $41/hour RN working in the insurance or managed care industry using medically accepted criteria...Remote workContract work- ...Alignment Health is seeking an experienced inpatient review nurse to join our remote utilization management team. You will guide patients through the care continuum, collaborate with physicians and case managers, and ensure care is appropriate, cost-effective, and safe...Remote work
$50 - $55 per hour
...Remote Utilization Review RN | CA RN License Required - -Must sit in CA Were seeking an experienced Utilization Review RN for a remote MondayFriday... ...: ~ Active California RN license ~5+ years of nursing experience ~ Inpatient clinical experience ~ Utilization...Remote workContract workTemporary work$30 - $38 per hour
...A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Remote workHourly payPart time- ...Integra Partners is seeking an LPN/LVN experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to review benefit and medical necessity within an NCQA...Remote work
- ....Paid HolidaysWork-life balance.Remote settingRole Description:This individual will utilize clinical knowledge and communication... ...criteria sets and acceptable nursing practice guidelines for... ...defer decision to a second level reviewer. This individual interfaces with...Remote workTemporary workWork at officeMonday to FridayFlexible hours
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