Remote Clinical Review Nurse - Utilization Management
Centene Corporation
- Remote job
Centene Corp. is seeking a clinical professional to join our Medical Management/Health Services team in a remote role based in Missouri. The position requires an active Missouri RN license and residence in Missouri, with the work schedule from 8am to 5pm Central Time, Monday through Friday, plus occasional holidays. The role focuses on Medicaid populations and leverages strong clinical background, managed care, and utilization management experience. #J-18808-Ljbffr Centene Corp.
- ...Brighton Health Plan Solutions is seeking an Utilization Management Nurse to perform medical necessity and benefit reviews remotely. The role requires current LPN licensure and expertise in CMS/MCG criteria with experience in inpatient/outpatient reviews. The successful...Remote work
- ...Job Title: Clinical Review Nurse - Concurrent Review Location: Remote -Anywhere in US Shift : Tuesday - Thursday 9:30 am... ...) standards. Works with senior management to identify and implement opportunities... ...on training needed within the utilization management team based on trends...Remote workLocal areaShift work
$34 - $35 per hour
Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical Nurse - Work from Home... ...Conducts telephonic and concurrent review of hospitalizations and extended... ...Clinical Review Nurse- Prior Authorization Remote Registered Nurse (Remote Patient...Remote workFull timeWork at officeWork from homeNight shift- A healthcare organization is seeking a Clinical Review Nurse - Concurrent Review to perform utilization management functions remotely. The role requires conducting concurrent reviews, collaborating with medical teams, and ensuring quality healthcare outcomes. Candidates...Remote jobWork at office
- ...Friend Back Remote Work from Home... ...MD 21076 Category: Nursing Schedule: Day Shift... ...Plans (JHHP) is the managed care and health services... ...- 5:00 PM As a Utilization Review Registered Nurse for... ...opportunity to use your clinical, managed care, utilization...Remote workFull timeLocal areaWork from homeMonday to FridayDay shift
$36 - $40 per hour
...Actalent is Hiring a Team of Concurrent Review Nurses (Utilization Management)!! This role performs concurrent... ...in accordance with established clinical criteria, regulatory requirements, and... ...Vacation or Sick Leave) This is a fully remote position. This position is...Remote workContract workTemporary workWork at office- ...CVS Health is hiring a Utilization Management Nurse Consultant focused on Medical Review. This fully remote role supports timely, medically necessary care through expert clinical review and provider collaboration. The position requires an active RN license, 3+ years of...Remote workFull time
$219k - $286.9k
Oscar Health is hiring a Physician Reviewer to join our Utilization Management team. You will determine the medical appropriateness... ..., and pharmacy services by reviewing clinical information and applying evidence-based guidelines. This remote role in the United States offers work...Remote jobWork from home$1,600 - $1,800 per week
...NOW HIRING: Registered Nurse - Utilization Management Location: Buckley AFB & Peterson AFB, Colorado... ...weekends, no holidays, no telehealth/remote work Minimum Qualifications... ...Utilization Management, Utilization Review, or Case Management ~• Preferred...Remote workContract workImmediate startMonday to Friday- A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing utilization management, reviewing medical records, and coordinating discharge planning. Candidates must have an active RN license...Remote workContract work
- Centene Management Company LLC is seeking a registered nurse to perform concurrent reviews for the Missouri Medicaid population in a fully remote role. The incumbent will assess health status, evaluate... ...discharge planning within utilization management guidelines. Requires...Remote job
- ...experienced RN to support Arizona Plan clinical member services review processes. The role requires an... ...AZ RN license and experience with utilization management, prior authorization, and both inpatient and outpatient settings. Remote position, must reside in Arizona, with...Remote job
- ...Incorporated is seeking a Peer-to-Peer Utilization Review Nurse to join the central utilization management team. The role focuses on... ...discussions through expert clinical analysis and standardized criteria... ..., and care management, with remote work options and a 32-hour weekly...Remote job
- Brighton Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate with partners, and ensure timely, compliant documentation and communications...Remote jobWork at office
- ...Corporation is looking for a Utilization Review Supervisor RN to direct operations... ...Cucamonga. The role includes managing day-to-day operations,... ...and handling HR matters. This remote position requires strong communication skills, clinical experience, and the ability to...Remote job
- Brighton Health Plan Solutions, LLC is seeking an Utilization Management Nurse to perform medical necessity reviews remotely. Licensed LPN with strong MS Office skills will review clinical criteria, coordinate with care partners, and document determinations in compliance...Remote job
- ...Ensures completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical... ...week. This role will be remote BUT regular meetings/trainings... ...~ Bachelor of Science in Nursing ~ Previous experience with...Remote workReliefWeekend work3 days per week
- Comagine Health is seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess medical necessity and quality of care... ...prospective, concurrent, and retrospective utilization management reviews. This full-time, remote position supports compliant, cost-effective care...Remote jobFull time
$65k - $75k
Piper Companies is seeking a Remote Utilization Management/Review Nurse to evaluate member cases, ensuring medical necessity and appropriate healthcare service utilization. The role requires clinical expertise and collaboration with providers to make high-quality care...Remote job$27.02 - $48.55 per hour
...million members as a clinical professional on our Medical Management/Health Services team.... ...This position is fully remote/work from home; applicants... ..., managed care and utilization management/review experience are helpful... ...Accredited School of Nursing or Bachelor’s degree in...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hours- Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires...Remote job
- University of Miami Health System seeks a full-time Utilization Review Case Manager to work remotely. The role reviews patient charts for prior authorization, concurrent and retrospective utilization, coordinating with the care team for timely and appropriate care. You...Remote jobFull time
- ...Oak Street Health in the United States is seeking a Full-Time Utilization Management Physician Reviewer to provide coverage determinations for inpatient and outpatient services using UM criteria and clinical judgment. You will collaborate with Transitional Care and PCP...Remote workFull time
$65.52k - $111.61k
...Maximum Offer $111,612.80Now Hiring: LTC Utilization Management Reviewer Summary: Build your Career.... ...LTC Responsible for conducting Nursing (NF) Facility Level of Care (LOC)... .... Able to summarize from medical clinical notes, progress notes, needs...Remote workTemporary workLocal areaImmediate startWork from homeShift work- ...Oak Street Health is seeking a full-time Utilization Management Physician Reviewer for a remote role. You will review requests, apply UM criteria, and coordinate... ...care. The position includes comprehensive benefits and a focus on clinical excellence. #J-18808-Ljbffr...Remote workFull time
- ...Oak Street Health is seeking a full‑time Utilization Management Physician Reviewer who will remotely assess inpatient and outpatient requests using UM criteria and clinical judgment. You will coordinate with Transitional Care and PCP teams to ensure medically appropriate...Remote workFull time
$130 - $145 per hour
...We’re hiring a part-time Physician Reviewer to join our Utilization Management team. Oscar is the first health... ...and pharmacy services by reviewing clinical information and applying evidence-based... .... Work Location This is a remote position, open to candidates who reside...Remote workHourly payFull timePart timeLocal areaWork from homeHome officeWeekend work- ...Oak Street Health seeks a Full-Time Utilization Management Physician Reviewer to provide timely coverage determinations for inpatient and outpatient services using UM criteria and clinical judgment. You will coordinate with care teams to ensure medically appropriate care...Remote workFull time
- ...Street Health is hiring a Full-Time Utilization Management Physician Reviewer to provide timely coverage... ...services. You will use UM criteria, clinical judgment, and internal policies to... ...willingness to collaborate across care teams in a remote setting. #J-18808-Ljbffr...Remote workFull time
- IntePros is seeking a Physician Reviewer to provide remote support for a healthcare organization. The role involves reviewing... .... This position offers a collaborative environment with opportunities to leverage clinical expertise in utilization management. #J-18808-LjbffrRemote work
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