Remote Utilization Management RN & Coding Specialist
Optum
- Remote job
A healthcare solutions 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 Associate’s Degree, relevant coding certifications, and an unrestricted RN license. The position supports remote flexibility, ensuring compliance with healthcare regulations and involvement in quality improvement initiatives. Competitive salary and a comprehensive benefits package are included based on experience and qualifications. #J-18808-Ljbffr Optum
$60.2k - $107.4k
Job Overview The Utilization Management RN Coder will accurately and efficiently review and extract pertinent case details from patient medical... ...in tele‑hearings. The role requires a thorough knowledge of coding systems (ICD‑9, ICD‑10, CM, PCS, CPT, HCPCS) and the ability...Remote workMinimum wageFull timeLocal area$62.4k - $96.08k
...provider in Rochester, NY is seeking a Utilization Management Coordinator responsible for coordinating... .... Candidates must have an active NYS RN license, clinical experience, and strong... ...communication skills. The position may offer remote work on a case-by-case basis, and the...Remote work$72.36k - $143.72k
...Purpose This clinical position will support our Government Program lines of business. Utilizing key principles of utilization management, the Utilization Review Specialist (RN) will perform prospective, concurrent and retrospective reviews for authorization, appropriateness...Remote workWork experience placementWork at office$84.78k - $131.41k
...Department/Unit Care Management/Social Work Work Shift Day (United States... ...Under direction of the Manager of Utilization Management, the Utilization Management Specialist is responsible for coordination... ...reimbursement system and coding structures preferred. Essential...SuggestedWork at officeShift work- ...Cambia Health Solutions in Tacoma, WA is looking for a UM IP Clinical Specialist to support the Clinical Services team. In this role, you will research and manage inpatient utilization management cases, collaborating with clinical professionals. Candidates must possess...Remote workWork from homeFlexible hours
- ...Cambia Health Solutions is seeking a UM IP Clinical Specialist to support Inpatient Utilization Management cases. In this role, you will work from home and leverage your clinical knowledge to manage requests and collaborate with healthcare professionals. The ideal...Remote workWork at officeWork from home
- ...Partners is seeking Senior Virtual Utilization Review Specialists to join their remote team in the United States. This... ...conducting medical necessity reviews, managing denial processes, and... ...experience, possess current LPN or RN compact licensure, and have strong...Remote work
- Providence Health & Services is seeking an RN Utilization Review for a part-time remote position. This role focuses on conducting clinical reviews and... ...years of experience in remote UR or acute hospital case management. A comprehensive benefits package, including...Remote jobPart time
- ...Utilization Management Specialist We are seeking a full-time Utilization Management Specialist to provide oversight of person-centered plans to improve quality of care and ensure plans are individualized to meet the needs of each client. Supports Utilization Management...Remote workFull timeTemporary workWork experience placementWork from home
$80.17k - $95.83k
...Lead Clinicial Specialist, RN (Richland) page is loaded## Lead Clinicial Specialist, RN (Richland)locations: WA Remote: WA Spokanetime type: Full timeposted on: Posted Todayjob requisition... ...and assess performance of procedures.* Utilize your clinical judgment to ensure...Remote workTemporary workWorldwideShift workDay shift- ...Lumen Solutions Group Inc. seeks a Prior Authorization Specialist to support their Utilization Management team. The role involves authorization processing and provider support within a 100% remote setting. Ideal candidates will have experience in Utilization Management...Remote work
- ...Appeal Specialist II - RN The Appeal Specialist II - RN reviews, analyzes... ...Denial Liaisons, and Managed Care Coordinators to ensure... ...Monitors payer billing and coding updates and communicates changes... ...reimbursement regulations. Utilizes practice management systems...Remote jobWork at office
$55k - $70k
...Utilization Review Specialist – Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary: $55K - $70K Who We Are Exact Billing Solutions... ...team of revenue cycle management professionals... ...LSW, LMHC, PT, OT, SLP, RN). Proven experience in utilization...Remote workWork at officeFlexible hours$62.74k - $78.01k
...may have the ability to work remotely. DESCRIPTION UC San... ...complex issues that requiring coding, clinical, billing, contract... ...relationships: peer to peer, management, third party payors,... ...integrity, patient access, utilization management, clinical appeals...Remote workHourly payDaily paidContract workFlexible hours- ...Overview Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote About Exact Billing Solutions Exact Billing... ...Innovative revenue cycle management and advanced billing... ...LSW, LMHC, PT, OT, SLP, RN) Proven experience in utilization...Remote workWork at officeFlexible hours
$50k
...Employer Industry: Behavioral Healthcare Management Why consider this job opportunity Starting pay up to $50,000 per year, based on... ...Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary treatment...Remote work$20.45 - $24.7 per hour
...Medical Coding Specialist Ensemble is a leading provider of technology‑enabled revenue cycle management solutions for health systems, including hospitals... ...for observation cases, utilizing third‑party software such... ...& Travel This is a remote position; however, candidates...Remote workHourly payTemporary workWork at officeLocal area- ...United Cerebral Palsy of Georgia is hiring a Utilization Management Specialist in Miami, Florida. The role requires collaboration with Medical Directors... ...in a relevant setting and specific licenses like LCSW or RN. The job involves some travel to local hospitals and...Remote workLocal area
$18.92 - $23.46 per hour
...voice matters. Proven knowledge and skill in utilizing MS Office suite of software and pharmacy... ...of home infusion therapy is required. Coding Course Certification is highly preferred.... ...in E-Verify. This position is a full-time remote position. The salary range for this...Remote workFull timeContract workTemporary workLocal areaFlexible hours$34 - $39 per hour
...specializes in accounts receivable management services offering two... ...domestic, high-quality medical coding and revenue cycle management... ...industry with our unique focus on utilizing cutting-edge technology and... ...isolation that can come with remote work, so we’ve dialed in on...Remote workHourly payFull timePart timeFlexible hours$114k - $161k
...Principal Consultant - Utility Return on Equity & Cost of Capital Specialist Job Title: Principal Consultant – Utility... ...Type: Hybrid – 3 days in office, 2 remote days per week 2025 Salary Range:... ...Concentric") is an employee‑owned leading management consulting and financial advisory...Remote workWork at officeWork from homeFlexible hours2 days per week- ...visit Job Title: RCM Specialist-Ophthalmology Must... ...of the Revenue Cycle Management Team, the RCM... ...limited to: Billing, Coding, Payment Posting, Accounts... ...payment discrepancies • Utilizing aging reports and workflow... ...standards. For remote team members, HIPAA compliant...Remote workWork at officeHome officeFlexible hoursAfternoon shiftEarly shift
- ...Denial Specialist - Epic PB Westerkamp Group, LLC is an Accounts Receivable Management company focused on hospital and professional billing... ..., lack of authorization, coding errors, timely filing, incorrect... ...or in a role heavily utilizing Epic PB for operational analysis...Remote workPermanent employment
$28.83 - $46.14 per hour
...8.83 - $46.14 per hour. Location: Remote in Washington State only. Posted wage... ...with departments including Case Management, Coding, and Health Information Management (HIM... ...years of experience in denial management, utilization review or prior authorization in a...Remote workHourly payContract workFlexible hoursShift work$25.06 - $32.58 per hour
...Location: Remote - FL Department: Coding Work Type: Full Time Shift: Shift 1/8:00:00 AM to 4:30:00 PM Minimum to Midpoint Pay Rate:... ...employees in coding/abstracting diagnosis and procedures. Utilizes Epic's electronic health record and 360 Encompass...Remote workFull timeShift work- ...Phoebe Putney Health System is looking for an RN UR Specialist in Albany, Georgia. This role involves performing utilization review tasks, overseeing insurance company communications... ..., and working with clinical staff to manage patient care requirements. Candidates should...
- ...University Medical Center, Inc. seeks a Utilization Review RN in Louisville, KY to perform utilization management tasks ensuring optimal healthcare delivery. You will evaluate patient admissions and coordinate with interdisciplinary teams while advocating for patient needs...
- ...Phoebe Putney Memorial Hospital, Inc. seeks an RN Utilization Review Specialist to manage insurance notifications and authorizations in Care Management. This role requires strong communication with insurance companies and collaboration with Care Managers and physicians...
- ...CareFirst BlueCross BlueShield seeks a Utilization Review Specialist (RN) in Baltimore, MD. This role will support Government Program lines through utilization management, performing comprehensive reviews to authorize medical and behavioral health services. The ideal candidate...
- Connections Health Solutions is seeking a Utilization Management Coordinator to handle authorizations and ensure proper utilization of services. This fully remote role requires support for inpatient care reviews and compliance with regulations. Applicants should have at...Remote job
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