Remote Utilization Review RN: Care Management Expert
Sentara Health
Sentara Health is seeking a Remote Utilization Review Registered Nurse based in Virginia. The role focuses on utilization review and prior authorization for inpatient and outpatient cases, with emphasis on upholding regulatory criteria and documenting clinical information.
The ideal candidate has a Virginia RN license, 3+ years of acute care nursing, and 3 years in case management, with strong verbal and written communication skills and computer proficiency.
#J-18808-Ljbffr- ...Jobgether is seeking a Case Manager – Utilization Review Specialist to oversee admissions and concurrent... ...appeals. You will work remotely from the United States alongside physicians... ...will have five or more years of acute care nursing and five to seven years in case...Remote work
- ...is seeking an experienced Registered Nurse for a fully remote Case Manager – Utilization Review Specialist position in the United States. The role focuses... ...evidence-based appeals to support appropriate patient care and financial performance. You will analyze clinical...Remote work
- ...Occupational Therapist to perform clinical reviews of therapy services and durable medical... ...practice standards and policies are met. This remote role supports TX and OK markets and collaborates with Utilization and Care Management teams to optimize care delivery. The...Remote job
- ...Arkansas Blue Cross Blue Shield is seeking an experienced Utilization Management Nurse to perform clinical reviews for prior approvals, benefit inquiries, and... ...determine medical necessity and promote cost-effective care. The position is work-from-home with eligibility...Remote workWork from home
- ...A healthcare staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates to reside in PA, DE, or NJ. Key duties involve applying criteria for medical necessity, collaborating...Remote work
- ...a health solutions company, seeks an Utilization Management RN to evaluate medical necessity and service... ...our Health Plan. You will authorize care, refer complex cases to medical directors... ...potential growth into CM roles. Remote work is available in Colorado and other...Remote work
- ...Humana is seeking a Utilization Management Registered Nurse to interpret and coordinate medical services... ...benefit determinations for post-acute care settings, including SNF, home health,... ...the One Home/Home Solutions UM team.The RN applies clinical skills and established...Remote work
$65k - $85k
...Concierge Home Care is seeking an experienced Utilization Review Specialist (RN) to join our remote home health team. This role focuses on reviewing OASIS data, coding accuracy, QA, and documentation compliance, with certifications in Oasis and Coding highly preferred...Remote workMonday to Friday- ...Health Solutions, Inc. is seeking an experienced Utilization Management Nurse to support our Clinical Services team.... ...on prospective, concurrent, and retrospective reviews to ensure medical necessity and cost-effective care across Oregon, Washington, Idaho, and Utah....Remote work
- ...Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination... ...members receive appropriate care in the right setting. This is a remote position with 40 weekly hours and... ...travel for training. A compact RN license in your state and 1+ year...Remote work
- ...Licensed Practical Nurse to perform pre-service and post-service utilization management reviews and appeals within a NCQA-compliant UM program. You will... ...license, at least 3 years of nursing in acute or outpatient settings, and 2+ years in managed care UM.J-18808-Ljbffr...Remote work
- ...Sentara Health Plans is seeking an RN Clinician for a remote role focused on utilization management and claim review. The position requires an active RN license (VA or Compact... ...) and a BSN, with at least 3 years of acute care experience, including utilization review or...Remote work
- ...Shield is seeking an experienced Utilization Management Nurse to perform clinical reviews of prior approvals, network exceptions... ...necessity and cost-effective care through adherence to guidelines and... ...The ideal candidate holds an active RN license, a BSN preferred, and at...Remote work
- ...invites a Nurse to support admissions and reviews at USC Verdugo Hills Hospital. The role involves... .... Candidates must hold a California RN license ( BSN preferred) and BCLS certification; prior Utilization/Quality/Case Management experience in acute settings is preferred....
- ...Ensemble Health Partners is seeking a Lead Utilization Review RN to drive medical necessity reviews, discharge planning, and appeals... ...The role supports revenue cycle integrity and patient care quality in a remote US-based environment. You will evaluate admissions,...Remote work
- ...UnitedHealth Group seeks an Inpatient Care Management Nurse to ensure proper utilization of health services. You will... ...levels of care. This role offers remote work flexibility with standard hours... ...team, Medical Directors, and Case Managers to review cases, #J-18808-LjbffrRemote workLocal area
- ...Sentara Health Plans seeks a Clinical Claims Reviewer RN for remote work. You will perform utilization management, review pre/post payment claims and authorizations for... ...a BSN, an RN license, and 3 years of acute care experience. The role supports multiple states and...Remote workFull time
- A leading staffing agency is looking for a Utilization Review Registered Nurse to work remotely with a major health insurance client. This role involves evaluating patient care cases and ensuring requested services align with medical necessity while adhering to confidentiality...Remote job
- HonorHealth is seeking a Utilization Review RN Specialist to review and monitor health care utilization, ensuring medical necessity across inpatient and outpatient... ...AHCCCS, and other payers, working with the Care Management team to optimize resource use and outcomes. The...Remote jobDaily paid
$47.03 - $63.48 per hour
...technology-enabled revenue cycle management solutions for health... ...possible in healthcare. The RN, Senior Utilization Review Quality will play an essential... ...experience in an acute care environment required Utilization... ...experiences This is a remote position; however, candidates...Remote workTemporary workWork at officeLocal area$63.1k - $94.65k
...enabled revenue cycle management solutions for health systems... ...have current compact RN license, or be willing... ...are seeking Virtual Utilization Review Specialist with at... ...utilization of health care resources and assists... ...Abilities Required: This is a remote role which requires...Remote workTemporary workWork at officeLocal areaMonday to FridayShift work$81.95k - $110.24k
...technology-enabled revenue cycle management solutions for health systems... ...in healthcare. The Lead Utilization Review RN is a key contributor to the... ...outcomes-oriented, patient care delivery system, which... ...Nursing required #LI-LS1 #LI-REMOTE Join an award-winning company...Remote workFull timeWork at officeLocal area- ...Description Job Description The utilization review and management (UM) component program ensures that external... ...at the appropriate level of care, while supporting regulatory compliance... ...for lunch This is an in-office, no remote work capability position Travel...Remote workWork at office
$39.4 - $53 per hour
...technology-enabled revenue cycle management solutions for health systems... ...Position Overview The Lead Utilization Review RN is a key contributor to the... ...outcomes-oriented, patient care delivery system, which... ...4 Monster Top Workplace for Remote Work 2024 Great Place to Work...Remote workWork at officeLocal area- ...Description Join our team as a remote (Oklahoma City) full time days and every other weekend RN Case Manager -Utilization Review at INTEGRIS Health, Oklahoma City, OK. Get to Know... ...timely transfers to appropriate levels of care as indicated by clinical needs and utilization...Remote workFull timeWork at officeWeekend work
$62.4k - $117.62k
...monitoring the utilization of physical health... ...Director for review. Refer to and... ...closely with Case Management to address... ...and efficient care delivery processes... ...the functions Expert and resource... ...and active NYS RN license required... ...opportunity for remote work within all...Remote workFull timeContract workWork at office- ...a contract-based professional to manage complex grievances and appeals for members and providers in a remote US-based role. The candidate will review medical necessity across inpatient... ...USRN license, at least 2 years in utilization management, strong communication,...Remote workContract work
- Jobgether is seeking a Case Manager - Utilization Review Specialist based in the United States. This fully remote role focuses on admission and concurrent reviews, medical necessity, and appeal coordination to improve reimbursement outcomes and compliance with clinical...Remote job
$85 per hour
...Requirements Must be eligible to work in Remote Fluent proficiency in English (... ...clinical/health field (MD, DO, RN, RD, NBHWC, etc.) Current... ...Why this role At $85/hr, this Utilization Review Nurse / Managed Care Expert position compensates Healthcare expertise...Remote workHourly payContract work- ...Health Care Service Corporation in the United States seeks a Registered Nurse for Utilization Management and Quality Review oversight. The role requires 5+ years of nursing experience with... ...exposure and travel as needed. This is a remote, nationwide position with potential...Remote work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Review RN: Care Management Expert. Be the first to apply!
- aesthetic rn United States
- hospice registered nurse United States
- intensive care unit rn United States
- travel or rn United States
- med surg rn travel contract United States
- occupational health nurse rn United States
- occupational health registered nurse United States
- cath lab registered nurse United States
- emergency room rn United States
- private duty rn United States




