Remote Clinical Utilization Review Nurse
Wns
- Remote job
WNS, a Capgemini subsidiary, seeks a licensed RN/LPN for utilization review in a remote U.S.-based role. You will determine medical necessity, support case management, and ensure HIPAA compliance while collaborating with providers and clients. Regular CST schedule applies after training, with a base salary between $65,000 and $75,000 and potential bonuses. Requires active RN/LPN license in the U.S. and at least 2 years in UR or clinical quality improvement; proficiency in MS Office is expected. #J-18808-Ljbffr Wns
$20 - $36 per hour
Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading... ...meaning behind Caring. Connecting. Growing together. The Utilization Review LVN nurse will perform documentation review for medical necessity...Remote jobHourly payMinimum wageFull timeWork experience placementWork at officeLocal area- ...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 work
- ...Johns Hopkins Health Plans is seeking a Utilization Review Registered Nurse to apply clinical, managed care and utilization review expertise to improve member outcomes. This remote role supports the organization with standard hours; you will monitor care relevance, evaluate...Remote work
$90k - $107k
...General Brigham Health Plan Holding Company, Inc. is seeking a Remote UM Nurse to support network adequacy review and authorization activities for members in ACO, HMO, and EPO products. The role requires clinical knowledge to review prior authorization requests, assess...Remote work$85.99k - $105.34k
...A community-focused healthcare organization in Oregon is seeking a Utilization Review Nurse for a full-time remote position. The role involves evaluating clinical service requests, conducting prior authorization reviews, and collaborating with interdisciplinary teams....Remote workFull time$30 - $34 per hour
...Overview Utilization Review Nurse - Remote at Astrana Health Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Compensation... ...Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient medical services...Remote workHourly payMonday to Friday- ...Utilization Review NurseAmerican Health Plans, a division of Franklin, Tennessee-based American... ...term care facilities. In partnership with nursing home operators, these Medicare... ...Utilization Management (UM) Nurse is to provide clinical support to the Clinical Services...Remote workFull timeTemporary workLocal area
- ...Remote Utilization Review Registered Nurse (UR RN) Nexus Health Systems is seeking an experienced Utilization Review Registered Nurse (UR RN) to join... ...criteria, including InterQual (or similar), to support clinical decision-making and payer compliance. Collaborate...Remote jobWork at office
- ...Comagine Health is seeking a remote clinical reviewer to evaluate medical necessity for behavioral health services across a national footprint. The role requires applying evidence-based criteria, managing high-volume reviews, and documenting outcomes within the EMR. You...Remote workFull time
$93k - $100k
...Integrity Systems seeks a Medical Review Supervisor (MCP) to lead the MR... ...reporting to the MR Project Manager. Remote from home OFFICE when not local... ...3+ years in management, 4+ years clinical experience, and 4+ years in medical/utilization review or fraud investigation....Remote workLocal areaHome office- ...Currently seeking a Utilization Management RN . Please see... ...qualifications below: Position is remote - candidate must reside... ...active PA license or a Nurse Licensure Compact to... ...will evaluate members’ clinical conditions through medical record review to determine medical...Remote workImmediate startDay shift
- ...Overview Title: Clinical Review Nurse – Prior Authorization Review Location: Fully Remote (PST Time Zone - WA/OR Resident) Duration: 12-Month (Potential for... ...for Prior Authorization Review to join our Utilization Management team. In this role, you will conduct...Remote workContract work
- ...Management Location: 100% Remote Schedule: M-F 9:00... ...Assess and analyze clinical service requests (e.g.... ...Works with the Utilization Management team primarily... ...necessity/utilization review and other utilization... ...unrestricted IL State Registered Nursing (RN) license in good...Remote workContract work
- ...applicants This is full-time remote, but candidates must reside in... ...performing accurate and timely medical review of claims suspended for... ...skills. ~ Registered Nurse (RN) with unrestricted license in state . ~3 years clinical experience . #J-18808-LjbffrRemote workFull timeContract work
$35 - $43 per hour
...pay range $35.00/hr - $43.00/hr Job Title Clinical Review Nurse – Concurrent Review Location: Remote (California only – must reside in CA or hold an... ...Review Nurse – Concurrent Review will perform utilization management functions to ensure members receive the...Remote work- ...Umpqua Health in Oregon is seeking a Utilization Review Clinician to perform clinical reviews and assess care related to mental health and substance use disorders. This full-time, exempt role requires evaluating medical necessity, level of care, and coverage decisions...Remote workFull time
- ...Utilization Management Registered NurseDuration: 6 Month Contract... ...(UM) Registered Nurse to support outpatient utilization review and prior authorization... ...authorization, and outpatient clinical review. This role is... ...work independently in a remote environment.Comfortable...Remote workContract work
$35 - $45 per hour
...Base pay range $35.00/hr - $45.00/hr Direct message the job poster from IntePros IntePros is seeking a Remote Utilization Review Nurse serves as a key clinical liaison, coordinating resources and services to meet patients’ needs while ensuring compliance with federal,...Remote workContract workWeekend work- ...SummaryPerforms medical record review for severity of... ...information from clinical medical record for severity... ...and Training:Nurse, Registered (RN) licensureBSN... ...preferred. 2-5 years previous Utilization Review experience... ...:Days, Primarily remote; onsite orientation requirement...Remote workShift workWeekend work
- ...Utilizing clinical expertise, the full-time Licensed Medical Review Nurse (LVN/LPN) will conduct medical reviews of claims and documentation to ensure medical necessity... ...and compliance with regulations while working remotely on a MST/PST schedule. Key responsibilities...Remote workFull time
- ...Utilization Review NurseWe are seeking a detail-oriented and experienced Utilization Review Nurse to evaluate the medical necessity, appropriateness,... ...Review Nurse will perform clinical reviews, ensure compliance... ...utilization management department. Remote, hybrid, or on-site...Remote workWork at office
$40.12 - $62.19 per hour
...Utilization Review RNSinai Hospital's Utilization Review operates as a distinct... ...line of physician advisors, nurses, and support staff who ensure hospital stays are clinically appropriate and fully covered... ....This is a Full-time remote position.Responsibilities:The...Remote workFull time$34 - $40 per hour
...pay range $34.00/hr - $40.00/hr Remote (Compact Licensure Required) - Open to... ...Role Medix is seeking an experienced Utilization Review Nurse to support our mission of improving... ...States $65,000.00-$85,000.00 1 day ago Clinical Review Nurse - Prior Authorization...Remote workFull time- ...Utilization Review NurseSentara Health Plans Community Care is looking to hire a Utilization Review Nurse.The Utilization Review Nurse is responsible for... ...state, medical policy, clinical criteria). Facilitates accreditation... ...that are available as remote work, Sentara Health...Remote workTemporary work
$30 - $40 per hour
...RN Clinical Review Nurse (Utilization Review Nurse)The Clinical Review Clinician for Appeals is responsible for performing clinical reviews to resolve... ..., Vacation or Sick Leave)Workplace Type:This is a fully remote position.Application Deadline:This position is anticipated...Remote workContract workTemporary work$30.64 - $45.8 per hour
...Utilization Review NurseThe Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-... ...Management department and of CorVel. This is a remote position.Essential Functions &...Remote workFull timeWork at officeLocal areaFlexible hours- ...Utilization Review NurseThis position has a remote option for those living close and will be able to come into the hospital as needed.The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper...Remote workFull time
- ...EmployerOffice Location: Remote option in NC; Available for... ...by medical necessity and clinical guidelinesServices are authorized... ...and need for Peer Review when the MHSU Utilization Management Reviewer cannot... ...behavioral health; or a Registered Nurse with two (2) years of...Remote workContract workWork at officeShift work
- ...Utilization Review Nurse, LPNAcrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment... ...care in accordance with applicable clinical guidelines and regulatory requirements... ...per week in the office and three days remote. Candidates must also have flexibility...Remote workWork at officeImmediate startFlexible hours2 days per week
$55 per hour
...Akkodis is hiring a Concurrent Review Nurse to support our client in the... ...Healthcare space. Location: Remote (must be based in California... ...of three (3) years of clinical experience as a Registered Nurse... ...in case management, utilization management, or discharge planning...Remote workFull timeContract workTemporary workLocal area
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