Remote RN/LPN Utilization Review Specialist
Remote Jobs
- Remote job
Ensemble is seeking Virtual Utilization Review Specialists to join our remote team. You will evaluate medical necessity, coordinate with physician advisors, and collaborate with care management and financial clearance teams to ensure high-quality patient care and appropriate utilization of resources. Must hold an unrestricted RN or LPN license and have 3+ years of acute care nursing experience. This remote role requires strong communication, problem-solving skills, and the ability to work with #J-18808-Ljbffr Remote Jobs
- 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
$65k - $85k
...Utilization Review Specialist (RN) – Remote At Concierge Home Care, we are growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team. This role is ideal for an RN with strong experience in OASIS, coding, QA, and...Remote workMonday to FridayWeekday work- TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews, assisting...Remote job
- HonorHealth is seeking a Utilization Review RN Specialist to review and monitor health care utilization, ensuring medical necessity and appropriate... ..., and driving accurate documentation for data reporting. Remote work is available after training, with a day shift in a major...Remote jobDay shift
- ...seeking experienced nursing professionals to review medical records and ensure appropriate... .... Candidates must have a valid California RN license and at least two years of clinical... ...degree in a related field. The position offers remote work with emphasis on critical thinking...Remote work
- ...NeighborHealth’s SCO RN UM Reviewer role is based in East Boston within the Senior Care Options team. You will review clinical appeals and service authorization needs to ensure medical necessity aligns with CMS standards and organizational determinations. The role requires...Remote work
- ...Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The role involves performing retrospective medical... ...experience in a relevant medical setting, and the ability to work in a remote environment. Comprehensive benefits are provided, including...Remote workContract workWork from home
- ...an Appeals and Grievances Clinical Specialist to manage member complaints and... ...case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities... ...practice and knowledge of Utilization Review Guidelines. The position offers a...Remote work
- ...patients-we invest in our people. About the Role: The Utilization Review Specialist plays a critical role in ensuring that healthcare services... .... Preferred Qualifications: Registered Nurse (RN) license or equivalent clinical certification. Experience...Remote workPart time
- ...Utilization Review Specialist The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients... ...skills. Preferred Qualifications: Registered Nurse (RN) license or equivalent clinical certification....Remote work
$39.4 - $53 per hour
...This position pays: RN pay scale $39.40 - $53/hr based on experience LPN pay scale $32.65 - $46.90/hr... ...We are seeking Virtual Utilization Review Specialists to join our team. Essential... ...Abilities Required: This is a remote role which requires access...Remote workTemporary workWork at officeLocal areaMonday to FridayWeekend work- ...Utilization Review Specialist | Remote | Full-Time Banyan Treatment Centers is seeking an experienced and detail-driven Utilization Review Specialist... ...health related field Clinical licensure (LCSW, LMHC, LPC, RN, or equivalent) — valued but not required Experience...Remote workFull timeTemporary work
- Spectrum Healthcare Resources seeks a Utilization Manager Registered Nurse (UMRN) to work entirely from home in a fully remote role. The nurse will review cases, educate patients on... ...schedule of 8 hours per day, requiring an RN with a Bachelor's degree, state licensure...Remote jobWork from homeMonday to Friday
- ...providing telephonic and e-referral case review and authorization of services utilizing established mental health and... ...This position is full-time, fully remote (work from home) and requires some... ...State of Michigan clinical license (RN, LMSW, LP, LPC, or LLP) required....Remote workFull timeWork from homeShift workWeekend workAfternoon shift
- ...General Hospital is seeking an Utilization Management Nurse (UMN) to ensure... ...concurrent, and retrospective reviews, collaborate with physicians and... .... Role requires Florida RN licensure and at least 3 years of nursing experience. Remote or hybrid work options may apply...Remote job
- ...integrating, and monitoring the utilization of behavioral health (BH) or... ...cases to the Medical Director for review. Refer to and work closely... ...Associates degree and active NYS RN license required. Bachelors... ...There may be opportunity for remote work within all jobs posted by...Remote workContract workWork at office
- ...Seeking an experienced and detail-driven Utilization Review Specialist, the full-time remote position will manage a caseload of 50-75 patients, conducting admission and continuing-stay reviews, coordinating authorizations, and serving as a liaison between clinical operations...Remote workFull time
- ...American Health Plans in Franklin, TN seeks an Utilization Review Nurse to assess medical necessity and quality of care for plan members. You... ...services comply with regulatory guidelines. The role requires RN licensure and UM experience; knowledge of Interqual/MCG and Medicare...
$30 - $45 per hour
...consulting agency is seeking an Operations Specialist III for a contract opportunity in Long... ...along with experience in Epic EHR and Utilization Review. The selected candidate will perform... ...program metrics. This position is remote and offers a pay range of $30-$45 per...Remote workHourly payContract work- ...Coronis Health is seeking a remote Utilization Review Specialist to manage treatment authorization for behavioral health and substance abuse, interfacing with insurance and managed care entities. The role covers pre-certification, concurrent reviews, and appeals with...Remote work
- ...Alliance Health is seeking a UM Clinical Specialist-LTSS for full-time remote work, NC-based. You will perform utilization reviews and authorizations for I/DD and TBI waivers, ensuring services meet clinical guidelines and are provided in the least restrictive setting....Remote workFull time
$29.62 - $45.31 per hour
...Department Coordinate and execute the review and research functions required to support... ...Critically assess and prepare all cases for RN/MD review of coverage (medical necessity,... ...inquiries, provider resolutions, etc.) Remote Work This position offers 100% remote work...Remote workMinimum wageFull timeWork experience placementLocal areaShift work$55k - $70k
...support to behavioral health programs. We are looking for a Utilization Review (UR) Specialist in Boca Raton, FL Compensation: $55,000 - $70,000 a year... ...position and must have prior UR & clinical experience. Remote hires and applicants without prior experience will not be...Remote workFull timeWork at office$70k - $100k
...of the Surgery Partners network, is seeking an experienced Utilization Review Specialist to join its team in Addison, Texas. This position is ideal... ...is a hybrid opportunity offering the flexibility of three remote workdays per week while maintaining an onsite presence two...Remote workContract work2 days per week- ...ABA Utilization Review Specialist Spectrum Billing Solutions offers industry-leading revenue cycle management services for healthcare providers... ...in a cohesive and rewarding environment. This is a fully remote or office/home hybrid position. Your Responsibilities:...Remote workWork at officeFlexible hours
- Mass Digital Health is seeking a Utilization Review Nurse in Quincy, Massachusetts. This role involves evaluating patients for appropriate admission... ...coordination. This position requires at least two years of RN experience in care management or utilization management. The...
- UofL Health is seeking a Utilization Review RN in Louisville to support utilization management. The role includes admitting and concurrent reviews, interfacing with physicians and payors, and ensuring compliance with UM criteria and documentation standards. Ideal candidates...
- ...Utilization Review Specialist The primary purpose of the Utilization Review Specialist is to create and manage the flow of revenue for each client... ...limits. Proficient in Microsoft Office Satisfactory CORI and background check. Satisfactory drug screen Part Time Remote Role...Remote workPart timeWork at officeFlexible hours
- ...to help improve the health of individuals and the quality of life in our community. New Horizons is seeking an Utilization Review Specialist , who will be responsible for following up on patient accounts when authorization for stay is required, initiate pre-...Remote workLocal area
$50k
...the lives of patients and their families What to Expect (Job Responsibilities) Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary treatment team to gather necessary information for concurrent...Remote work
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