Remote RN: Medical Management & Utilization Specialist
SCAN
SCAN, a nonprofit health organization, seeks an experienced Medical Management Specialist-RN in California. You will promote quality and cost-effective care, conduct pre-service reviews, and coordinate complex medical needs under clinical supervision.
Remote work mode, 3–6 month contract, with strong emphasis on regulatory compliance. Qualifications include an active CA RN license, nursing degree, and 3+ years in medical-surgical nursing and utilization management in managed care.
#J-18808-Ljbffr- ...Logan Health is hiring a Utilization Management Specialist to join the UM team. The role focuses on reviewing... ...to authorize care and ensure medical necessity. The position emphasizes strong... ..., with a four-day work week and remote options for Montana residents. #J-...Remote work
$69.39k - $88.61k
Cincinnati Children’s is seeking an experienced Utilization Review professional for a remote role in the United States. The position supports case management, authorization, compliance, and... ...s degree in a related field, an active RN/Social Work/Clinical Counselor license,...Remote jobFull time$39.4 - $53 per hour
...technology-enabled revenue cycle management solutions for health... ...in healthcare. The Lead Utilization Review RN is a key contributor to the... ...quality and completeness of medical record documentation. They... ...Nursing required #LI-LS1 #LI-REMOTE Join an award-winning...Remote workWork at officeLocal area- Highmark Inc. is seeking a full-time REMOTE Care Management professional with weekend availability to coordinate utilization management and health coaching. You will review services... ...3 years of progressive clinical experience; RN licensure in PA or multi-state licensure,...Remote jobFull timeWeekend work
- Highmark Inc. is seeking a full-time remote Care Management professional available on weekends and... ...appropriateness of health care services, applying utilization criteria, and identifying referrals to... .../case management. The job requires RN licensure and clinical experience,...Remote jobFull timeWeekend workWeekday work
- CVS Health is seeking a Behavioral Health Utilization Management Clinician for a 100% remote nationwide role. This position emphasizes clinical decision-making... ...behavioral health license in their state (LPC/LMHC/LCMHC or RN) and have 3+ years of post-licensure experience with...Remote job
- CVS Health Corporation seeks a Behavioral Health Utilization Management Clinician. This remote role prefers Louisiana residency and requires Sunday-Thursday... ...candidates hold a LA behavioral health license or psychiatric RN with EMR experience and 3+ years in behavioral health...Remote job
- ...from-home position. The role involves performing retrospective medical reviews based on patient eligibility and contract requirements,... ...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 Administrative Nurse, LPN to support Clinical Review and Utilization Management activities in a hybrid Florida-based role. The position... ...member care while aligning with NCQA UM standards and involves medical review, authorization management, and referral creation....Work at office
$101.72k - $198.36k
...Location: California - Ability to work remote, but selected candidate must reside in... .... This position requires California RN Licensure. Candidates must have significant... ...or all of the following functions: utilization management, care management, behavioral health and...Remote workContract workWork experience placementWork at officeLocal area$53.19k - $82.43k
...times for providing the highest-quality medical care in Los Angeles. We also were... ...You Will Do in This Role: The Utilization Management Specialist provides advanced operational and workflow... ...current and complete. *Approved Remote States: Arizona, California,...Remote workFull time- ...operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce... ...Program JOB SUMMARY: The Utilization Review Nurse is to assess the medical necessity... ...and unrestricted Registered Nurse (RN) license EQUAL OPPORTUNITY EMPLOYER...Remote workFull timeTemporary workLocal area
$90.9k - $129.9k
...It takes great medical minds to create powerful solutions that solve... ..., rather you will provide utilization review and quality assurance.... ...authorization outcomes into the Medicaid Management Information System (MMIS) for... ...in this role ~100% Remote home office. ~ Full-time...Remote workFull timeWork experience placementHome officeFlexible hours$100k - $130k
...those who need it most. The Utilization Management (UM) team plays a vital role... .... As the Lead RN, Utilization Management, you... ...performance. You will partner with Medical Directors and teams across Clover... ...Additionally, we embrace a remote-first culture that supports...Remote workFull timeWork experience placementWork at officeFlexible hours- ...institution that delivers quality, medically integrated personalized... ...are seeking an experienced specialist who is passionate about... ...What You'll Do Responsible for managing all clinical authorization processes... ...preferred. 2-3 years of utilization review experience in...Remote workDaily paidFull time
$63.1k - $83.65k
...We are seeking a Utilization Review Specialist to perform utilization... ...While the position is remote, the individual in this... ...Registered Nurse (RN) in Michigan with at... ...and apply established medical necessity criteria to... ...spreadsheets, email, database management, and data entry...Remote workFull timeTemporary workMonday to Friday- ...A leading healthcare staffing firm is seeking a Utilization Review RN in Syracuse, NY. The role involves conducting utilization management activities, certification reviews, and collaborating with healthcare providers. Candidates must have an RN License in NY and at least...Monday to Friday
- ...Administrators has an immediate need for a full-time Utilization Review Specialist to support our Managed Care department and can be located remotely if technical requirements are met and the... ...data collection of demographics, claim and medical information; #J-18808-LjbffrRemote workFull timeImmediate startMonday to Friday
- ...Case Manager - Utilization Review Specialist - Remote Full-Time Position You must reside in one of these states... ...EXPERIENCE: Current state-issued RN license. Knowledge in areas such as... ...standards. Compares inpatient medical records to established criteria and...Remote workFull time
- ...Adventist Health in Roseville, CA, is seeking a registered nurse in Utilization Management to ensure high-quality patient care while optimizing resources. You will review medical records for appropriateness of treatments, collaborate with healthcare providers and insurers...
- Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for UR activities, ensuring timely and compliant authorization processes. You will work with UR Nurses, Case Management, Revenue Cycle, and external payers to manage documentation...Remote job
- Cedars-Sinai is seeking a skilled Utilization Management Specialist to support UR Nurses in timely, compliant utilization review processes. You will manage case portfolios, assemble documentation for payer submissions, and monitor payer timelines to prevent delays. In collaboration...Remote job
$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... ...Medicaid program metrics. This position is remote and offers a pay range of $30-$45 per hour...Remote jobHourly payContract work- ...partner company, who manages all applications and... ...for a Case Manager – Utilization Review Specialist based in the United States... .... In this remote role, you will oversee... ...expertise to evaluate medical records, assess medical... ...active registered nurse (RN) license issued by a...Remote workFull timeLive in
$26.01 - $56.14 per hour
...am-5:00pm EST Location: 100% Remote (U.S. only) About Us... ...Health, is a URAC-accredited medical management organization founded in 1993... ...complex medical journeys. As a Utilization Management (UM) Nurse Consultant... ...Active, unrestricted RN license in your state of residence...Remote workHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hoursShift work- ...ODS), including review of medical records to ensure proper utilization of treatment resources... ...behavioral health treatment. UR Specialists also interpret, advise... ...The option for hybrid remote work may be available... ...pertaining to managed care; laws and regulations...Remote workContract workLocal areaTrial periodFlexible hours
$60k - $70k
...Time Office/Clerical Remote, Birmingham, AL, US... ...journey. We are seeking a Utilization Review Specialist to add to our dynamic... ...to patients are medically necessary, efficient,... ...companies, and case managers to facilitate timely... ...certification, such as RN, LPN/LVN, LMSW, LPC,...Remote workFull timePart timeWork at office- MU Health Care is seeking a Utilization Management Analyst RN to oversee patient admissions, reviews, and ensure medical necessity and efficient care. The role emphasizes maximizing reimbursements while advocating for patients, educating staff and physicians on utilization...
- Summa Health System is seeking a Full-Time Utilization Management Nurse to optimize cost-effective care across the hospital care continuum. The role involves performing initial and concurrent reviews, aligning with Medicare/ payer guidelines, and applying clinical criteria...Full time
- Mass Digital Health is seeking a Utilization Review Nurse in Quincy, Massachusetts. This role... ...and collaborating with healthcare teams to manage care effectively. The ideal candidate... ...position requires at least two years of RN experience in care management or utilization...
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN: Medical Management & Utilization Specialist. Be the first to apply!




