Remote Nurse: Clinical Utilization Review
HealthHelp - A WNS Company
Houston, TX
- Remote job
WNS is seeking a clinically trained reviewer to perform utilization reviews and case management activities. The role requires RN or LVN/LPN licensure and at least two years in related functions, with strong knowledge of regulatory standards and insurance terminology. The candidate will work remotely, coordinate with providers and clients, and help ensure timely, compliant care decisions while maintaining thorough documentation. #J-18808-Ljbffr HealthHelp - A WNS Company
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Remote Nurse: Clinical Utilization Review in Houston, TX vacancy
- Devoted Health is seeking a Clinical Guide on our Outpatient Utilization Management team to review outpatient authorization requests using evidence-based criteria and... ...navigating the healthcare system. This full-time remote role offers multiple schedules and requires collaboration...Remote jobFull time
- Brighton Health Plan Solutions is seeking an Utilization Management Nurse to perform medical necessity and benefit reviews remotely. The role requires current LPN licensure and expertise in CMS/MCG criteria with experience in inpatient/outpatient reviews. The successful...Remote job
- ...looking for motivated individuals who want to be part of our mission and join our team! As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise and judgement along with established medical criteria to perform first level...Remote jobLocal area
- Comagine Health is seeking a Clinical Utilization Review Nurse (RN) for a remote, full-time role based primarily in Alabama. You will assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews, ensuring compliance with clinical...Remote jobFull timeContract work
$65k - $75k
...Description • Performs utilization review of cases to determine if the... ...special handling. • Performs clinical reviews according to the... ...requirements in collaboration with Nursing Management. • Keeps... ...CST - 7:00pm CST Location: Remote Compensation Disclosure...Remote workWork at officeLocal areaMonday to FridayWNS Global Services
United States4 days ago- 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 appropriate care, and manage health care costs for dependents of active duty and eligible...Remote jobWork from homeMonday to Friday
- Akido Labs is looking for a Clinical Review Nurse in California to manage prior authorization requests. This role ensures compliance with clinical... ...or RN license and have 3-5 years of experience in clinical utilization management. Key responsibilities include reviewing...
- ...department, the full-time Registered Nurse Clinical Reviewer will perform clinical validation by ensuring... ...within medical records, while working remotely from anywhere in the United States.... ...use Windows PC with the capability to utilize multiple applications simultaneously...Remote workFull time
Virtual Vocations Inc
United States5 days ago $69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant, we’re focused on helping our clients... ...and Commercial Payers. You will work remotely in a fast paced and dynamic... ...And Abilities Needed Experience with utilization management systems or clinical decision...Remote workFor contractorsWork at officeWork from homeHome officeShift work- Devoted Health is seeking a Clinical Guide on our Outpatient Utilization Management team. This remote, full-time role focuses on clinical review of outpatient authorization requests using evidence-based criteria and CMS requirements to ensure appropriate care. The ideal...Remote jobFull time
$78k - $88k
...Utilization Review Nurse- Remote It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges... ...necessity and appropriateness of services, following clinical criteria, coverage policies, and contract guidelines. This...Remote workFull timeContract workWork at officeWork from homeFlexible hoursGainwell Technologies
United States4 days ago- ...Description Job Description: Clinical Supervisor, UM Denial... ...AreaPosition Type: Hybrid (85% remote, 15% onsite in Burbank, CA)Company... ...managing daily tasks, performance reviews, and disciplinary actions.2.... ...an accredited Registered Nursing Program; RN preferred.2. Minimum...Remote workPermanent employmentTemporary work
Vivo HealthStaff
Burbank, CA12 days ago - ...Registered Nurse – Utilization Review (Remote) This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care, including Inpatient, Extended Hospital Outpatient, and Observation (OBS). Minimum of 3 years acute medical Care...Remote work
3B Healthcare, Inc.
United States3 days ago - A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active... ...with management and providing guidance on clinical questions. This is a unique opportunity to work from...Remote jobFull timeWork from home
- ...Registered Nurse - Utilization Review About Company Bestica: We at Bestica believe our success is a direct result of hard work and outstanding employee dedication. Our environment is dynamic, friendly, and collaborative. We foster a positive culture, where innovation...Remote work
Bestica Healthcare
United States5 days ago - ...Remote DUR Pharmacist Safe & Cost-Effective Medication Use Work From Home Analyze medication use patterns, apply clinical guidelines, and collaborate with providers all from home. This remote Drug Utilization Review Pharmacist role is ideal for pharmacists who enjoy...Remote jobWork from home
$219k - $286.9k
Oscar Health is hiring a Physician Reviewer to join our Utilization Management team. You will determine the medical... ...outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. This remote role in the United States offers work...Remote jobWork from home- ...R1 RCM is seeking an experienced Utilization Review Author (RN) for our Physician Advisory Team. The role involves first-level admission and continued stay reviews using InterQual/MCG criteria and requires hospital-based UR or Case Management experience. The position...Remote workFlexible hours
R1 RCM
Nashville, TN1 day ago $65 per hour
...RN – Utilization Review Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule Shift: Day 5x8-Hour (08:00 - 16:30... ...? No Locals accepted? No. Pending License accepted: No Fully Remote Position RTO Restrictions: Please include all RTO at the time...Remote workHourly payLocal areaImmediate startMonday to FridayShift workWeekend workPacer Group
United States3 days ago$1,949.74 per month
...Job Type Travel Offering Nursing Profession Registered Nurse Specialty Utilization Review Job ID 17979666 Job Title... ...13 Week(s) Job Description Remote Utilization Review RN responsible for concurrent...Remote workWeekly payShift workProvidence Health and Services
Eureka, CA2 days ago$71.1k - $97.8k
...part of our caring community The Utilization Management Nurse 2 uses clinical nursing skills to support the... ...experience in prior authorization, claims review, utilization management, or other... ...: US Nationwide Work Style: Remote Travel Requirements: None Work...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday- ...Remote Drug Utilization Review Pharmacist Safe & Cost-Effective Medication Use Work from home analyze medication use patterns, apply clinical guidelines, and collaborate with providers all from home. This remote Drug Utilization Review Pharmacist role is ideal for...Remote jobWork from home
- ...Overview In this remote role, the RN will manage utilization reviews, ensuring patient care meets medical necessity standards. Responsibilities include assessing patient cases, collaborating with interdisciplinary teams, and utilizing Epic and InterQual criteria...Remote workWeekly pay
Slate Healthcare
Torrance, CA1 day ago - Nationwide Children's Hospital is seeking a utilization review professional to evaluate behavioral health cases, ensuring medical necessity and... .... After a 90-day in-office training, the position offers remote work from home options. #J-18808-Ljbffr Nationwide-ChildrenRemote jobWork at officeWork from home
- ...Ascension Sacred Heart Hospital is seeking a nurse to join our Utilization Management team in a remote role. You will perform prospective, concurrent, and retrospective reviews to ensure medical necessity and alignment with reimbursement policies. Join a multidisciplinary...Remote work
Ascension
Milton, FL1 day ago - ...RN Utilization Review Review patient medical records to assess the appropriateness and medical... ...providers and payers to ensure compliance with clinical guidelines, regulatory requirements,... ...-based) ~ Skilled experience with remote work Length of assignment: 13...Remote workShift workWeekend work
AMN Healthcare
United States4 days ago - ...WNS, part of Capgemini, is seeking a remote RN/LPN for utilization review in the United States. The role involves assessing medical necessity, resolving... ...documentation with HealthHelp policies. Requires active nursing license and at least 1 year in utilization review, plus...Remote workWork at office
HealthHelp
Houston, TX3 days ago - ...RN Utilization Review Location: Torrance, CA Job Type: Travel Discipline: RN Specialty: Utilization Review Facility Setting: Short Term Acute Care (STAC) Accepting Locals per Radius Rule?: Yes Contract Length: 13 weeks Shifts: Days Shift Details...Remote workContract workTemporary workLocal areaShift work
Hired by Matrix
United States4 days ago - ...and experienced Registered Nurse with specialties in Medical/... ...health, or hospice care. Clinical assessment, medication... ...Certifications: Experience in Utilization Review or case management roles.... ...to work independently in remote settings. Must be able...Remote workFlexible hours
vTech Solution
Santa Rosa, CA1 day ago $1,600 - $1,800 per week
...Now Hiring: Registered Nurse – Utilization Management Location: Buckley AFB & Peterson AFB, Colorado... ...weekends, no holidays, no telehealth/remote work Minimum Qualifications U.... ...in Utilization Management, Utilization Review, or Case Management Preferred...Remote workContract workImmediate startMonday to FridayJ Edward Staffing LLC
Aurora, CO5 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Nurse: Clinical Utilization Review. Be the first to apply!
Related searches
- holistic nurse practitioner Houston, TX
- trainee nurse practitioner Houston, TX
- nursing home nurse practitioner Houston, TX
- nurse practitioner - women's health Houston, TX
- nurse practitioner-internal medicine Houston, TX
- oncology nurse practitioner Houston, TX
- pediatric nurse practitioner Houston, TX
- clinical nurse Houston, TX
- matron Houston, TX
- director of nursing don Houston, TX