Remote Utilization Review RN - Insurance/URAC Expertise
Innovative Systems Group
- Remote job
A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and knowledge of accreditation standards. Candidates must reside in IL or TX and possess strong communication skills to interact with providers and members. #J-18808-Ljbffr Innovative Systems Group
$35 - $40 per hour
...Registered Nurse (RN) with health plan or payer-side Utilization Management (UM) experience... ...clinical quality review and AI model... ...will have expertise in applying evidence... ...hrs/week Fully Remote Position Pay Range... ...coverage (accident insurance, critical illness...Remote workHourly payLocal areaShift work- ...Remote Utilization Review SpecialistIn this remote role, you will conduct utilization reviews, ensuring that patient care meets the necessary... ...documentation and compliance with regulatory requirements. Your expertise in Epic and InterQual Criteria will be crucial for success...Remote work
$63.1k - $94.65k
.... Our partner is looking for a Utilization Review RN based in the United States.... ...operations. In this part-time, remote role, you will apply your clinical expertise to evaluate medical necessity,... ...with physicians, care managers, insurance representatives, and revenue cycle...Remote workTemporary workPart timeWork at officeWork from homeFlexible hoursShift workAfternoon shift$2,158.8 per week
...Ref. 65547807 RN - Utilization Review $2,158.80 per week Location... ...in Fort Myers, FL. This remote position requires expertise in utilization management, making... ...healthcare professionals Health insurance - comprehensive medical coverage...Remote workWeekly payWork experience placementMonday to FridayFlexible hoursShift workWeekend work$2,023.3 per month
...Profession Registered Nurse (RN) Specialty Utilization Review Job ID 3824522... ...some experience with remote work. Responsibilities Utilize clinical expertise to conduct reviews and... ...Medical, Dental, Vision Insurance After 90 Days ~ Accrued...Remote workWeekly payContract workLocal areaMonday to FridayShift workWeekend work- ...Responsibilities As our Utilization Review RN, you will meticulously review... ...authorization from insurance providers, ensuring seamless... ...regarding review outcomes. Your expertise will be vital in supporting... ...This position is open to remote/out of state candidates residing...Remote work
$40 per hour
...Insurance Or Managed Care Industry Registered Nurse (RN) $40/hour - Contract for 6 months Must reside in TX Full time remote Candidates must be based in TX. RN working... ...initial, concurrent review activities;... ...information regarding utilization management requirements...Remote workFull timeContract workWork at office- ...Pace Program sites. Job Title: Utilization Review RN Job Summary The... ...state Medicaid, Medicare Advantage, NCQA/URAC, and internal policy requirements, including... ...Environment Work Conditions ~ Remote role with reliable high-speed internet....Remote workFull timePart timeWork at officeLocal areaWeekend workAfternoon shift
- 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
- ...Position Summary: The RN Integrated Care... ...are required to address utilization review cases. Roles and Responsibilities... ...of medical and insurance industry terminology... ...health programs, NCQA/URAC standards. You have... ...This is a remote position. Our whole company...Remote workLive inFlexible hoursWeekday work
$35 - $40 per hour
...decades of healthcare domain expertise to help clients draw... ...and analytics. Job Title RN Utilization Management Reviewer Responsibilities Conduct timely... ...weekends. Location: Fully remote work at home role. Secure,... ...Dental Vision Life Insurance Short‑Term and Long‑Term Disability...Remote workHourly payTemporary workMonday to FridayFlexible hoursWeekend work- ...The Texas Department Of Insurance. Through Its Network... ...Community is accredited by URAC for its health plan... ...Behavioral Health Utilization Manager will perform concurrent... ...and discharge reviews on assigned patients.... ...systems Work Schedule: Remote Other...Remote workContract workWork experience placement
- ...an experienced Registered Nurse (RN) to join our Utilization Review team in a remote capacity. This role is responsible... ...with physicians, care managers, insurance carriers, and interdisciplinary teams... ...RN looking to apply their expertise in utilization review, care coordination...Remote workTemporary workWork at office10 hours per weekShift workWeekend workDay shiftAfternoon shift
- ...seeking a Pre-Authorization Registered Nurse for a remote, full-time role based in Virginia. The RN will review prior authorization requests, determine appropriate care settings, and educate providers on utilization and management processes. Requirements include an...Remote workFull time
- ...Allegheny Health Network seeks an RN Utilization Review professional to obtain pre-certifications, coordinate authorizations and manage denials... ...appropriate levels of care and timely approvals. This remote role requires PA RN licensure (or multi-state eNLC), a care-...Remote work
- ...United States is seeking an Inpatient Utilization Management Clinician to evaluate... ...across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and experience... ...care management to ensure timely reviews, document outcomes, and maintain...Remote workFull time
- ...BJC HealthCare is seeking a registered nurse to join a remote Utilization Review team. The role supports multiple hospital units with no patient communication, and it is designed for local remote work with weekend rotation. Responsibilities include applying Interqual criteria...Remote workLocal areaWeekend work
- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant... ...team-oriented environment. Requirements include active RN or LVN licensure, a minimum of two years in utilization...Remote workWork at office
- ...Cleveland Clinic is seeking an Utilization Management RN Reviewer to support remote operations from home. The role covers admission and concurrent reviews, and ensures medical necessity criteria are applied to hospital stays and discharges. Qualifications include RN...Remote work
- ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge planning and utilization review.Responsibilities:• Reviews admissions and service requests within...Remote work
- ...Cleveland Clinic Health System is seeking an experienced Utilization Management RN Reviewer to work remotely with a focus on admission, concurrent and retrospective reviews. The role supports payer communications, data collection, and clinical decision-making to ensure...Remote workWork at office
- ...Providing timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions, treatment planning, and recovery for injured employees while advocating for effective medical treatment. Key responsibilities...Remote workFull timeWork experience placement
$1,949.74 per month
...Registered Nurse Specialty Utilization Review Job ID 17979666 Job Title Utilization Review RN Weekly Pay $1949.74 Shift... ...13 Week(s) Job Description Remote Utilization Review RN responsible for concurrent...Remote workWeekly payShift work- ...Job Title: RN Utilization Review City: Torrance State: CA Job Type: Travel Discipline: RN Speciality: Utilization Review Facility Setting: Short Term Actut Care (STAC) Accepting Locals per Radius Rule?: Yes Contract Length: 13 weeks Shifts...Remote workContract workTemporary workLocal areaShift work
$65 per hour
...Fully Remote Position Job Title : RN - UTILIZATION REVIEW Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule Shift: Day 5x8-Hour (08:00 - 16:30) Shift Notes: Days (5×8) | 08:00 - 16:30PAY DETAILS (72 HOURS / 2 WEEKS)...Remote workLocal areaImmediate startMonday to FridayShift workWeekend work- ...To support a mission-driven health organization, the full-time Utilization Review Nurse - RN will conduct medical necessity reviews, escalate non-certifications for secondary clinical review, and analyze clinical records to ensure timely and compliant care determinations...Remote workFull time
- Gainwell Technologies LLC is seeking a Senior Nurse Reviewer to perform reviews of medical records,... ...practices. This role requires clinical review expertise and itemized bill review experience, with potential utilization review responsibilities. Home-based position within...Remote jobWork from homeFlexible hours
- ...Details POSITION SUMMARY - RN Utilization Review POSITION DUTIES - Review patient... ...-based) ~ Skilled experience with remote work LENGTH OF ASSIGNMENT -... ...planning ~ Short-term disability, life insurance, paid jury duty ~ Access to the...Remote workTemporary workShift workWeekend work
- ...Job Description Job Description The utilization review and management (UM) component program... ...Familiarity with healthcare regulations, insurance policies, and quality improvement... ...for lunch This is an in-office, no remote work capability position Travel ~...Remote workWork at office
$63.1k - $94.65k
...Registered Nurse to perform hospital utilization reviews, assess medical necessity, and... ...levels of care. This remote role partners with physicians, care managers, insurance carriers, and revenue cycle teams... ...: Current unrestricted RN license required; RN compact license...Remote workTemporary workWork at officeLocal areaShift workAfternoon shift
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