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
- vision insurance, paid time off, paid holidays, tuition assistance, 403(b), remote work United States, Maryland, Hanover... ...AM - 5:00 PM As a Utilization Review Registered Nurse for... ...Knowledge and expertise in utilizing various... ...Unencumbered Registered Nurse (RN) license in Maryland...Remote workFull timeMonday to FridayDay shift
- ...Johns Hopkins Medicine is seeking a Utilization Review Registered Nurse based in Hanover... ...you to leverage your clinical expertise to enhance member care through effective... ..., work-life balance, and comprehensive insurance benefits while working remotely. #J-18808-LjbffrRemote workFull time
$2,210 per week
...and voluntary life insurance. Critical Illness,... ...Work-life balance. Remote/hybrid setting (once... ...This individual will utilize clinical knowledge... ...to a second level reviewer. This individual interfaces... ...knowledge of URAC guidelines, Hines... ...is not limited to RN, LMSW, LMHC. Successful...Remote workFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours- 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
- 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
$67.2k - $85k
...80127, Job Title: BH Utilization Manager RN, Salary: $67,200.00 -... ...Texas Department of Insurance. Through its network... ...Community is accredited by URAC for its health plan... ...and discharge reviews on assigned patients.... ...systems Work Schedule: Remote Other Requirements...Remote workContract workWork experience placement$26.01 - $56.14 per hour
...EST Location: 100% Remote (U.S. only) About... .../CVS Health, is a URAC-accredited medical... ...journeys. As a Utilization Management (UM) Nurse... ...in Medical Review, you’ll play a vital... ...apply your clinical expertise in a fast-paced, desk... ..., unrestricted RN license in your state...Remote jobHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hoursShift work- ...Case Manager, RN- Utilization Review Under the general supervision of the Utilization Management... ...retrospective utilization reviews using clinical expertise and medical necessity screening tools;... ...interdisciplinary collaboration in a remote or hybrid work environment....Remote workFull timeMonday to FridayShift 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
- ...Utilization Review Specialist The Utilization Review Specialist plays a... ...with healthcare providers, insurance companies, and case managers... ...Qualifications: Registered Nurse (RN) license or equivalent... ...Specialist applies clinical expertise and analytical skills daily...Remote work
- ...Hopkins Health Plans is seeking a Utilization Review Registered Nurse to apply... ...managed care and utilization review expertise to improve member outcomes. This remote role supports the organization with... ...initiate discharge planning. Maryland RN license (or compact) and 3+ years...Remote work
$77.25k - $128.75k
...Department Name: Utilization Mgmt Work Shift:... ...waiting for. As a Remote RN Utilization Management Care Reviewer , you’ll play a... ...your clinical expertise to review medical... ...health care models, insurance plans and physicians... .... Experience with URAC and NCQA accreditation...Remote workWork experience placementMonday to FridayShift work- ...RN Utilization Review Review patient medical records to assess the appropriateness and medical necessity of hospital admissions, continued... ...management experience (hospital-based) ~ Skilled experience with remote work Length of assignment: 13 weeks Shift / hours...Remote workShift workWeekend work
- ...WNS, part of Capgemini, is seeking a remote RN/LPN for utilization review in the United States. The role involves assessing medical necessity, resolving escalations, and maintaining HIPAA-compliant documentation with HealthHelp policies. Requires active nursing license...Remote workWork at office
- Netsmart is seeking a Registered Nurse with solid utilization management experience to perform ED utilization reviews and admissions screening using established criteria. The role requires adept EMR review, strong clinical judgment, and collaboration with ED physicians...Remote job
- Concierge Home Care is seeking an experienced Utilization Review Specialist (RN) to join our remote home health team. This role emphasizes OASIS review, coding accuracy, QA, and remote documentation audits. The ideal candidate holds an active Florida RN license, OASIS certification...Remote job
$2,213 per month
...Job Description Job Description RN - Utilization Review - Travel Gross Pay (weekly): $2213.0 Taxable Pay (weekly): 680.0 Non-taxable Pay (weekly): 1533.0 Shift: Type - 8hr Days, Schedule - No schedule available Location: Fort Myers, FL Scheduled Hours...Remote jobWeekly payShift work- ...Healthcare seeks an experienced RN to support Arizona Plan clinical member services review processes. The role requires an... ...RN license and experience with utilization management, prior authorization,... ...inpatient and outpatient settings. Remote position, must reside in Arizona...Remote job
- Comagine Health is seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess medical necessity and quality of care through prospective... ..., concurrent, and retrospective reviews. This full-time remote role supports compliant, cost-effective care under Alabama...Remote jobFull timeContract work
- ...nights, weekends, or holidays. The position emphasizes clinical reviews to determine if treatments meet criteria, with collaboration... ...care experience, plus mental health or substance abuse expertise. A remote setting is available within a national scope. #J-18808-Ljbffr...Remote jobMonday to FridayWeekend workDay shift
- ...Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate... ...in various reviews and knowledge of URAC/NCQA are a plus. #J-18808-Ljbffr Brighton...Remote jobWork at office
$65k - $85k
Concierge Home Care is seeking an experienced Utilization Review Specialist (RN) for a fully remote home health role in the US. Salary ranges from $65,000 to $85,000 annually, based on experience, with Florida RN license and OASIS/coding certifications required. The role...Remote jobFlexible hours$30 - $38 per hour
A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Remote jobHourly payPart time- CorVel Corporation is looking for a Utilization Review Supervisor RN to direct operations in Rancho Cucamonga. The role includes managing day-to-day... ...ensuring quality service, and handling HR matters. This remote position requires strong communication skills, clinical experience...Remote job
- ...Quick Job Details: Setting: Fully Remote – Utilization Review Schedule: Full-Time, Monday–Friday... ...: N/A Job Requirements: Active RN license with Multi-State/Compact license... ...with physicians, case managers, and insurance payers Support denial prevention, documentation...Remote workFull timeMonday to Friday
- HonorHealth in Arizona seeks an Utilization Review RN Specialist to review and monitor utilization for cost-effective, high-quality care. This... ...and a strong collaboration with physicians and care teams. Remote work is available after training. #J-18808-Ljbffr HonorHealthRemote job
- ...Quick Job Details: Setting: Fully Remote – Utilization Review Schedule: Full-Time, Monday–Friday... ...Hours Job Requirements: Active RN license with Multi-State/Compact License... ...system (provider-side required) Payer/insurance-only Utilization Management experience...Remote workFull timeMonday to Friday
- Sentara Health Plans is seeking a Utilization Review Nurse/ RN for Medicaid to work remotely. The role includes pre-certification, inpatient and concurrent reviews, and care coordination across the patient care continuum, with weekend and holiday coverage requirements....Remote jobWeekend work
$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) Shift... ...No Locals accepted? No. Pending License accepted: No Fully Remote Position RTO Restrictions: Please include all RTO at the...Remote workHourly payLocal areaImmediate startMonday to FridayShift workWeekend work- Children's Hospital Colorado in Aurora, CO, is seeking an Utilization Review RN to support medical necessity reviews and denial mitigation as part of a multidisciplinary team. The role is primarily remote with potential onsite shifts, and requires BSN, 3 years UR experience...Remote jobPart timeRelocation packageShift workWeekend workAfternoon shift
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