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... ...:00 AM - 5:00 PM As a Utilization Review Registered Nurse for... ...Knowledge and expertise in utilizing various criteria... ...Registered Nurse (RN) license in Maryland (...Remote workFull timeMonday to FridayDay shift
- ...solutions across a range of insurance, reinsurance, payroll, benefits... ...Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment... ...the office and three days remote. Candidates must also have flexibility... ...state-mandated and URAC turnaround requirements Accurately...Remote workWork at officeImmediate startFlexible hours2 days per week
- ...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,...Remote work
- Netsmart is seeking a Remote Utilization Review Nurse to evaluate ED admissions using InterQual/MCG criteria and apply... ...status with ED physicians and enter reviews for insurance authorization. Ideal candidates have an active RN license, 3+ years in acute care (ER/ICU/...Remote job
- 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
- ...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 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- 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
$48.52 - $72.78 per hour
...RN Utilization Management Reviewer - Remote (OR, WA, AK) Join PeaceHealth in advancing compassionate, mission... ...retrospective UM reviews, leveraging clinical expertise, payer policy knowledge, and... ...off and paid disability & life insurance (with buy-up options) ~ Tuition...Remote jobFull timeLocal areaDay shift- ...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
$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$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 workHourly payPart time- ...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
$71.1k - $97.8k
...communities? As a Utilization Management (UM) Nurse... ...members by reviewing and authorizing Long... ...combine your clinical expertise, critical thinking... ...Registered Nurse (RN) in Illinois with... ...: This is a remote position supporting... ...disability, life insurance and many other opportunities...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday- ...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
- 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
$30 - $34 per hour
A healthcare services company is seeking an experienced Utilization Review Nurse to work remotely. The ideal candidate must hold an active LVN license in California and have experience in outpatient utilization management. Responsibilities include approving or denying medical...Remote workHourly pay- ...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 work
$65k - $85k
...Utilization Review Specialist (RN) – RemoteAt 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 home health...Remote workMonday to FridayWeekend 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
$35 - $43 per hour
...Job Title Clinical Review Nurse – Concurrent Review Location: Remote (California only – must... ...CA or hold an active CA RN license) Duration: 1... ...Concurrent Review will perform utilization management functions to... ...Provide subject matter expertise and guidance to...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 job
- ...completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees... ...first week. This role will be remote BUT regular meetings/trainings... ...years of experience in hospital or insurance related utilization review highly...Remote workReliefWeekend work3 days per week
- 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
- ...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
- ...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
- 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... ...: N/A Job Requirements: Active RN license with Multi-State/Compact license... ...with physicians, case managers, and insurance payers Support denial prevention, documentation...Remote jobFull timeMonday to Friday
$34 - $40 per hour
....00/hr - $40.00/hr Remote (Compact Licensure Required... ...) - Open to LPN's & RN's About the Role... ...seeking an experienced Utilization Review Nurse to support our... ..., managed care, NCQA/URAC standards, and community... ...this job Medical insurance Vision insurance...Remote workFull time- ...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 jobFull timeMonday to Friday
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