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
- ...Netsmart is seeking a Remote Utilization Review Nurse to evaluate ED admissions using InterQual/MCG criteria and apply... ...with ED physicians and enter reviews for insurance authorization. Ideal candidates have an active RN license, 3+ years in acute care (ER/ICU/medical...Remote work
$63k - $65k
...Workplaces in Financial Services & Insurance RN Utilization Review As a nurse at Sedgwick, you can build... ...and well-being of others in a remote work environment. Enjoy flexibility... ...navigating the unexpected. The company's expertise, combined with the most advanced AI-...Remote workWork experience placementLocal areaFlexible hours$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- 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
- ...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
- ...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- ...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
- ...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... ...applicable state-mandated and URAC turnaround requirements...Remote workWork at officeImmediate startFlexible hours2 days per week
- 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
- ...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... ...experience in various reviews and knowledge of URAC/NCQA are a plus. #J-18808-LjbffrRemote workWork 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-LjbffrRemote workMonday to FridayWeekend workDay shift
- ...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
$78k - $88k
...Utilization Review Nurse- Remote It takes great medical minds to create powerful solutions that solve some... ...challenges. Join us and put your expertise to work in ways you never imagined possible... ...on clinical guidelines. Maintain RN license and meet continuing education...Remote workFull timeContract workWork at officeWork from homeFlexible hours$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 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
- 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
- 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
- ...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
$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
- ...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
- ...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
- 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
- ...building the future of health insurance with a first-of-its-kind... ...overseeing and performing utilization reviews, prior authorizations, and... ...peer discussions. This is a remote position requiring a "roll... ...services, applying clinical expertise, established medical policies...Remote workFull timeFlexible hours
- ...Job Description Job Description Remote Utilization Review Registered Nurse (UR RN) Location: Remote (Texas RN License or Compact License Required)... ...compliance with payer and regulatory requirements. Manage insurance authorizations, denials, appeals, and level-of-care...Remote workFull timeWork at office
$2,000 per month
...Job Description Job Description RN - Utilization Review - Travel Gross Pay (weekly): $2000.0 Taxable Pay (weekly): 2000.0 Non-taxable Pay (weekly): 0.0 Shift: Type - 8hr Days, Schedule - No schedule available Location: Fort Myers, FL Scheduled Hours...Remote jobWeekly payShift work
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