Remote Utilization Management RN Path to CM
WPS Health Solutions
WPS Health Solutions is seeking an Utilization Management RN to evaluate medical necessity and authorize services for our Health Plan. This role involves clinical judgment, collaboration with Medical Directors, and potential cross-training in Case Management. The position offers remote/hybrid options across multiple states with growth opportunities toward a combined UM/CM role in the future.
#J-18808-LjbffrVacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote Utilization Management RN Path to CM in United States vacancy
$75k - $100k
...WPS Health Solutions is seeking a Utilization Management RN to evaluate medical necessity and approve appropriate services... ...into Case Management with future growth into CM and a broader UM/CM path. The position offers remote work in approved states, with a start date of...Remote workCmsWPS Health Solutions
United States3 days ago- ...a health solutions company, is seeking an Utilization Management RN to assess medical necessity, authorize services... ...with medical directors. The role offers remote work in multiple states and a potential path toward combined UM/CM responsibilities. There is a strong...Remote jobCms
$75k - $100k
...WPS Health Solutions is seeking an Utilization Management RN to evaluate medical necessity and authorize services for... ...with potential growth into a combined UM/CM position or CM in the future. The position offers remote work options across approved states and a strong...Remote workCmsWPS Health Solutions
United States3 days ago- ...WPS Health Solutions is seeking an Utilization Management RN to evaluate medical necessity and coordinate... ...with growth potential toward CM roles.The role requires Wisconsin RN licensure... ...preferably in a commercial health plan. Remote work is available in approved states.J-...Remote workCms
WPS Health Solutions
Madison, WI2 days ago $75k - $100k
...WPS, a health solutions company, seeks an Utilization Management RN to evaluate medical necessity and authorize services... ...with potential growth into a combined UM/CM position or CM in the future. Start Date: 01/10/2027. Remote work options available in a defined set of...Remote workCmsWPS—A health solutions company
United States2 days ago$75k - $100k
WPS Health Solutions is seeking a Utilization Management Registered Nurse to evaluate efficiency, appropriateness, and medical... ...with potential growth into a combined UM/CM position. The position offers remote work options in multiple states, including Texas, with...Remote jobCms- WPS Health Solutions seeks an Utilization Management RN to evaluate medical necessity and appropriateness... ...extended hospital stays. We support remote work in multiple states and offer opportunities to grow into a combined UM/CM role. #J-18808-Ljbffr WPS Health SolutionsRemote jobCms
$75k - $100k
WPS Health Solutions is seeking a Utilization Management Registered Nurse to evaluate medical necessity and appropriateness of... ...Management and potential growth into a combined UM/CM position. The position offers remote work in approved states, a salary range of $75,000-...Remote jobCms- ...Sentara Health Plans is seeking an RN Clinician for a remote role focused on utilization management and claim review. The position requires an active RN license (VA or Compact) and a BSN, with at least 3 years of acute care experience, including utilization review or...Remote workCms
Sentara Health
United States3 days ago - ...WPS, a health solutions company, seeks an Utilization Management RN to evaluate medical necessity and appropriateness of services for our Health... ...potential to cross-train in Case Management and grow into a combined UM/CM position. Start Date: 01/10/2027. #J-18808-LjbffrRemote workCms
WPS—A health solutions company
New York, NY2 days ago $75k - $100k
...WPS Health Solutions is seeking an Utilization Management RN to evaluate medical necessity for services and procedures... ...Directors and may grow into a combined UM/CM role with cross-training in Case Management. The role offers remote work in multiple states and a base salary...Remote workCmsWPS Health Solutions
United States3 days ago- ...Clover Health is seeking a Lead RN, Utilization Management, to coach UM nurses, oversee daily review operations, and monitor quality. You will partner... ...leadership, clinical judgment, and member-first decision-making within a remote-friendly environment. #J-18808-Ljbffr...Remote workCms
Clover Health
Salem, OR4 days ago - ...The Utilization Management RN position at WPS Health Solutions evaluates medical necessity and appropriateness of services for our... ...training toward Case Management to grow into a combined UM/CM position. We offer a remote-friendly work arrangement with multiple states...Remote workCms
WPS Health Solutions
Denver, CO4 hours ago $52 - $56 per hour
...find a role that uses both. We're hiring a contract RN for a New York health plan (Medicare Advantage, Medicaid... ...apply the same medical necessity judgment you built in utilization management. 100% remote (U.S.) | Contract | $52–$56/hr based on experience...Remote workCmsContract workAfternoon shiftPhaxis
United States3 days ago- ...Highmark Inc. is seeking a full-time RN Care Manager for a remote role in California City, CA, requiring... ...weekdays. The role focuses on utilization management, reviewing care appropriateness... ...3+ years of clinical experience; UM/CM experience and strong communication...Remote workCmsFull timeWeekend workWeekday work
Highmark Health
United States3 days ago - ...Highmark Health is seeking a full-time remote RN-focused Care Manager to implement utilization management strategies and coordinate care across the network. The... ...~3 years of clinical RN experience, knowledge of UM/CM/QA/Managed Care, and licensure in PA or multi-state...Remote workCmsFull timeWeekend workWeekday work
Highmark Health
Topeka, KS3 days ago - Central California Alliance for Health is seeking a Prior Authorizations Nurse (RN) for a temporary, full-time role. This remote-in-California position reports to the Utilization Management Supervisor and involves ensuring PA requests comply with contracts and evidence-...Remote jobCmsFull timeContract workTemporary work
$72.8k - $130k
...scheduling and there is an occasional opportunity for remote work based on business needs. As a Sr Utilization Management Nurse in the Springfield MA Regional Area, the... ...Qualifications: ~ Must be a Registered Nurse (RN) with a current, active, unrestricted RN License...Remote workCmsMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal areaOptum
Westfield, MA1 day ago- ...About the role We're looking for an RN who has personally owned grievance and... ...hospital-based role. The best fit has a utilization management or case management foundation and has... ...time-sensitive cases at once in a fully remote setting. Nice to haves BSN or MSN...Remote jobCms
Phaxis LLC
New York, NY14 days ago - ...Description Join our team as a remote (Oklahoma City) full time days and every other weekend RN Case Manager -Utilization Review at INTEGRIS Health, Oklahoma City, OK. Get to Know Your Team: INTEGRIS Health, Oklahoma's largest not-for-profit health system, is seeking...Remote workCmsFull timeWork at officeWeekend work
INTEGRIS Health
New York, NY1 day ago $75k - $100k
...Utilization Management RN (Registered Nurse) evaluates efficiency, appropriateness, and medical necessity... ...to cross-training in Case Management (CM), with the potential for the role to grow... .... Work Location We are open to remote work in the following approved states:...Remote workCmsFor contractorsWork at officeLocal areaImmediate startWPS—A health solutions company
Indianapolis, IN2 days ago$81.95k - $110.24k
...provider of technology-enabled revenue cycle management solutions for health systems,... ...the possible in healthcare. The Lead Utilization Review RN is a key contributor to the overall financial... ...degree Nursing required #LI-LS1 #LI-REMOTE Join an award-winning company...Remote workCmsFull timeWork at officeLocal area$62.4k - $117.62k
...integrating, and monitoring the utilization of physical health (PH)... ...work closely with Case Management to address member needs... ...degree and active NYS RN license required.... ...areas (i.e. UM and CM). Incumbent is required... ...may be opportunity for remote work within all jobs posted...Remote workCmsFull timeContract workWork at office$70.2k - $120.4k
...norm and every member feels valued.The Utilization Review RN will review and document member case... ...revision of medical policies and utilization management and/or clinical appeals policies.... ...RN license requiredThis position is a Remote role. To be eligible for consideration...Remote workCmsWork experience placement$63.1k - $94.65k
...technology-enabled revenue cycle management solutions for health systems,... .... *Must have current compact RN license, or be willing to... ...coverage We are seeking Virtual Utilization Review Specialist with at... ...Abilities Required: This is a remote role which requires access to...Remote workCmsTemporary workWork at officeLocal areaMonday to FridayShift workEnsemble Health Partners
New York, NY4 days ago- ...Blue Zones Health is seeking an LVN for Utilization Management & Inpatient Case Management in a fully remote role. The ideal candidate will perform concurrent reviews, monitor inpatient utilization, and coordinate transitions of care while collaborating with hospital...Remote workCms
Blue Zones Health
United States5 days ago - ...To support a managed care environment, the full-time LPN Utilization Management Nurse will perform pre-service and post-service utilization reviews and appeals... ..., collaborating with the Medical Director in a remote setting. Key responsibilities Conduct pre-service...Remote workCmsFull time
Virtual Vocations Inc
United States3 days ago - ...diversity. Monitors and coordinates resource utilization throughout the health system and... ...experience and 1 year of previous Case Management experience or a UCI employee who meets the... ...communication skills in English Current RN License Computer literacy and...Remote workCmsWork at officeMonday to Friday
University of California
United States5 days ago $39.4 - $53 per hour
...provider of technology-enabled revenue cycle management solutions for health systems,... ...Advancement. Position Overview The Lead Utilization Review RN is a key contributor to the overall financial... ...2024 Monster Top Workplace for Remote Work 2024 Great Place to Work certified...Remote workCmsWork at officeLocal area- ...Utilization Management Nurse The primary role of the Utilization Management Nurse is to review and... ...nursing facility. This is primarily a remote telephonic position with normal business... ...Minimum 2 years clinical experience as RN, LPN/LVN required. Minimum 1-year managed...Remote workCmsContract workWork at officeWeekend work
AllyAlign Health
United States3 days ago
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