Remote Medical Management Specialist (Utilization Review)
Elevance Health, Inc.
Elevance Health, Inc. seeks a Medical Management Clinician Associate in Florida. The role supports virtual, full-time work with occasional in-person training, offering flexibility and autonomy.
Candidates must reside in Florida and be prepared for hybrid onsite requirements. The position reviews clinical information to assess medical necessity for benefits, focusing on less complex plans and following policies, with responsibilities including precertification and reviews, and collaboration with
#J-18808-Ljbffr$24 - $27 per hour
...Remote Salary Range:$24.00 To $27.00 Hourly... ...innovative medical claims solutions through... ...comprehensive Medical Review Services, Medical Case Management Services and... ...Medical Review Specialist Type Full time... ...reviews medical bills utilizing professional knowledge...Remote workHourly payFull timeWork at office- ...SCAN is seeking a Medical Management Specialist-RN in California to promote quality and cost-... ...regulatory guidelines. You will support utilization management, conduct reviews, and coordinate with the Medical... ...and privacy standards. Remote work mode is available. #J-188...Remote workTemporary work
- ...organization, seeks an experienced Medical Management Specialist-RN in California. You will... ...care, conduct pre-service reviews, and coordinate complex... ...clinical supervision. Remote work mode, 3–6 month... ...medical-surgical nursing and utilization management in managed care...Remote workContract work
- ...BlueCross BlueShield of South Carolina is seeking a Remote RN Medical Reviewer II to perform medical reviews using clinical documentation and... ...documentation, determine medical necessity, and support claims and utilization practices in a work-from-home setup. The role requires...Remote workWork from home
$275k
...re Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health... ...the role: You will determine the medical appropriateness of inpatient, outpatient... .... Work Location: This is a remote position, open to candidates who...Remote workFull timeLocal areaWork from homeHome officeWeekend work- ...Gainwell Technologies is seeking a Medical Reviewer (Laboratory Specialist) to provide laboratory subject-matter expertise supporting Medical Review... ...program requirements. Your role emphasizes a full-time remote work environment in California, with a focus on meeting...Remote workFull timeFlexible hours
$65k - $78k
...Utilization Review Nurse- Remote job at Gainwell Technologies LLC. North Carolina. It takes great medical minds to create powerful solutions that solve some of healthcare's most complex... ...findings and rationale in medical management systems. Assist in training new nurses...Remote workFull timeContract workWork at officeWork from homeFlexible hours$275k
...Oscar Health is hiring a Physician Reviewer to join our Utilization Management team. The role is remote for candidates in the United States, with standard business... ...weekend rotation. You’ll report to the Associate Medical Director, Utilization Management, and perform...Remote workWeekend work- ...Clinical CM based in Oregon. The role oversees clinical reviewers in utilization review to determine medical necessity, quality, and appropriateness of care. You... ...with stakeholders, and ongoing process improvements in a remote-friendly setting. #J-18808-LjbffrRemote work
- ...Humana Inc. is seeking a Medical Director to lead expert clinical reviews of inpatient records, ensuring medical necessity per national guidelines, CMS... ...physicians, and advancing patient outcomes through rigorous utilization review. Ideal candidates hold an MD or DO with board...Remote work
- ...Brighton Health Plan Solutions seeks a Medical Director to perform utilization review and medical necessity determinations for BHPS-administered self-funded... ...clinical decisions that guide member care. This remote role requires board-certified physicians with UR experience...Remote work
- ...Broadway Ventures is seeking a Medical Reviewer for a remote role handling various claims (Radiology, Ambulance, Physical Therapy, Surgical). You... ...license in the U.S., an Associate’s degree, and 2+ years in clinical work with utilization/medical review. #J-18808-LjbffrRemote work
$38 - $41 per hour
Utilization Clinical Reviewer - Remote | WFH job at Get It - Healthcare. Los Angeles, CA. Job Summary As a Utilization... ...will use your expertise to assess medical records and ensure the appropriate... ...At least 2 years of experience in managing or working with Medicaid,...Remote jobHourly payFull timeWork from homeFlexible hours- ...Elevance Health is seeking a Medical Management Clinician Associate to ensure accurate and consistent... ...of plan benefits. You will review clinical information and assess medical... ...a HS diploma, 2 years of clinical or utilization review experience, and an active RN/LPN...Remote workFull time
- ...Elevance Health seeks a Medical Management Clinician Associate to review clinical information and assess medical necessity... ...must have 2+ years of clinical or utilization review experience and a current active RN/LPN license. Hybrid/remote work policy applies based on...Remote work
- Lynn Rodens is seeking an experienced RN for utilization review work. The role involves reviewing medical records, identifying quality and utilization issues, and... ...and DoD clearance eligibility. Position is remote with AZ hours (typically first shift). #J-18808-Ljbffr...Remote jobDay shift
$275k
Oscar Health, Inc. is seeking a Physician Reviewer to join our Utilization Management team. You will assess medical necessity for hospital, outpatient, and pharmacy services based on evidence-based guidelines. This remote role supports candidates in the United States. The...Remote job- ...Interventional Pain Management Excellence WNS... ...through evidence-based review of interventional... ...experienced IPM specialists on Contract to... ...within the medical community Ensure... ...improvement of our utilization management processes... ...SIS ) Location - Remote Schedule - Completely...Remote workContract workFor contractorsLocal areaFlexible hours
- ...executives, and healthcare specialists, delivers tailored strategies... ...bearing entities, we focus on medical management, quality, compliance,... ...Role Description This is a remote contract role for a Utilization Management Physician Reviewer. Responsibilities include conducting...Remote workContract work
- ...with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room... ...Employee Referral Bonus Program JOB SUMMARY: The Utilization Review Nurse is to assess the medical necessity and quality of healthcare...Remote workFull timeTemporary workLocal area
$26.01 - $56.14 per hour
...am-5:00pm EST Location: 100% Remote (U.S. only) About Us... ...Health, is a URAC-accredited medical management organization founded in 1993... ...complex medical journeys. As a Utilization Management (UM) Nurse Consultant... ...specializing in Medical Review, you’ll play a vital role in...Remote workHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hoursShift work$81.95k - $110.24k
...technology-enabled revenue cycle management solutions for health systems... ...in healthcare. The Lead Utilization Review RN is a key contributor to... ...quality and completeness of medical record documentation. They... ...Nursing required #LI-LS1 #LI-REMOTE Join an award-winning...Remote workFull timeWork at officeLocal area$39.4 - $53 per hour
...technology-enabled revenue cycle management solutions for health systems... ...Position Overview The Lead Utilization Review RN is a key contributor to... ...quality and completeness of medical record documentation. They... ...4 Monster Top Workplace for Remote Work 2024 Great Place to Work...Remote workWork at officeLocal area- ...Arkansas Blue Cross Blue Shield is seeking an experienced Utilization Management Nurse to perform clinical reviews for prior approvals, benefit inquiries, and... ...based criteria, guidelines, and policies to determine medical necessity and promote cost-effective care. The...Remote workWork from home
- ...responsible for providing case management services and... ...efficiency of the use of Medical Services for Long-Term... ...and concurrent review. Provides monthly telephonic... ...treatment setting by utilizing the applicable medical... ...Additional Info: *possible remote opportunity after...Remote workContract workMonday to FridayFlexible hours
- ...Job Description\n Utilization Management Medical Director Oncology\n\n\n \n \n Work Location: REMOTE (work from home)\n \n \n The Medical Director role provides clinical expertise... ...a focus on direct utilization management for case review and clinical decision making. \n \n...Remote workWork from home
$25 per hour
Location: Remote (Work From Home) Pay: $25.00/hour Schedule... ...months) Overview Seeking a Medical Review Specialist to create and write... ...Communicate issues/updates to management and coordinate with IT support... ..., duplicate billing, utilization review, fee schedules, and...Remote workFull timeTemporary workWork at officeMonday to Friday- ...Leave Your Mark is seeking a Registered Nurse for Utilization Review to support a Michigan health plan client from a home-based setting. The... ..., concurrent, and retrospective reviews to determine medical necessity, level of care, and length of stay for various services...Remote workWork from home
- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board certification and unrestricted medical license in relevant states. The role involves performing detailed...Remote workFull timeWork from home
- ...Yale University is seeking a Clinical Reviewer within the Yale School of Medicine to support medical necessity reviews, Authorization compliance, and reimbursement optimization. This role evaluates clinical records, payer policies, and treatment plans to ensure services...Remote work
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