Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

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
Vacancy posted 8 hours ago
Similar jobs that could be interesting for youBased on the Remote Medical Management Specialist (Utilization Review) in United States vacancy
  • $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 work
    Hourly pay
    Full time
    Work at office

    Medlogix

    United States
    2 days ago
  •  ...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 work
    Temporary work

    SCAN Group

    Long Beach, CA
    1 day ago
  •  ...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 work
    Contract work

    SCAN

    Long Beach, CA
    1 day ago
  •  ...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 work
    Work from home

    Southcarolinablues

    South Carolina
    1 day ago
  • $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 work
    Full time
    Local area
    Work from home
    Home office
    Weekend work

    Oscar Health

    Abbeville, GA
    7 days ago
  •  ...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 work
    Full time
    Flexible hours

    Gainwell Technologies LLC

    United States
    3 days ago
  • $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 work
    Full time
    Contract work
    Work at office
    Work from home
    Flexible hours

    Gainwell Technologies LLC

    Raleigh, NC
    3 days ago
  • $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 work
    Weekend work

    Physician Pivot

    United States
    4 days ago
  •  ...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-Ljbffr
    Remote work

    Comagine-Health

    United States
    1 day ago
  •  ...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

    Humana

    Richmond, VA
    3 days ago
  •  ...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

    Brighton Health Plan Solutions

    United States
    4 days ago
  •  ...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-Ljbffr
    Remote work

    BROADWAY VENTURES, LLC

    United States
    1 day ago
  • $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 job
    Hourly pay
    Full time
    Work from home
    Flexible hours

    Get It - Healthcare

    Los Angeles, CA
    4 days ago
  •  ...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 work
    Full time

    Elevance Health

    Costa Mesa, CA
    4 days ago
  •  ...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

    Elevance Health (Anthem)

    Boght Corners, NY
    1 day ago
  • 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 job
    Day shift

    Lynn Rodens

    Phoenix, AZ
    4 days ago
  • $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

    Oscar Health, Inc.

    New York, NY
    4 days ago
  •  ...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 work
    Contract work
    For contractors
    Local area
    Flexible hours

    HealthHelp, LLC

    New York, NY
    5 days ago
  •  ...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 work
    Contract work

    Toney Healthcare

    New York, NY
    3 days ago
  •  ...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 work
    Full time
    Temporary work
    Local area

    TruHealth

    Remote
    13 days ago
  • $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 work
    Hourly pay
    Full time
    Temporary work
    Local area
    Monday to Friday
    Flexible hours
    Shift work

    CVS Health

    Clayton, MO
    5 days ago
  • $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 work
    Full time
    Work at office
    Local area

    Ensemble Health Partners

    Remote
    15 days ago
  • $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 work
    Work at office
    Local area

    Ensemble Health Partners

    New York, NY
    3 days ago
  •  ...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 work
    Work from home

    Arkansas Blue Cross

    United States
    3 days ago
  •  ...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 work
    Contract work
    Monday to Friday
    Flexible hours

    Healthcare Support Staffing

    New York, NY
    4 days ago
  •  ...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 work
    Work from home

    Starling Oncology

    Cerritos, CA
    3 days ago
  • $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 work
    Full time
    Temporary work
    Work at office
    Monday to Friday

    A-Line Staffing Solutions

    Atlanta, GA
    3 days ago
  •  ...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 work
    Work from home

    LEAVE YOUR MARK LLC

    Lansing, MI
    4 hours ago
  •  ...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 work
    Full time
    Work from home

    ExamWorks

    New York, NY
    3 days ago
  •  ...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

    Yale

    United States
    3 hours ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Medical Management Specialist (Utilization Review). Be the first to apply!