Remote RN: Medical Review & Utilization Auditor
$29.05 - $67.97 per hourMolina Healthcare
Molina Healthcare is seeking a qualified Registered Nurse with clinical experience to perform utilization reviews and ensure medical necessity of claims. The role involves reviewing medical documentation, facilitating appeals for authorizations, and validating claims coding. The ideal candidate must have at least two years of clinical nursing experience and be proficient in ICD-10 and CPT coding. This position offers a competitive pay rate of $29.05 to $67.97 per hour. #J-18808-Ljbffr
- ...clinical professional in Miami to perform utilization reviews and ensure proper coding for... ...regulations. The candidate will evaluate medical claims and facilitate appeals, contributing... ...assurance and regulatory compliance. An active RN license is essential, along with...Remote workMedical
- ...Healthcare is looking for a Registered Nurse (RN) to join their team in Akron, Ohio. This role involves clinical review to ensure medical necessity and appropriate care levels,... ...prior authorizations. With a focus on utilization review, candidates should have at least 2...Remote workMedical
$29.05 - $67.97 per hour
...Molina Healthcare is seeking a Clinical Review Nurse to review medical documentation ensuring medical necessity and appropriate billing... ...at least two years of nursing experience including utilization review, an active RN license, and strong analytical skills. This...Remote workMedicalHourly pay$29.05 - $67.97 per hour
...clinical nurse specialist responsible for reviewing documentation to ensure medical necessity and appropriate level of care. This... ..., and resolving complaints regarding utilization management. Candidates must have an active RN license and at least 2 years of clinical nursing...Remote workMedicalHourly pay$29.05 - $67.97 per hour
...Molina Healthcare is seeking a Clinical Reviewer in Columbia, South Carolina. This role involves utilizing advanced clinical knowledge to assess medical necessity and ensure appropriate... ...The ideal applicant will hold an active RN license and must possess strong problem...Remote workMedicalHourly pay$29.05 - $67.97 per hour
...is looking for a Clinical Nurse with experience in utilization review. The role includes reviewing medical claims and ensuring compliance with guidelines to support... ...reimbursement. Candidates must have an active RN license and at least 2 years of clinical experience....Remote workMedicalHourly pay$29.05 - $67.97 per hour
...Molina Healthcare is seeking an experienced Registered Nurse for clinical review roles based in Jacksonville, Florida. This position involves reviewing documentation for medical necessity, handling appeals, and ensuring compliance with coding regulations. The ideal candidate...Remote workMedicalHourly pay$80k - $90k
...Expected Hiring Range: $80-90k The Medical Review Clinical Appeals Auditor (RN) is responsible for conducting... ...be necessary. Experience with utilization management systems or clinical decision... ...ability to work independently in remote setting with minimum supervision...Remote workMedicalFor contractorsImmediate startWork from homeHome officeFlexible hoursShift work- ...Management Council, Inc is looking for a Remote RN to join their team. The role requires 2 years of RN experience and Utilization Review expertise, supporting various units in a... ...flexible scheduling with benefits that include medical, dental, and retirement contributions...Remote workMedicalWork from homeFlexible hours
$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 workMedicalHourly payPart time- ...Utilization Management Position Provide health care services regarding admissions, case... ...management, discharge planning and utilization review. Review admissions and service... ...prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement...Remote workMedical
$1,949.74 per month
...Nurse Specialty Utilization Review Job ID 17979666... ...Title Utilization Review RN Weekly Pay $1949.7... ...Job Description Remote Utilization Review RN responsible for concurrent reviews, medical necessity determinations, prior...Remote workMedicalWeekly payShift work$30 - $34 per hour
...healthcare services company is seeking an experienced Utilization Review Nurse to work remotely. The ideal candidate must hold an active LVN license in... ...management. Responsibilities include approving or denying medical services based on established criteria. Competitive...Remote workMedicalHourly pay- ...telephonic and e-referral case review and authorization of services utilizing established mental health and substance abuse medical necessity criteria to... ...position is full-time, fully remote (work from home) and... ...Michigan clinical license (RN, LMSW, LP, LPC, or LLP) required...Remote workMedicalFull timeWork from homeShift workWeekend workAfternoon shift
$35 - $45 per hour
...Position: RN / Utilization Review Nurse Location: Sacramento, CA (ON-SITE) Employment Type: Potential... ...role is responsible for reviewing medical records, treatment requests, and clinical... ...Comfortable working independently in a remote or office-based setting. Working...Remote workMedicalWeekly payContract workWork at officeMonday to Friday$75k
...seeking a dedicated Registered Nurse for inpatient utilization review responsibilities. This role requires performing medical necessity reviews and collaborating with... ...informed decisions. Candidates must hold an active RN license and have experience in acute care settings...Remote workMedical- Medix™ is seeking an experienced RN for a Utilization Review role, allowing you to work from the comfort of home. In this contract-to-hire position... ...'ll review inpatient treatment plans and communicate with medical teams to ensure appropriate care levels. Ideal candidates...Remote jobMedicalContract workWork from home
$2,220 per week
...Care Career is seeking a travel nurse RN Utilization Review for a travel nursing job in Hanover, Maryland... ...Travel Utilization Review Nurse (Remote) Location: 100% Remote Schedule:... ...a fully remote opportunity. This is a medical review role with no direct patient...Remote workMedicalWeekly payContract workMonday to FridayShift work$2,210 per week
...and benefits, including medical, dental, vision, long-... ...Holidays Work-life balance. Remote/hybrid setting (once... ...: This individual will utilize clinical knowledge and... ...to a second level reviewer. This individual interfaces... ...but is not limited to RN, LMSW, LMHC. Successful...Remote workMedicalFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours$75k
...seeking a Registered Nurse for the role of Utilization Review Specialist. The position involves... ...Successful candidates must possess an active RN license and have at least two years of... ...annually, with additional benefits including medical, dental, and paid time off. #J-18808-...Remote jobMedical- Humana is seeking a Utilization Management Behavioral Health Registered Nurse (RN) Intern to join their National Medicaid... ...role involves conducting medical necessity reviews for behavioral health services... ...license. This position supports remote work, providing work-life...Remote jobMedicalInternship
- ...Office for 3 months, then remote/hybrid Must have 3-5... ...hospital setting doing utilization management.... ...limited to: o Accurate medical necessity screening and... ...for Physician Advisor review o Care coordination... ...maintain a current Florida RN license. • Handle with...Remote workMedicalWork at officeLocal area
- ...Remote: Yes Area of Interest: Nursing FTE/Hours... ...period: .9 Department: Utilization Management Shift: Monday... ...Health is seeking an RN Utilization Management Specialist... ...utilization management reviews using established criteria to confirm medical necessity, appropriate...Remote workMedicalDaily paidTemporary workMonday to FridayShift work
$34 - $52.7 per hour
...0 facility. This job is REMOTE. FTE: 0.500000 Standard... ..., for a second level review as needed. Facilitates communication... ...is required; Prior utilization management or case management... ...Academic Partnership with the Medical College of Wisconsin Referral...Remote workMedicalHourly payTemporary workShift work- ...Epidemiologists is seeking a Clinical Review Supervisor to provide... ...supervision of clinical staff conducting utilization review activities. This fully remote position requires an RN license and relevant experience in patient care and medical management. The role focuses on...Remote jobMedical
$57.28 - $88.92 per hour
...Description RN Utilization Review - Remote. This position is Per Diem and will work 8-hour, Day shifts. Provide prospective, retrospective... ...CA ministries. Conduct clinical reviews and review medical records daily during admission for all payers, as required...Remote workMedicalDaily paidMinimum wageLocal areaShift workDay shift- Oregon Health & Science University is seeking a part-time Utilization Review RN to work remotely. This role involves assessing the medical necessity of hospital admissions and ongoing stays while ensuring compliance with clinical guidelines. You will collaborate with various...Remote jobMedicalPart time
$47.69 - $94.06 per hour
...Job Summary The Utilization Review (UR) Nurse supports the Utilization Management (UM) program by... ...report data related to patient status and medical necessity. Ensure compliance with... ...Providence St. Peter Hospital Location: Remote, Olympia, WA (work site Providence St Peter...Remote workMedicalHourly payFull timeLocal areaShift workDay shift$47.06k - $70.24k
...healthcare solutions provider is seeking a Utilization Review Nurse in Fort Worth, TX. This remote role involves analyzing medical bill appropriateness, documenting findings,... ...claims examiners. Candidates must have a current RN license and at least four years of clinical...Remote jobMedical- ...for clinical member services review assessment processes. Responsible... ...verifying that services are medically necessary and align with... ...Molina care model. Adheres to utilization management (UM) policies and... ...experience. Registered Nurse (RN). License must be active and...Remote jobMedical
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