Remote RN: Utilization Management & Care Optimization
Arkansas Blue Cross and Blue Shield
Arkansas Blue Cross and Blue Shield is seeking an experienced Utilization Management Nurse to perform clinical reviews for prior approvals, network exceptions, and benefit inquiries. The role evaluates medical necessity using evidence-based criteria and contributes to cost containment and quality of care.
The position requires a RN license in good standing, a BSN preferred, and at least four years of clinical nursing experience in medical-surgical, ICU, or related areas.
#J-18808-Ljbffr- ...As an on-site Hospital Utilization Management (UM) Nurse, you are... ...administrative compliance. Unlike remote roles, this position... ...teams to optimize hospital resources.The... ...is a Registered Nurse (RN) responsible for performing... ...the current level of care.o Medical Provider Liaison...Remote workFull timeImmediate startShift work
- ...Medicare Precertification Utilization Management Nurse Consultant. You... ...assess and coordinate care, determine coverage... ...communicate with providers to optimize patient outcomes. The... ...requires 3+ years of RN experience, an active... ...Med/Surg exposure. Remote work from home with...Remote jobWork at officeWork from homeFlexible hours
$113.73k - $170.46k
...patients receive high-quality care while efficiently utilizing medical resources. Reviews... ...patient outcomes and optimizing resource allocation. Utilizes... ...~ Registered Nurse (RN) licensure in the state of... ...variances to the on-site care management teams when appropriate. Reviews...Remote workFull timeWork experience placement- ...Medicare Precertification Utilization Management Nurse Consultant via remote work in the United States. The role requires RN licensure and 3+ years of... ...will assess and coordinate care, determine coverage, and collaborate... ...with providers to optimize healthcare services for...Remote workWork at officeAfternoon shift
- ...experienced Registered Nurse to join our Utilization Management team in a remote role based in Florida. You will review... ...providers to ensure appropriate, high-quality care and optimal benefit utilization. The role requires an active RN license, at least 2 years in adult acute...Remote job
$39 - $40 per hour
...Recruiter at The Judge Group Utilization Management Registered Nurse (RN) Type: 6-Month Contract W2 Location: Remote - but MUST reside in one... ...services, coordinating care, and ensuring members receive... ...monitor care options for optimal outcomes Conduct utilization...Remote workDaily paidContract workMonday to FridayShift workWeekend work- Highmark Inc. is seeking a full-time remote care manager in California to support utilization management across weekends and weekdays.The role reviews care appropriateness, applies criteria to optimize resource use, coordinates with Health Coaching and case management,...Remote jobFull timeWeekend workWeekday work
- ...CVS Health is hiring an experienced Registered Nurse (RN) for Utilization Management to ensure appropriate care at the right time through evidence-based review and coordination. This role supports 24/7 operations and may require evenings, weekends, and holidays from a...Remote workWork from homeWeekend workAfternoon shift
- Humana is seeking a Utilization Management Registered Nurse to interpret and coordinate... ...for post-acute care programs (SNF, Home Health,... ...documentation while working remotely with periodic travel to Humana... ...needed. You must have a Compact RN license, 1+ year of RN experience...Remote work
$72.8k - $130k
...Sr Utilization Management Nurse Optum is a global organization that delivers care, aided by technology to help millions... ...help us advance health optimization on a global scale.... ...opportunity for remote work based on business... ...~ Registered Nurse (RN) with a current, active...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- ...CVS Health is seeking a Utilization Management Nurse Consultant (Remote) to support Florida Medicare home-care requests. You will review cases, determine coverage, and coordinate... ...setting. The position requires an active RN license, 2+ years of experience (including 1+...Remote workFull time
$71.1k - $97.8k
...Become a part of our caring community Why Humana?... ...their best health. The Utilization Management (UM) Nurse uses... ...parties to facilitate optimal care and treatment... ...Licensed Registered Nurse (RN), unrestricted ~3+ years... ...Programs Previous remote work experience Work...Remote workFull timeTemporary workApprenticeshipWork experience placementWork at officeLocal areaWork from homeHome officeFlexible hoursWeekend work- ...Health has a long tradition of providing world-class care to the people of the Mid-South, living out our... ...our neighbors throughout the region. Organization Utilization Management Job Summary Facilitates optimal reimbursement through accurate certification and complete...Remote jobTemporary workWork experience placementLive outFlexible hours
- Arkansas Blue Cross Blue Shield is seeking an Utilization Management Nurse to perform clinical reviews of... .... The role requires an active RN license and a Bachelor's degree is preferred... ...and emphasizes evidence-based patient care, cost containment, and compliance with...Remote jobWork from home
$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote The Utilization Management Registered Nurse is responsible for performing utilization review activities... ...of inpatient or outpatient services, Quality of care concerns. Interfacing routinely with ordering providers...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home- ...Guidehealth, a data-powered healthcare company, seeks a Utilization Management Registered Nurse (RN) to perform utilization review remotely. The role supports compliance with federal and state regulations and URAC standards, applying medical necessity criteria to documentation...Remote work
- ...Logan Health is seeking a Utilization Management Specialist to join our team in a fully remote role focused on inpatient admissions reviews, physician documentation assessment... ...necessity. Ideal candidates bring acute care hospital experience, familiarity with Medicare/...Remote work
- ...seeking an experienced Registered Nurse for a remote Utilization Management Nurse Consultant role focused on Medicare... ...coordinate treatment plans, ensuring appropriate care and utilization. The position requires 3+ years RN experience, an active RN license, an...Remote work
- ...recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an... ...include evaluating healthcare services and coordinating care for members. Join a dynamic team and make a meaningful impact...Remote workContract work
$71.1k - $97.8k
...Become a part of our caring community The Utilization Management Nurse 2 utilizes clinical nursing... ...Registered Nurse (RN) in a compact state with... ...minimum standard speed for optimal performance is 25mbs download... ....Travel: While this is a remote position, occasional...Remote workFull timeTemporary workApprenticeshipWork at officeHome officeMonday to FridayShift work- ...Integrated Home Care Services (IHCS) seeks a Utilization Management Nurse to ensure home health services are delivered with quality... ...with a multidisciplinary team to optimize patient outcomes. State licensure as an LPN or RN and a minimum of 2 years in Utilization...Remote work
- ...CVS Health is seeking a Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) to support treatment decisions remotely. You will collaborate with providers and apply clinical judgment for the right care at the right time. An active RN license...Remote workWork at office
$26.01 - $62.32 per hour
...by passionate colleagues who care deeply, innovate with purpose... ...one community at a time. RN Utilization Management Nurse Consultant (Medicare - Joint Procedures) Remote | Full-Time | Monday-Friday (... ...to improve care quality and optimize healthcare utilization Support...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work- ...the role We're looking for an RN who has personally owned... ...outpatient and community-based care: home health, long-term services... ...role. The best fit has a utilization management or case management foundation... ...cases at once in a fully remote setting. Nice to haves...Remote job
- ...Logan Health is seeking a Utilization Management Specialist to review admissions across our system and... ...status. The role demands strong acute care experience, effective collaboration with... ...communication. This full-time, remote-enabled position requires Montana residence...Remote workFull timeShift workWeekend work
- ...Description Job Description The utilization review and management (UM) component program ensures that external... ...at the appropriate level of care, while supporting regulatory compliance... ...for lunch This is an in-office, no remote work capability position Travel...Remote workWork at office
- ...is seeking a Medicare Precertification Utilization Management Nurse Consultant to assess, coordinate,... ...collaboration with providers to facilitate care and referrals, leveraging clinical... ...practices. The position requires an active RN license, 3+ years of nursing experience...Remote workWork at office
$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 the... ...outcomes-oriented, patient care delivery system, which... ...Nursing required #LI-LS1 #LI-REMOTE Join an award-winning company...Remote workFull timeWork at officeLocal area- ...Job Description Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY, NJ, or CT) Schedule: Monday... ...operations, Medicare, and Managed Long-Term Care (MLTC). This is a 100% remote position , but...Remote workFull timeMonday to Friday
- Exceptional care starts with exceptional... ...well as knowledge of utilization and discharge... ...hospital resources, or optimal financial... ...department Vice President/Manager of Regulatory... ...patient care as an RN. Experience in Case... ...interested in is remote or on-site. Individuals...Remote jobFull timeWork experience placementLocal areaImmediate startFlexible hoursWeekend work
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