Remote Medical Management Nurse - Case Review
Elevance Health, Inc.
- Remote job
Elevance Health is seeking a Medical Management Nurse to review complex cases and determine medical necessity using nursing judgment while collaborating with providers and applying clinical guidelines. The role is remote with occasional in-person training, requiring an active RN license, multi-state licensure where needed, and shift overlap Monday–Friday 11:30 a.m. to 8:00 p.m. ET to support member care. #J-18808-Ljbffr Elevance Health, Inc.
- Elevance Health is seeking an experienced nurse to review complex cases for medical necessity, applying clinical guidelines and nursing judgment. The role involves collaboration with physicians, case managers, and Medical Directors to optimize member outcomes. Ideal candidates...Remote job
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- Clinical Review Nurse - Concurrent Review TX All On-site... ...Description Location: 100% Remote - TX: RN only with TX... ...in by facilities for medical necessity. The nurse... ...deadlines. Will be reviewing cases for medical necessity... ...records in health management systems according to...Remote jobContract workWork from homeShift work
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- WPS—A health solutions company is seeking an Appeals Nurse (RN) to review medical records and claims for first-level appeal cases to determine medical necessity under Medicare guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations. In...Remote job
- ...Utilization Review NurseThis position has a remote option for those living close... ...Utilization Review Nurse is responsible for determining... ...and efficiently manage a diverse workload... ...and if it is medically necessary.Promote quality... ...and present cases of possible quality...Remote workFull time
$26.01 - $56.14 per hour
...0pm EST Location: 100% Remote (U.S. only) About Us American... ..., is a URAC-accredited medical management organization founded in... ...Management (UM) Nurse Consultant specializing in Medical Review, you'll play a vital role... ...medical review cases. Applies the appropriate...Remote workHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hoursShift work- ...for coordinating, processing and managing all in-patient and out-patient claims from a medical standpoint to ensure proper... ...information. Obtains request for reviews from and notifies determinations... ...authorization, medical review, and case management experience is required...Remote workWork experience placementH1bLocal areaRelocationVisa sponsorship
- ...is seeking an experienced nurse for a 10-month contract role primarily focused on reviewing clinical data and managing member appeal requests in accordance... .... The position allows for remote work, preferably from Iowa,... ...include preparing case reviews, generating appeal...Remote jobContract work
- Elevance Health is seeking a Medical Management Nurse (RN) to review complex cases and determine medical necessity with nursing judgment. The role involves collaboration with healthcare providers, consultation with the Medical Director, and supporting clinicians in assessing...Remote job
$2,784 per week
...Travel RN - Case Management/Utilization Review - Case Management American Traveler... ...or Associate's Degree in Nursing required; BSN or MSN preferred... ...be prepared to take a medication calculation math test for... ...Hospital housing provided in a remote area with shared common...Remote workWeekly payWork experience placementShift workDay shift$60.3k - $133.4k
...functions of Utilization Management (UM), Case Management (CM) and... ...managing care. The Primary Nurse Coordinator performs concurrent review, discharge planning and... ...Knowledge of medical management policies and... ...This is a Telecommute (Remote) role: Must reside within...Remote workTemporary workWork at officeLocal areaImmediate start$26.01 - $56.14 per hour
...0pm EST Location: 100% Remote (U.S. only) About Us American... ..., is a URAC-accredited medical management organization founded in... ...Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a vital role... ...medical review cases. Applies the appropriate...Remote workHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hoursShift work- ...CVS Health is recruiting a remote RN Case Manager to support members nationwide. The role involves telephonic case management, reviewing medical necessity, and coordinating care with a focus... ...candidates hold 5+ years as a registered nurse with multi-state licensing and...Remote work
- ...DescriptionLocation: Fully remote. Candidates must be... ...experienced Concurrent Review Registered Nurse (RN) to join its Utilization Management team. In this role, you... ...prior authorizations, medical necessity reviews, discharge... ...management, or case management.What You Will...Remote workWork at officeImmediate start
- ...responsible for providing case management services and... ...efficiency of the use of Medical Services for Long-Term... ...authorization and concurrent review. Provides monthly... ...Additional Info: *possible remote opportunity after... ...Requires an AS/BS in Nursing At least 2 years of...Remote workContract workMonday to FridayFlexible hours
$85k - $92k
...Equivalent: ~$41–$44/hr Location: Remote Schedule: Must work AZ... ...Quality / Utilization Review / Case Review experience Experience... ...exposure Bachelor’s degree in Nursing or healthcare-related field... ...THEY ACTUALLY DO) Review medical records for quality, safety,...Remote workHourly payDay shift- Remote Medical Case Reviewer (Contract) Location: Remote About the Opportunity PsyPhyCare is seeking Medical Case Reviewers to support a federal... ...consensus discussions. Ensure compliance with records management, HIPAA, and confidentiality standards. If required, provide...Remote jobHourly payContract work
$150 per hour
...US physicians: review de-identified health records and clinical reasoning tasks in a remote project. See qualifications and application... ...Clinical Reasoning Reviewer – EHR Cases United States Open ·... ...Share this project Use your medical expertise to review clinical...Remote workHourly payPart time- Optum is seeking a Per Diem Utilization Management Nurse to review medical records and craft defensible appeal letters. You will extract pertinent case details, adhere to HIPAA, and follow OPAS/Optum guidelines while meeting time expectations. The role offers telecommuting...Remote jobDaily paidLocal area
$37 - $39 per hour
...Excellent opportunity for Case Management / Case Manager RN's!!... ..., State of MI 100% remote. Contract, to... ...team is inclusive of Medical and Behavioral Health... ...EDUCATION AND EXPERIENCE ~ Nursing Diploma or Associates... ...) Utilization Review Nurse, LTSS and HCBS -...Remote workFull timeContract workLocal areaFlexible hours- WPS is seeking an Appeals Nurse (RN) to review medical records and denial information for first-level Medicare appeals, ensuring services meet medical... ...license with 1+ year of clinical experience, and offers remote work options in approved states, including Michigan. #J-1...Remote job
$54.1k - $155.54k
...Summary This is a remote work from home role anywhere... ..., Inc (AHH) is a medical management company that is a division... ...is URAC accredited in Case Management, Disease... ...medical necessity reviews. Required Qualifications... ...as a Registered Nurse with at least 1 year of...Remote workHourly payFull timeLocal areaWork from homeFlexible hours- ...healthcare employer to recruit a Case Manager - Utilization Review Specialist for a fully remote role in the United States. The... ...and concurrent reviews, medical necessity determinations, and coordination... .... The role leverages clinical nursing expertise, analytical thinking,...Remote job
- ...application, please review these frequently... ...Clinical Financial Case Mgr - RN... ...and Revenue Cycle Management Shared Services responsible... ...University Wexner Medical Center. The CFCM-RN... ...’s degree in nursing with current license... ...: Location: Remote Location Position...Remote workFull timeFlexible hoursShift workDay shift
- ...collaboration with the Medical Director on driving the... ...Reports to the Health Plan Manager of Utilization... ...1. Current Registered Nurse license issued by the state... ...implements care management review processes (Prior... ...enhanced by coaching and/or case management interventions...Remote workCasual workWork at officeShift work
- Elevance Health is seeking a Transplant Nurse II to provide case and medical management for members receiving transplant services. The role offers virtual full-time work with required in-person training sessions and periodic on-site onboarding. Responsibilities include...Remote jobFull time
$80.31k - $116.19k
...care, care for the most medically and socially complex... ...Job Provide clinical review of medical claims and... ...of issues and management of medical services and... ...Quality of Care (QOC) Nurse, Medical Management Specialist... ...to $55.86 per hour Remote position An annual...Remote workHourly payFull timeFor contractorsLocal area- ...facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care... ...JOB SUMMARY: The Utilization Review Nurse is to assess the medical... ...clinical data provided Certify cases that meet clinical review...Remote workFull timeTemporary workLocal area
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