Remote RN Reviewer, Utilization Management
Cook Children's Health Care System
Cook Children's Health Care System is seeking a Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer to coordinate the efficient utilization of health care resources for CCHP members and ensure timely, quality care throughout the continuum.Working with the Department Manager and Team Lead, you will assess clinical information, determine medical necessity with the Medical Director, and communicate with providers to facilitate appropriate care transitions, whileJ-18808-Ljbffr
Vacancy posted 7 hours ago
Similar jobs that could be interesting for youBased on the Remote RN Reviewer, Utilization Management in Fort Worth, TX vacancy
$52 - $56 per hour
...both. We're hiring a contract RN for a New York health plan (Medicare... ...medical necessity judgment you built in utilization management. 100% remote (U.S.) | Contract | $52–$56/hr based... ...: intake, investigation, clinical review, decision and notification...Remote workContract workAfternoon shiftPhaxis
United States4 days ago$35 - $40 per hour
...Sagility LLC, a leader in healthcare transformation, seeks an RN Utilization Management Reviewer for a fully remote role. You will perform timely clinical decision reviews for services requiring prior authorization across various clinical areas, applying criteria like...Remote workHourly paySagility LLC
United States3 days ago- ...That's the power of the Cleveland Clinic Health System team, and The Power of Every One. Job Title Utilization Management RN Reviewer Location Cleveland Facility Remote Location Department Utilization And Quality Assur-Weston Hospital Job Code 000446 Shift Days Schedule...Remote workFull timeWork at officeShift workWeekend work
CCF
New York, NY2 days ago - ...Working remotely in a full-time capacity, the Florida RN Utilization Reviewer will conduct admission, concurrent, and retrospective reviews of medical records to ensure... ...standards and reimbursement guidelines while managing a caseload of 25-30 reviews per day. Key...Remote workFull time
Virtual Vocations Inc
United States4 hours ago - Coastal Care Services, Inc. is seeking an LPN licensed Utilization Management Nurse Reviewer for a work-from-home opportunity serving the Miami, FL area. Work schedule is 10am to 7pm, with every other Sunday and a weekday off for a total of five days per week. The role...Remote jobWeekday work
$230k
...health care one person, one family and one community at a time. Company: Oak Street Health Title: Utilization Management Physician Reviewer Location: Fully Remote Hours: Full-Time, Monday - Friday, 8am -5pm CST Salary: $230k per year Role Description...Remote workHourly payFull timeLocal areaMonday to FridayOak Street Health
Illinois10 hours ago- ...Flexible Independent Contractor (1099) Remote Opportunity Required State Medical... ...ABOUT MRIoA Founded in 1983, Medical Review Institute of America (MRIoA) is a nationally... ...) specializing in technology-driven utilization management and clinical medical review solutions....Remote workFor contractorsFlexible hours
Medical Review Institute
United States4 days 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 workFull timeWork from home
ExamWorks
United States3 days ago - ...Sentara Health Plans is seeking a Clinical Claims Reviewer/RN for a remote, full-time position. Responsibilities include utilization management, pre/post payment claim reviews, and authorization assessments across inpatient and outpatient cases, with regulatory compliance...Remote workFull time
Sentara Health
United States2 days ago $219k - $286.9k
...Remote Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to...Remote workFull timeFor contractorsLocal areaWork from homeRelocationHome officeWeekend workOscar-Health-
Arizona1 day ago- ...SummaryResponsible for the coordination and efficient utilization of health care resources for Cook... ...) members. Works with the Department Manager and Team Lead to assure the timely... .../Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate and...Shift work
Cook Children's Health Care System
Fort Worth, TX7 hours ago - ...Oak Street Health is seeking a Utilization Management Physician Reviewer for a fully remote, full-time role. You will apply UM criteria and clinical judgment to determine coverage for inpatient and outpatient services, coordinating with care teams to ensure appropriate...Remote workFull time
Oak Street Health, part of CVS Health
United States7 hours ago - ...Oscar Health is seeking a Physician Reviewer for our Utilization Management team. You will assess medical appropriateness for inpatient, outpatient,... ...pharmacy services using evidence-based guidelines. This is a remote position open to US residents. Typical hours are 8am...Remote workLocal areaWeekend work
Oscar Health
Yuma, AZ2 days ago - Centers Plan for Healthy Living in New York is hiring a Full Time Registered Nurse, entry level welcome, to join the utilization management team. You will assess and process authorization requests to determine medical necessity and ensure needed care services and member...Full time
- Oscar Health is seeking a Physician Reviewer for its Utilization Management team. This remote role supports determining medical appropriateness for inpatient, outpatient, and pharmacy services, with a focus on evidence-based guidelines and clear documentation. You will...Remote jobWeekend work
$219k - $286.9k
Oscar Health seeks a Physician Reviewer to join the Utilization Management team. You will assess medical appropriateness for inpatient, outpatient, and... ...clinical data and applying evidence-based guidelines. This remote position, open to candidates nationwide in the United...Remote job- A leading independent review organization is seeking a Utilization Management Physician Reviewer for a full-time remote role. Candidates must possess an active Nebraska medical license and have a minimum of 5 years clinical practice experience. Responsibilities include...Remote jobFull timeCasual workMonday to Friday
- ExamWorks is seeking a Board Certified physician (Family Medicine or Internal Medicine) to join as a Utilization Management Physician Reviewer in a full-time, 100% remote role. The schedule is Monday through Friday, 8:30am-5:00pm, with occasional weekend/holiday coverage...Remote jobFull timeMonday to Friday
- Oscar Health seeks a Physician Reviewer to join the Utilization Management team in a remote US-based role. You will determine the medical appropriateness of services and document decisions using evidence-based guidelines and Oscar workflows. Responsibilities include timely...Remote job
- ...Gainwell Technologies is seeking a Nurse Reviewer (RN) to perform clinical reviews determining medical necessity and documenting findings... ...The role is full-time, with day-one benefits, and offers a remote option for US-based employees. Travel is minimal, and opportunities...Remote workFull time
Gainwell Technologies LLC
United States3 days ago - ...Arkansas Blue Cross and Blue Shield is seeking an RN Utilization Management Nurse to perform clinical reviews for medical necessity across various services. The role involves weekend coverage and work from home within Arkansas and several western states. The ideal candidate...Remote workWork from homeWeekend work
Arkansas Blue Cross
United States5 days ago - ...Healthcare Management Solutions, LLC is seeking experienced CHSD Audit reviewers to conduct independent medical record reviews for the STS CHSD program. This remote, part-time role focuses on data accuracy, source... .... Ideal candidates have RN/MD/NP/PA licensure, 2+ years...Remote workPart time
ADP
Fairmont, WV3 days ago - ...CVS Health Corporation seeks an experienced Registered Nurse (RN) to support 24/7 Utilization Management operations. You will review cases, assess medical necessity, coordinate care, and ensure members receive appropriate, high-quality healthcare services. Join a dynamic...Remote workWork from home
CVS Health
United States4 days ago - ...seeking an experienced Registered Nurse for a remote Utilization Management Nurse Consultant role focused on Medicare joint procedures. You will review clinical information for... ...utilization. The position requires 3+ years RN experience, an active RN license, an associate...Remote work
CVS Health
United States2 days ago - ...patient care initiatives, the full-time Florida Licensed Utilization Management RN will monitor admissions, perform medical necessity reviews, and collaborate with the multidisciplinary care team in a fully remote setting. Key responsibilities Monitor admissions and...Remote workFull time
Virtual Vocations Inc
United States2 days ago - ...Humana is seeking a remote Utilization Management Behavioral Health Professional 2 in Indiana. The role requires an active RN license in Indiana, an ASN (BSN preferred), and 1+ year of clinical and managed care experience. You will coordinate with providers and members...Remote work
Humana
United States5 days ago - ...Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY, NJ, or CT) Schedule: Monday – Friday, 9:00 AM – 5:00 PM... ...brings proven experience conducting utilization reviews within a SNF, health plan, or managed care...Remote workFull timeMonday to Friday
Medix™
New York, NY2 days ago - ...Services and Supports, the full-time Massachusetts Licensed Utilization Management RN will manage clinical determinations, authorization support, and appeals in a hybrid role that is approximately 75% remote and 25% onsite for meetings and training. Key responsibilities...Remote workFull time
Virtual Vocations Inc
United States4 days ago - ...CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN), remote and full-time with a weekend schedule after training. You’ll review clinical information for coverage determinations, apply guidelines, and coordinate with care teams...Remote workFull timeWeekend workAfternoon shiftWeekday work
CVS Health
United States4 days ago $60.2k - $107.4k
...About This Role As a Fertility Utilization Management RN at UnitedHealth Group, you will ensure health services are administered efficiently... ...identifying solutions to help them live healthier lives. This remote position is ideal for those looking to make a significant...Remote workFull timeDay shiftUnitedHealth Group
United States3 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN Reviewer, Utilization Management. Be the first to apply!
Related searches
- public health registered nurse Fort Worth, TX
- temporary rn Fort Worth, TX
- cath-lab rn Fort Worth, TX
- perioperative rn Fort Worth, TX
- part time rn Fort Worth, TX
- pacu rn Fort Worth, TX
- travel registered nurse l&d Fort Worth, TX
- nicu registered nurse Fort Worth, TX
- telephonic rn Fort Worth, TX
- rn urgent care Fort Worth, TX