Remote RN: Medical Management & Utilization Specialist (Temp)
SCAN Group
SCAN is seeking a Medical Management Specialist-RN in California to promote quality and cost-effectiveness of care under regulatory guidelines. You will support utilization management, conduct reviews, and coordinate with the Medical Director for complex requests.
Responsibilities include coordinating care across inpatient and outpatient settings, ensuring timely determinations, and maintaining strict documentation and privacy standards. Remote work mode is available.
#J-18808-Ljbffr- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant patient... ...-oriented environment. Requirements include active RN or LVN licensure, a minimum of two years in utilization...Remote workWork at office
$65k - $85k
...Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning... ...and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team... ...Collaborate with Branch Directors, Clinical Managers, and field clinicians Support...Remote workMonday to FridayWeekend workWeekday work- ...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
- ...Saint Joseph Health System is seeking an RN Utilization Review specialist for a part-time, remote PRN role that requires on-site training in Mishawaka, Indiana. The position emphasizes reviewing medical necessity, insurance requirements, and discharge planning in collaboration...Remote workPart timeRelief
$28.5 - $38.5 per hour
...Medical Necessity Reviewer Sanford Health, the largest rural... ...-site with consideration of remote work after 6 months to 1 year... ...s medical records. Performs utilization management (UM) activities in accordance... ...registered nurse (RN) license with the State Board...Remote workFull timeLocal areaMonday to FridayShift workWeekend workDay shift- ...experienced nursing professionals to review medical records and ensure appropriate admission... .... Candidates must have a valid California RN license and at least two years of clinical... ...degree in a related field. The position offers remote work with emphasis on critical thinking...Remote work
- ...Cohere Health seeks an experienced RN Reviewer to perform prospective, concurrent, and retrospective reviews ensuring medical necessity and high-quality care. You will collaborate... ..., and Medicaid lines. The role is fully remote, requires strong communication, and entails...Remote workFlexible hours
$45 per hour
...Job Description Job Description Utilization Management Nurse Coordinator (RN or LVN) needed for a temp 6+ month, remote contract opportunity with Yoh’s managed care health... ...authorization requests, assesses medical necessity, collaborates with interdisciplinary...Temporary workRemote workContract workMonday to FridayWeekend work$29.1 - $62.32 per hour
...Health, is a URAC-accredited medical management organization founded in 1993... ...Summary Join our Utilization Management team as a Nurse Consultant... ...from providers. Remote Work Expectations This is... ...Associate's degree in nursing (RN) required, BSN preferred....Temporary workRemote workHourly payFull timeWork experience placementLocal areaMonday to FridayFlexible hoursShift workWeekend work- ...Utilization Management Nurse This is a remote position. The Utilization Management (UM) Nurse is responsible for conducting... ...clinical reviews and assessing the medical necessity, appropriateness, and... ..., unrestricted Registered Nurse (RN) license in the applicable state or...Remote work
$30 - $35 per hour
...Location: Remote Schedule: Monday-Friday 8am-5pm MST... ...the Northpoint team, the Utilization Review Specialist is a licensed professional... ...patient continues to meet medical necessity Document actions... ...with clinical care team and management staff when patient no longer...Temporary workRemote workFull timeFor contractorsWork at officeMonday to Friday- ...TEEMA is seeking a Registered Nurse for a remote role with Arizona hours (1st shift). You will review medical records for quality, safety, and utilization issues, identify PQIs, and support QA... ...Directors. Must hold an active RN license, have 3+ years of clinical experience...Remote workDay shift
$45 - $50 per hour
...care, care for the most medically and socially complex... ...we serve. CA RN required, M-F 9am-6pm... ...The Job The Medical Management Specialist-RN promotes and supports... ...for supporting the utilization management processes... ...to $50.00per hour Remote Work Mode Excellent...Temporary workRemote workFor contractors$46.76 - $51.76 per hour
...experience. ~2+ years Care Management. ~ Bachelor's Degree in Nursing... ...Determines medical necessity and appropriateness... ...Qualification And Education RN - Registered Nurse - State Licensure... ...Licensure. CNS-Clinical Nurse Specialist Preferred. Cynet SystemsRemote jobWork experience placementWork at office- ...POSITION SUMMARY - RN Utilization Review POSITION DUTIES - Review patient medical records to assess the appropriateness... ...CMCN ~2-5 years utilization management experience (hospital-based) ~ Skilled experience with remote work LENGTH OF ASSIGNMENT...Temporary workRemote workShift workWeekend work
- ...Description Job Description: Manager of Clinical Utilization Management - Denial... ...Position Type: Hybrid (85% remote, 15% onsite in Northridge,... ...with physician reviewers, medical directors, and other relevant... ...Registered Nursing Program; RN preferred. 2. Minimum of...Temporary workRemote workPermanent employmentFull timeFlexible hours
$38.5 - $61.6 per hour
...talent in the nation leading the way in medical innovation and breakthrough research... ...medicine. Description The RN Utilization Specialist reflects the mission, vision, and values... ...care team assuring compliance with managed care contracts and payor guidelines while...Temporary workHourly payFor contractorsWork experience placementCasual workWork at officeLocal areaRelocation packageFlexible hours- ...Utilization Management RN Remote I'm currently working on a Utilization Management RN opportunity with a health plan client, supporting a temporary... ...be reviewing prior authorization requests, assessing medical necessity and benefit coverage, and rendering approval decisions...Temporary workRemote workContract workMonday to FridayShift work
$2,005 per week
...is seeking a travel nurse RN Utilization Review for a travel nursing... ...Review Extension (UR EXT) specialist for a remote position. This role involves conducting utilization management activities, requiring... ...proficiency with Electronic Medical Records (EMR) such as Epic...Temporary workRemote workZero hours contractMonday to FridayShift workWeekend work$35 per hour
.../hr - $35.00/hr Medical Review Nurse Location... ...Phoenix, AZ 85034 (Remote) 3+ Months... ...start date. The temp will need a computer... ...practice, medical case management protocols, quality management and utilization review protocols as... ...: • Active RN License in state of...Temporary workRemote workHourly payContract workPart timeFor contractorsWork at officeShift workDay shift$2,150 per week
...Revenue Cycle is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in... ...POSITION DUTIES – Review patient medical records to assess the appropriateness... ...hospital-based) ~ Skilled experience with remote work LENGTH OF ASSIGNMENT – 13...Temporary workRemote workZero hours contractImmediate startShift workNight shiftWeekend work- ...Location: Remote - TX Department: Utilization Shift: First Shift (United States of... ...Works with the Department Manager and Team Lead to assure the... ...Episodic Case Manager (UM/ECM - RN) Reviewer facilitates... ...providers and health plan medical directors. The UM/ECM - RN...Remote workFull timeShift workDay shift
$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote The Utilization Management Registered Nurse is responsible for performing utilization review activities... ...Guidehealth policies. This role applies established medical necessity criteria to obtain, analyze, and...Temporary workRemote workBi-weekly payFull timeFor contractorsLocal areaWork from home$63.1k - $94.65k
...enabled revenue cycle management solutions for health systems... ...have current compact RN license, or be willing... ...Information: Our Utilization Review team provides coverage... ...to third party payers Medical Necessity... ...Abilities Required: This is a remote role which requires...Temporary workRemote workWork at officeLocal areaFlexible hoursShift work- ...Registered Nurse – Utilization Review (Remote) Position Overview: This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care... ...: Minimum of 3 years acute medical Care Management/Utilization Review experience in a hospital...Remote work
$78.88k
...critical-thinking Utilization Review (UR) Nurse Specialist to join our team. In this fully remote position, you will play... ...role in resource management, care appropriateness... ...responsible for evaluating medical necessity, managing... ...are an experienced RN with acute care...Temporary workRemote workWork at office10 hours per weekShift workWeekend workAfternoon shift- ...detail-oriented Prior Authorization Specialist to join our national Utilization Management team. In this role, you will... ...verifying member eligibility, gathering medical documentation, and routing... ...Position Type: Full-Time | 100% Remote Schedule: Monday – Friday, 8:0...Remote workFull timeLive inWork from homeMonday to Friday
- ...and strong decision-making abilities. Remote position from LA with a choice of... ...Sat, or Sun-Thurs), 8-hour shifts. Active RN license in Louisiana and 2+ years RN experience are required; health plan or utilization management background is a plus. #J-18808-LjbffrRemote workShift work
$121.56k - $181.38k
...is hiring a Clinical Nurse Manager, Registered Nurse (RN) for our Intermediate Care... ..., evaluation, resource utilization, and environmental health)... ...who are too ill for general medical/surgical, but do not need... ...positions that are available as remote work, Sentara Health...Temporary workRemote workFull timeRelocationShift work- ...from-home position. The role involves performing retrospective medical reviews based on patient eligibility and contract requirements,... ...experience in a relevant medical setting, and the ability to work in a remote environment. Comprehensive benefits are provided, including...Remote workContract workWork from home
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