Remote Clinical Utilization Review Supervisor
Comagine.org
Comagine Health in Oregon is seeking a Clinical Review Supervisor to lead clinical reviewers and oversee utilization review activities, ensuring medical necessity and compliance. You will coach staff, monitor quality, and collaborate with stakeholders to support accurate determinations.
The role emphasizes remote management, staff development, adherence to InterQual criteria, and strong customer service as part of a mission-driven nonprofit health care consultancy.
#J-18808-Ljbffr- ...Job TitleIn this position you will be reviewing patient charts to determine if pre-elective surgical cases should... ...coding certification required.Minimum 3-5 years of clinical experience preferred.Previous utilization management or case management experience preferred.Certifications...Remote workFull timeMonday to Friday
- ...In this position you will be reviewing patient charts to determine if pre-elective surgical cases should be boarded... ...certification required. Minimum 3-5 years of clinical experience preferred. Previous utilization management or case management experience preferred....Remote workFull timeMonday to Friday
$84k - $126k
...the possible in healthcare. The Virtual Utilization Review Supervisor is a key contributor to the overall financial, quality, and clinical performance of the organization. The VUR... ...within 6 months of hire #LI-LS1 #LI-REMOTE Join an award-winning company Five-...Remote workFull timeWork at officeLocal area- ...Guidehealth is seeking a Utilization Management Registered Nurse (RN) for a fully remote, full-time position. The role involves... ...medical necessity criteria to reviews, documenting findings, and interfacing... ...license active and 3+ years clinical experience preferred....Remote workFull time
- ...Job Description Job Summary The Supervisor of Utilization Review (UR) oversees the development, implementation... ...of Utilization Review (UR) clinical policies, procedures, and protocols.... ...office environment. Hybrid (onsite/remote) work schedule available. The...Remote workWork at office
- ...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... ...active RN license, have 3+ years of clinical experience in med/surg or behavioral...Remote workDay shift
- ...Comagine Health in Oregon is seeking a Supervisor, Clinical CM to provide operational supervision of clinical staff performing utilization reviews and specialty reviews using InterQual... ...stakeholders. This role supports a flexible remote work model with occasional on-site...Remote workFlexible hours
- ...Rodens is seeking an experienced RN for utilization review work. The role involves reviewing... ...strong writing skills and 3+ years of clinical experience in med/surg or behavioral health... ...DoD clearance eligibility. Position is remote with AZ hours (typically first shift)....Remote jobDay shift
- Comagine Health is seeking a Clinical Utilization Review Nurse (RN) for a 100% remote, full-time role supporting Alaska contracts. The nurse will assess medical necessity and care quality through prospective, concurrent, and retrospective reviews, applying InterQual criteria...Remote jobFull time
- ...verification, billing and claims submission, and utilization review, we help treatment centers optimize... ...and managed care companies.Utilize clinical information and knowledge of Medical... ...sitting at a desk and working on a computer.Remote PositionBenefits:• Competitive salary•...Remote workHourly payWork at office
$20 - $25 per hour
...Job Title: Utilization Review Coordinator Reports To: Revenue Cycle Management Leadership Location: Remote FLSA Status: Temporary to Direct Hire Schedule: Monday-Friday... ...authorization tracking, payer correspondence, clinical documentation coordination, payer...Remote workTemporary workMonday to Friday$18 - $20 per hour
...Utilization Review Coordinator PRIMARY PURPOSE: To assign utilization review requests; to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic...Remote workWork at officeLocal areaFlexible hours- ...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... ...with management and providing guidance on clinical questions. This is a unique opportunity to work from...Remote workFull timeWork from home
$75.3k - $135.4k
...Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members... .... Supervises day-to-day activities of utilization management team. Key Details: Remote role. Candidates must possess a valid,...Remote workFull timePart timeWork at officeMonday to FridayFlexible hours- ...Description Job Description: Manager of Clinical Utilization Management - Denial Compliance... ...Burbank, CA Position Type: Hybrid (85% remote, 15% onsite in Northridge, CA); Full-Time... ...staff, managing daily tasks, performance reviews, and any necessary disciplinary actions...Remote workPermanent employmentFull timeTemporary workFlexible hours
- ...Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule Leverage your clinical knowledge... ...determinations. Collaborate with physicians, nurses, and utilization-management teams on complex cases. Document...Remote workWork from homeFlexible hours
- ...Description Job Summary The Supervisor of Utilization Management (UM) provides leadership, clinical oversight, and operational... ...other utilization management reviews conducted by the team. Demonstrates... .... Hybrid (onsite/remote) work schedule available. The...Remote workWork at office
- TEEMA is seeking an RN with 3+ years of clinical experience for a remote role in the United States. The position emphasizes medical record review, quality assurance, and collaboration with medical leadership. The role requires strong documentation skills, eligibility for...Remote jobDay shift
- ...Remote Drug Utilization Review Pharmacist Safe & Cost-Effective Medication Use Work from home analyze medication use patterns, apply clinical guidelines, and collaborate with providers all from home. This remote Drug Utilization Review Pharmacist role is ideal for...Remote jobWork from home
- Comagine Health is seeking a Clinical Reviewer with LCSW/LPC/LCPC licensure for a remote, Oregon-based role requiring travel to Salem and surrounding areas. Review... ...for diverse populations. The position emphasizes utilization review, documentation, and collaboration with...Remote jobWork from home
$48 - $65 per hour
Remote Registered Nurse - Clinical ReviewMake sure to apply quickly in order to maximise your chances of being... ...You'll work through clinical cases, review the information available, identify... ...work can touch prior authorization, utilization review, care coordination, patient...Remote workLong term contractWork from homeMonday to Friday$25.66 - $28.9 per hour
...maintaining electronic billing, bookkeeping, financial spreadsheets, utilization review or other similar electronic processes. Skills: Must pass... ...strict confidentiality. Regular attendance is mandatory. Remote / flexible work location eligible up to 80% of the time, subject...Remote workWork at officeLocal areaFlexible hours- ...Apply Refer a Friend Back Remote Work from Home Share This Page... ...hours are 8:00 AM - 5:00 PM As a Utilization Review Registered Nurse for Johns Hopkins Health... ..., you have the opportunity to use your clinical, managed care, utilization review, and...Remote workFull timeLocal areaWork from homeMonday to FridayDay shift
$92.67k - $143.59k
...Description The Senior Manager, Clinical Audit is responsible for... ...types of medical bill reviews and audits utilizing medical records, itemized... ...environment. This is a remote position. ESSENTIAL FUNCTIONS... ...made up of managers, supervisors, and staff through hiring,...Remote workMinimum wageFull timeWork at officeLocal areaFlexible hours- ...Northpoint Recovery Holdings, LLC is seeking a licensed Utilization Review Specialist to ensure clinically appropriate care, discharge planning, and cost-effective utilization across the treatment continuum. You will lead reviews of admissions, stays, discharges, and...Remote work
- ...The Clinical Pharmacy Reviewer (Pharmacist) evaluates complex prior authorization requests, appeals,... ...specialty medications. Through rigorous Drug Utilization Review (DUR) and objective decision-... ...Join Dane Street? Collaborative remote culture Professional growth...Remote workContract workLocal areaWork from home
- ...Centene Corporation seeks a Behavioral Health Utilization Review professional to perform clinical reviews and assess the appropriateness of mental health and substance use services. This fully remote role supports Ambetter / Marketplace, reviewing requests for inpatient...Remote work
- ...community? Do you enjoy using your clinical expertise to evaluate needs,... ...? In this role, you will review clinical documentation to... ...apply evidence-based criteria to utilization management reviews; document... ...on this team. This is a remote position based in Oregon and...Remote workFull timeContract workWork from home
$45.06 - $67.03 per hour
...Summary and Responsibilities As our Clinical Documentation Review Specialist (RN), you will help medical... ...medical coding requirements. As a remote employee, we will provide you with the... ...and detail oriented. Preferred Utilization review and / or inpatient concurrent...Remote workWork from home$130k - $145k
...Reporting to the Senior Director of Clinical Compliance Investigations,... ..., MDS coding, therapy utilization, clinical documentation, and... ...computer use. Ability to read, review, and analyze detailed... ...Location This position is fully remote and requires less than 25% travel...Remote workWork at officeFlexible hours
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