Utilization Review RN (Remote)
HealthPlus Staffing
- Remote job
Job Description
Job Description
Quick Job Details:
Setting: Fully Remote – Utilization Review
Schedule: Full-Time, Monday–Friday
Hours: Standard business hours
Patient Volume: N/A
Job Requirements:
- Active RN license with Multi-State/Compact license required
- Minimum 2 years of Utilization Review experience
- Minimum 3 years of clinical nursing experience (acute care/hospital preferred)
- Strong understanding of medical necessity, utilization management, healthcare reimbursement, and clinical documentation improvement
- Excellent communication, analytical, and critical thinking skills
- Ability to work independently in a remote environment
Responsibilities:
- Conduct admission, continued stay, and observation reviews
- Apply medical necessity criteria to determine appropriate level of care
- Review cases for Physician Advisor escalation when appropriate
- Collaborate with physicians, case managers, and insurance payers
- Support denial prevention, documentation improvement, and revenue cycle initiatives
- Ensure compliance with payer guidelines and regulatory requirements
- Analyze clinical and financial data to identify quality improvement opportunities
Compensation: Competitive; based on experience
Benefits: Comprehensive benefits package
About Us:
HealthPlus Staffing is a national leader in the healthcare staffing industry. We partner with top healthcare organizations nationwide to connect highly qualified professionals with outstanding career opportunities.
Our Promise:
- We will put you in front of the decision makers.
- We will provide feedback on your application.
- We will work on your behalf to obtain as much information as possible to help you make a well-informed decision.
If you're interested in this opportunity, please submit an application or call View phone number on ziprecruiter.com to speak with one of our experienced consultants. We look forward to helping you find your next opportunity!
The HealthPlus Team
- ...TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews,...Remote work
- ...Seeking a part-time Utilization Review Nurse RN, the candidate will perform medical-necessity reviews and level-of-care determinations, ensuring compliance with established guidelines while working up to 28 hours per week, including weekends. Key responsibilities Conduct...Remote workPart time
$30 - $38 per hour
...A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Remote workHourly payPart time- ...Comagine Health is looking for a Clinical Utilization Review Nurse (RN) to perform remote assessments on the medical necessity of healthcare services. This full‑time position involves managing utilization reviews and ensuring compliance with clinical policies for quality...Remote workFull time
- ...Job Title Utilization Review/Case Management – Nurse Department Case Management (Quality) Hours & Shift Requirements Full time position. Hybrid (combination of in person and remote considered) General Summary The Utilization Review/Case Management Nurse is directly responsible...Remote workFull timeShift work
$30 - $38 per hour
...personifyhealth.com. Responsibilities Job Summary We are seeking Utilization Review Nurse RN to join our team on a part‑time basis, working a minimum... ...communication skills to successfully perform in a remote healthcare environment. Ability to perform the essential job...Remote workHourly payFull timePart timeWork at officeMonday to FridayWeekend work$32 - $48 per hour
...RN-Utilization Review/Case Manage Nurse - RFT Hot Job Gibson City, IL 60936 Overview Salary Range $32.00 - $48.00 Hourly Position... ...REQUIREMENTS: Full time position. Hybrid (combination of in person and remote considered) GENERAL SUMMARY The Utilization Review/...Remote workHourly payFull timeWork at officeRelocation packageShift work$45 - $50 per hour
...for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical... ...of accredited nursing programs with an active New York RN license. #J-18808-Ljbffr...Remote workHourly pay- ...Job Description Job Description Remote Utilization Review Registered Nurse (UR RN) Location: Remote (Texas RN License or Compact License Required) Company: Nexus Health Systems Employment Type: Full-Time Make an Impact from Anywhere Nexus Health Systems...Remote jobFull timeWork at office
- ...Fully Remote Utilization Review Position Setting: Fully Remote – Utilization Review Schedule: Full-Time, Monday–Friday Hours: Standard business... ...Patient Volume: N/A Job Requirements: Active RN license with Multi-State/Compact license required Minimum...Remote workFull timeMonday to Friday
$1,949.74 per month
...Registered Nurse Specialty Utilization Review Job ID 17979666 Job Title Utilization Review RN Weekly Pay $1949.74 Shift... ...13 Week(s) Job Description Remote Utilization Review RN responsible for concurrent...Remote workWeekly payShift work$85.99k - $105.34k
...focused healthcare organization in Oregon is seeking a Utilization Review Nurse for a full-time remote position. The role involves evaluating clinical... ...interdisciplinary teams. Applicants should have an active RN license and at least five years of direct patient care...Remote workFull time$63k - $65k
...Fortune Best Workplaces in Financial Services & Insurance RN Utilization Review As a nurse at Sedgwick, you can build a meaningful and... ...making an impact on the health and well-being of others in a remote work environment. Enjoy flexibility and autonomy in your...Remote workWork experience placementLocal areaFlexible hours- ...providing telephonic and e-referral case review and authorization of services utilizing established mental health and... ...This position is full-time, fully remote (work from home) and requires some... ...State of Michigan clinical license (RN, LMSW, LP, LPC, or LLP) required....Remote workFull timeWork from homeShift workWeekend workAfternoon shift
- ...Brighton Health Plan Solutions, LLC is seeking an Utilization Management Nurse to perform medical necessity reviews remotely. Licensed LPN with strong MS Office skills will review clinical criteria, coordinate with care partners, and document determinations in compliance...Remote work
$65 per hour
...RN Utilization Review Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule Shift: Day 5x8-Hour (08:00 - 16:30) Shift... ...No Locals accepted? No. Pending License accepted: No Fully Remote Position RTO Restrictions: Please include all RTO at the...Remote workHourly payLocal areaImmediate startMonday to FridayShift workWeekend work- ...Responsibilities Responsible for the review of medical records for... ...and the Care Coordination staff utilizing evidence-based guidelines and... ...the market. Job Requirements Remote. Must reside within driving distance... ...1 year experience. California RN license. AHA BLS Ability to...Remote work
$30 - $34 per hour
...Overview Utilization Review Nurse - Remote at Astrana Health Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Compensation: $30.00 - $34.00 / hour Department: HS - UM This is a fully remote position. Description Astrana Health is looking...Remote workHourly payMonday to Friday- ...Partners is seeking a licensed Practical Nurse (LPN/LVN) experienced in managed care UM to perform pre-service and post-service utilization reviews and appeals for DMEPOS, working with our Medical Director in a NCQA-compliant UM program. You will review benefit and medical...Remote work
- ...leading healthcare solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services.... ...accredited nursing degree and experience in utilization review. Competitive pay and remote flexibility offered. #J-18808-Ljbffr...Remote work
- ...patients. Ensures completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review... ...days for first week. This role will be remote BUT regular meetings/trainings require being onsite...Remote workReliefShift workWeekend work3 days per week
- ...Providence is seeking a Utilization Review RN for a remote, full-time role in the California region. The position involves performing prospective, retrospective, and concurrent utilization reviews, reviewing medical records daily during admission for all payers, and applying...Remote workFull time
- ...Optum is seeking a Remote RN to perform clinical coverage review services and communicate benefit determinations. You will interpret mandates, work with... ...reliable internet. A Bachelor's Degree is preferred and experience with utilization review is a plus. #J-18808-Ljbffr...Remote workFlexible hours
- A healthcare provider is seeking a Utilization Review Nurse to coordinate resources and ensure efficient delivery of home health care. This role involves monitoring patient admissions and ongoing care while ensuring adherence to guidelines. The ideal candidate will have...Remote workContract work
- ...CVS Health is hiring a Utilization Management Nurse Consultant focused on Medical Review. This fully remote role supports timely, medically necessary care through expert clinical... .... The position requires an active RN license, 3+ years of clinical experience, and...Remote workFull time
$51.43 - $79.84 per hour
Overview Description - This is a remote role. You MUST live in the state of Washington (WA) to be considered. Care Manager RN, Per diem / On call, Day shift. The Utilization Review (UR) Nurse has a strong clinical background blended with knowledge and skills in Utilization...Remote workDaily paidLive inShift workDay shift- ...As a full-time Maryland Licensed Utilization Review Nurse working remotely, the candidate will monitor care appropriateness for plan members, evaluate benefits... ...Required qualifications Unencumbered Registered Nurse (RN) license in Maryland or a Compact state 3+ years of...Remote workFull time
- ...AHCCCS is seeking a Behavioral Health Prior Authorization Utilization Review Consultant to monitor and decide on medical and behavioral health... ..., and standards of care. The position supports AHCCCS’ remote-work options within Arizona, emphasizes collaboration with providers...Remote work
- ...Centene is seeking an Utilization Review Clinician - ABA to assess medical appropriateness of ABA services for members. The role emphasizes... ...credentials and 2–4 years of experience, including ABA exposure. Remote work with MO location, full-time day shift, and competitive...Remote workFull timeDay shift
- ...Gainwell Technologies LLC is looking for a Utilization Review Nurse to work remotely in Maine. You will conduct reviews for medical necessity and appropriateness... .... Qualified candidates should have an active Maine RN license and at least 3 years of inpatient clinical...Remote workFlexible hours
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