Remote RN: Clinical Utilization Review (Alabama)
COMAGINE HEALTH
- Remote job
Comagine Health is seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This full-time remote role supports compliant, cost-effective care under Alabama contract requirements. You will apply state criteria, meet timelines, and collaborate with a Physician Advisor when needed. A valid Alabama RN license and 3+ years of clinical experience are required. #J-18808-Ljbffr COMAGINE HEALTH
- ...Clinical Utilization Review Nurses (RN) Based In Alabama Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care... ...care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role...Remote workFull timeContract work
- ...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
- ...prospective patients. Ensures completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review... ...3-4 days for first week. This role will be remote BUT regular meetings/trainings require being onsite...Remote workReliefShift workWeekend work3 days per week
- ...A growing healthcare company in New York seeks a Utilization Review Nurse to conduct clinical reviews and ensure medical necessity authorizations are met. The ideal candidate will be an LPN or RN with critical thinking skills and attention to detail, able to manage tasks...Suggested
- ...WNS, part of Capgemini, is seeking a remote RN/LPN for utilization review in the United States. The role involves assessing medical necessity, resolving escalations, and maintaining HIPAA-compliant documentation with HealthHelp policies. Requires active nursing license...Remote workWork at office
- Enlyte is seeking a qualified Utilization Reviewer who can work remotely from home. The ideal candidate performs utilization review on workers’ compensation... ...retrospective treatment referrals. The role requires clinical judgment to ensure medical necessity, collaboration...Remote jobWork from home
$30 - $38 per hour
...Responsibilities Job Summary We are seeking Utilization Review Nurse RN to join our team on a part‑time basis... ...(Nursing program) required. 1+ year clinical experience required. Required... ...skills to successfully perform in a remote healthcare environment. Ability to perform...Remote workHourly payFull timePart timeWork at officeMonday to FridayWeekend work- ...POSITION SUMMARY: The Utilization Review Registered Nurse (UR RN) is a key contributor to the delivery of appropriate... ...conducts comprehensive reviews of clinical documentation, assesses medical... ...as required for facility based staff; optional for remote staff.Remote workWork at office
- ...Job Title Utilization Review/Case Management – Nurse Department Case Management (Quality) Hours... .... Hybrid (combination of in person and remote considered) General Summary The Utilization... ...issues on a case-by-case basis with clinical staff. Demonstrates working knowledge of...Remote workFull timeShift work
- 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, assisting...Remote job
$32 - $48 per hour
...RN-Utilization Review/Case Manage Nurse - RFT Hot Job Gibson City, IL 60936 Overview... ...Hybrid (combination of in person and remote considered) GENERAL SUMMARY The... ...and issues on a case-by-case basis with clinical staff. Demonstrates working knowledge...Remote workHourly payFull timeWork at officeRelocation packageShift work$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... ...must have a current RN license and at least 1 year of clinical experience. Competitive hourly compensation worth $30-$38...Remote jobHourly payPart time- ...Brighton Health Plan Solutions is seeking an Utilization Management Nurse to perform medical necessity and benefit reviews remotely. The role requires current LPN licensure and expertise in CMS/MCG criteria with experience in inpatient/outpatient reviews. The successful...Remote work
$35 - $45 per hour
Position: RN / Utilization Review Nurse Location: Sacramento, CA (ON-SITE) Employment Type: Potential... ...records, treatment requests, and clinical documentation to support timely, accurate... ...Comfortable working independently in a remote or office-based setting. Working Conditions...Remote workWeekly payContract workWork at officeMonday to Friday- ...RN Utilization Review Review patient medical records to assess the appropriateness and medical... ...and payers to ensure compliance with clinical guidelines, regulatory requirements, and... ...hospital-based) ~ Skilled experience with remote work Length of assignment: 13...Remote workShift workWeekend work
- ...Job Description Job Description Remote Utilization Review Registered Nurse (UR RN) Location: Remote (Texas RN License or Compact License Required)... ...criteria, including InterQual (or similar), to support clinical decision-making and payer compliance. Collaborate...Remote jobFull timeWork at office
$85.99k - $105.34k
...healthcare organization in Oregon is seeking a Utilization Review Nurse for a full-time remote position. The role involves evaluating clinical service requests, conducting prior... ...interdisciplinary teams. Applicants should have an active RN license and at least five years of direct...Remote workFull time- ...telephonic and e-referral case review and authorization of services utilizing established mental health... ...care appropriate to clinical needs. Responsible for... ...position is full-time, fully remote (work from home) and... ...Michigan clinical license (RN, LMSW, LP, LPC, or LLP) required...Remote workFull timeWork from homeShift workWeekend workAfternoon shift
- ...Responsible for the review of medical records for... ...Care Coordination staff utilizing evidence-based guidelines... ...authorization or provides clinical guidance to Payer... ...Job Requirements Remote. Must reside within driving... ...experience. California RN license. AHA BLS...Remote work
- ...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
$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...Remote workDaily paidLive inShift workDay shift$63k - $65k
...in Financial Services & Insurance RN Utilization Review As a nurse at Sedgwick, you can build... ...for patients in a nontraditional clinical setting. Apply your RN clinical knowledge... ...health and well-being of others in a remote work environment. Enjoy flexibility...Remote workWork experience placementLocal areaFlexible hours$30 - $34 per hour
...Overview Utilization Review Nurse - Remote at Astrana Health Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Compensation... ...Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient medical services...Remote workHourly payMonday to Friday- 1 week ago Be among the first 25 applicants Job Title:Clinical Review Nurse (RN) - Utilization Management Location:Oregon or bordering states Duration:... ...Future Opportunities) Clinical Program Coordinator RN *Remote* Clinical Program Coordinator RN *Remote* Medford, OR $...Remote workContract work
$84.56k - $126.84k
...Email this Job Job Overview The Utilization Review RN participates as a member of a... ...00 This position will be primarily remote but there may be occasions when you are... ...necessity for admission; communicates clinical review process with appropriate Payors...Remote workTemporary workPart timeLive inImmediate startRelocationRelocation packageShift workWeekend workAfternoon shift- ...in managed care UM to perform pre-service and post-service utilization reviews and appeals for DMEPOS, working with our Medical Director in... ...review benefit and medical necessity criteria, coordinate with clinical and non-clinical staff, and communicate outcomes both...Remote work
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing... ...applications This is a 100% remote role, and requires robust internet...Remote workFull timeFlexible hoursShift work$2,210 per week
...Holidays Work-life balance. Remote/hybrid setting (once trained)... ...DESCRIPTION: This individual will utilize clinical knowledge and communication... ...decision to a second level reviewer. This individual interfaces with... ...but is not limited to RN, LMSW, LMHC. Successful completion...Remote workFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours- ...A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and collaborating with teams to meet...Remote workContract work
$30 - $34 per hour
A healthcare services company is seeking an experienced Utilization Review Nurse to work remotely. The ideal candidate must hold an active LVN license in California and have experience in outpatient utilization management. Responsibilities include approving or denying medical...Remote workHourly pay
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