Remote RN: Prospective Review & Medical Necessity
$69.38k - $92.28kLE12 MVP Service Corp.
- Remote job
LE12 MVP Service Corp. is seeking a Prospective Review Registered Nurse to evaluate medical requests and treatment plans while ensuring alignment with clinical guidelines. This remote role emphasizes collaboration with healthcare providers and requires a current RN license (NY or VT) alongside 3-5 years of clinical experience. Candidates must have strong critical thinking skills, effective communication abilities, and a proven track record in managing multiple tasks efficiently. The compensation ranges from $69,383.00 to $92,279.00 based on experience and qualifications. #J-18808-Ljbffr LE12 MVP Service Corp.
- MVP Health Care is searching for a Prospective Review RN to join their remote team. This role involves evaluating medical requests and collaborating with healthcare providers to assess treatment plans per clinical guidelines. The ideal candidate holds a current RN license...Remote jobMedical
$33.12 - $56.77 per hour
...Elevance Health is seeking a Nurse Reviewer I who will perform medical necessity reviews for diagnostic imaging services from a virtual setting. Candidates are encouraged to apply remotely, ensuring a flexible work-life arrangement. The role requires a nursing degree and...Remote workMedicalHourly payFlexible hours- ...regarding admissions, case management, discharge planning and utilization review. Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provide case...Remote workMedical
- ...telephonic and e-referral case review and authorization of... ...and substance abuse medical necessity criteria to provide... .... Responsible for prospective, concurrent, and retrospective... ...is full-time, fully remote (work from home) and... ...clinical license (RN, LMSW, LP, LPC, or LLP...Remote workMedicalFull timeWork from homeShift workWeekend workAfternoon shift
$57.28 - $88.92 per hour
...Description RN Utilization Review - Remote. This position is Per Diem and will... ...Day shifts. Provide prospective, retrospective, and concurrent... ...reviews and review medical records daily during admission... ...Utilization Management, medical necessity, and patient status...Remote workMedicalDaily paidMinimum wageLocal areaShift workDay shift- ...Strategies, Inc. (HQSI) is seeking a Nurse Reviewer for a remote position supporting Medical Review Services. The role requires conducting comprehensive medical necessity reviews and ensuring compliance... ...will have a BSN with active RN licensure and 3-5 years of experience...Remote jobMedical
- ...complex appeal requests and performing clinical reviews. The job is full-time, Monday through Friday, and can be remote or on-site in Nashville, TN. Qualified candidates... ...experience in clinical settings, and an active RN license. Benefits include 401(k) match, health plans...Remote workMedicalFull timeMonday to Friday
- ...A healthcare organization is seeking a Clinical Services Specialist RN to perform reviews of patient records for medical necessity compliance. This full-time role involves analyzing records according to policies and facilitating communication with various stakeholders...Remote workMedicalFull timeWork from home
- ...Description Job Description Fully remote- Must have state of MI unrestricted RN license. You will perform prospective, concurrent and retrospective review of inpatient, outpatient,... ...and ancillary services to ensure medical necessity, appropriate length of stay, intensity...Remote workMedicalWork at officeFlexible hours
- ...Appeals - Licensed Nurse to investigate medical necessity appeals from members and providers.... ...successful candidate must hold an active RN license and have a minimum of 2 years of... ...managed care. Key responsibilities include reviewing medical records, preparing...Remote workMedicalFull time
- ...company is seeking a Registered Nurse (RN) Intern to conduct clinical reviews and support healthcare initiatives.... ...spouses, providing key training in a remote work setting. Key responsibilities include performing medical necessity reviews, documentation, and quality assurance...Remote workMedicalInternship
- ...clinical professional for a fully remote role focused on medical management. The position... ...an active New York State RN licensure and involves... ...requests to determine medical necessity. The successful candidate will... ..., conduct clinical reviews, and ensure that members receive...Remote workMedicalFlexible hours
- ...Molina Healthcare is looking for a Registered Nurse (RN) to join their team in Akron, Ohio. This role involves clinical review to ensure medical necessity and appropriate care levels, while also managing appeals for denied prior authorizations. With a focus on utilization...Remote workMedical
$36.27 - $56.77 per hour
...Elevance Health is looking for a Nurse Reviewer I in Walnut Creek, CA, allowing for virtual work full-time with in-person training. Responsibilities... .... Candidates must have an AS in nursing and possess a current RN license, with a minimum of 3 years of clinical experience. The...Remote workMedicalFull time- ...Appeals - Licensed Nurse to investigate medical necessity appeals from members and providers.... ...The ideal candidate must hold an active RN license and have experience in a managed... ...care setting. Responsibilities include reviewing denied services, documenting appeals, and...Remote workMedicalFull time
- A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and...Remote workMedicalFull 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 workMedicalHourly payPart time$29.05 - $67.97 per hour
...Molina Healthcare is seeking an experienced Registered Nurse for clinical review roles based in Jacksonville, Florida. This position involves reviewing documentation for medical necessity, handling appeals, and ensuring compliance with coding regulations. The ideal candidate...Remote workMedicalHourly pay$29.05 - $67.97 per hour
...Molina Healthcare is seeking a Clinical Reviewer in Columbia, South Carolina. This role involves... ...advanced clinical knowledge to assess medical necessity and ensure appropriate coding for claims... ...The ideal applicant will hold an active RN license and must possess strong problem-...Remote workMedicalHourly pay$29.05 - $67.97 per hour
...Molina Healthcare is seeking a qualified Registered Nurse with clinical experience to perform utilization reviews and ensure medical necessity of claims. The role involves reviewing medical documentation, facilitating appeals for authorizations, and validating claims...Remote workMedicalHourly pay$29.05 - $67.97 per hour
...seeking a clinical nurse specialist responsible for reviewing documentation to ensure medical necessity and appropriate level of care. This role involves facilitating... ...management. Candidates must have an active RN license and at least 2 years of clinical nursing experience...Remote workMedicalHourly pay$29.05 - $67.97 per hour
...Molina Healthcare is seeking a Clinical Review Nurse to review medical documentation ensuring medical necessity and appropriate billing. This role includes managing appeals... ...including utilization review, an active RN license, and strong analytical skills. This position...Remote workMedicalHourly pay- ...Corp. is looking for a Clinical Review Nurse - Prior Authorization to work remotely. This position entails analyzing... ...authorization requests to determine medical necessity, working with healthcare... ...must have an active New York State RN licensure and a degree from an Accredited...Remote workMedicalMonday to Friday
- ...Behavioral Health Registered Nurse Intern to assist with medical necessity reviews in a remote setting. The role involves collaborating with healthcare... ...transitioning military members or spouses and hold an active RN license in Kentucky or have an enhanced compact license....Remote workMedicalInternship
$1,949.74 per month
...Specialty Utilization Review Job ID 17979666... ...Title Utilization Review RN Weekly Pay $1949.7... ...Job Description Remote Utilization Review RN responsible for concurrent reviews, medical necessity determinations, prior authorizations...Remote workMedicalWeekly payShift work$75k
...dedicated Registered Nurse for inpatient utilization review responsibilities. This role requires performing medical necessity reviews and collaborating with clinical teams to... ...decisions. Candidates must hold an active RN license and have experience in acute care settings...Remote workMedical$28.37 - $36 per hour
...Acentra Health, LLC is seeking a Clinical Reviewer - RN - PRN (Remote U.S.) to join our growing team. The role involves reviewing patient records and ensuring medical necessity while adhering to HIPAA policies. Candidates should have a valid RN license in South Carolina...Remote workMedicalHourly payReliefFlexible hours$2,220 per week
...is seeking a travel nurse RN Utilization Review for a travel nursing job in... ...Utilization Review Nurse (Remote) Location: 100% Remote... ...remote opportunity. This is a medical review role with no direct... ...Responsibilities: • Perform medical necessity and utilization reviews for...Remote workMedicalWeekly payContract workMonday to FridayShift work- ...Management Behavioral Health Registered Nurse (RN) Intern to join their National Medicaid team. This role involves conducting medical necessity reviews for behavioral health services while... ...RN license. This position supports remote work, providing work-life balance while...Remote jobMedicalInternship
- ...a Behavioral Health Registered Nurse (RN) Intern to join the National Medicaid team... ...members and spouses, focusing on medical necessity reviews and clinical decision-making. Responsibilities... ...health experience. The position is remote, ideally for candidates in Kentucky. #J...Remote jobMedicalInternship
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