Remote Utilization Review RN - Insurance/URAC Expertise
Innovative Systems Group
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 knowledge of accreditation standards. Candidates must reside in IL or TX and possess strong communication skills to interact with providers and members. #J-18808-Ljbffr
$30 - $38 per hour
...Job Summary We are seeking Utilization Review Nurse RN to join our team on a part‑... ...external audits to include URAC and NCQA. Maintain HIPAA compliance... ...successfully perform in a remote healthcare environment.... ...that values your expertise Technology and equipment support...Remote workHourly payFull timePart timeWork at officeMonday to FridayWeekend work- ...Quick Job Details: Setting: Fully Remote – Utilization Review Schedule: Full-Time, Monday–Friday... ...: N/A Job Requirements: Active RN license with Multi-State/Compact license... ...with physicians, case managers, and insurance payers Support denial prevention, documentation...Remote jobFull timeMonday to Friday
$63k - $65k
...Workplaces in Financial Services & Insurance RN Utilization Review As a nurse at Sedgwick, you can build... ...and well-being of others in a remote work environment. Enjoy flexibility... ...navigating the unexpected. The company’s expertise, combined with the most advanced AI-...Remote workWork experience placementLocal areaFlexible hours$2,210 per week
...and voluntary life insurance. Critical Illness,... ...Work-life balance. Remote/hybrid setting (once... ...This individual will utilize clinical knowledge... ...to a second level reviewer. This individual interfaces... ...knowledge of URAC guidelines, Hines... ...is not limited to RN, LMSW, LMHC. Successful...Remote workFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours$84.06k - $118.67k
...glance** **Location:** Remote **Facility:**... ...Services **Department:** Utilization Management **Schedule:... ...bring their skills and expertise every day to reimagining... ..., disability and life insurance + **Time to recharge:*... ...impact in this role** + Review admissions and service...Remote workPart timeLocal area- 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
- ...POSITION SUMMARY: The Utilization Review Registered Nurse (UR RN) is a key contributor to... ...Systems policies on Health Insurance Portability and... ...professional development and expertise in utilization review.... ...required for facility based staff; optional for remote staff.Remote workWork at office
$26.01 - $56.14 per hour
...Utilization Management Nurse Consultant We're... ...Location: 100% Remote (U.S. only) About... .../CVS Health, is a URAC-accredited medical... ...specializing in Medical Review, you'll play a... ...your clinical expertise in a fast-paced, desk... ...Active, unrestricted RN license in your...Remote workHourly payFull timeTemporary workMonday to FridayFlexible hoursShift work- ...the Texas Department of Insurance. Through its network... ...Community is accredited by URAC for its health plan... ...Behavioral Health Utilization Manager will perform concurrent... ...and discharge reviews on assigned patients.... ...systems Work Schedule: Remote Other Requirements:...Remote workContract workWork experience placement
- ...Utilization Review Specialist The Utilization Review Specialist plays a... ...with healthcare providers, insurance companies, and case managers... ...Qualifications: Registered Nurse (RN) license or equivalent... ...Specialist applies clinical expertise and analytical skills daily...Remote work
- ...telephonic and e-referral case review and authorization of services utilizing established mental health... ...is full-time, fully remote (work from home) and... ...Include: • One (1) year health insurance plan experience or... ...Michigan clinical license (RN, LMSW, LP, LPC, or LLP) required...Remote workFull timeWork from homeShift workWeekend workAfternoon shift
$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- ...RN Utilization Review Review patient medical records to assess the appropriateness and medical necessity of hospital admissions, continued... ...management experience (hospital-based) ~ Skilled experience with remote work Length of assignment: 13 weeks Shift / hours...Remote workShift workWeekend work
- ...a Friend Back Remote Work from Home Share... ...- 5:00 PM As a Utilization Review Registered Nurse for... ...Medical, Dental, and Vision Insurance. ~403B Savings Plan... ...Knowledge and expertise in utilizing various criteria... ...Registered Nurse (RN) license in Maryland (...Remote workFull timeLocal areaWork from homeMonday to FridayDay shift
$65 per hour
...Fully Remote Position Job Title : 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 Notes: Days (5×8) | 08:00 - 16:30PAY DETAILS (72 HOURS / 2 WEEKS)...Remote workLocal areaImmediate startMonday to FridayShift workWeekend work- ...Responsible for the review of medical records for... ...Care Coordination staff utilizing evidence-based guidelines... ...communication with the insurance providers to obtain admission... ...Job Requirements Remote. Must reside within... ...experience. California RN license. AHA BLS...Remote work
- ...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
$71.1k - $97.8k
...caring community The Utilization Management Nurse, National... ...is responsible for reviewing and evaluating clinical... ...requirements. The RN Review Nurse works closely... ...of payer policies, insurance companies and government... ...Travel: While this is a remote position, occasional...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to FridayWeekend 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- ...Utilizing clinical expertise, the full-time Licensed Medical Review Nurse (LVN/LPN) will conduct medical reviews of claims and documentation to ensure medical necessity... ...and compliance with regulations while working remotely on a MST/PST schedule. Key responsibilities...Remote workFull 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
- ...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
- ...building the future of health insurance with a first-of-its-kind... ...overseeing and performing utilization reviews, prior authorizations, and... ...peer discussions. This is a remote position requiring a "roll... ...services, applying clinical expertise, established medical policies...Remote workFull timeFlexible hours
- ...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
- 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...Remote jobFull timeContract work
$51.43 - $79.84 per hour
...Overview Description – This is a remote role. You MUST live in the state... ...to be considered. Care Manager RN, Per diem / On call, Day shift. The Utilization Review (UR) Nurse has a strong clinical... ...(medical, dental, vision), life insurance, disability insurance, time off...Remote workDaily paidLive inShift workDay shift$35 - $45 per hour
...poster from IntePros IntePros is seeking a Remote Utilization Review Nurse serves as a key clinical liaison,... ...professional nursing program (RN, LPN, or LVN). Minimum of two years of... ...procedures, and community resources. NCQA and URAC knowledge beneficial. Proficient in MS...Remote workContract workWeekend 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... ...paid time off, medical/dental/vision insurance, company provided life and disability...Remote workTemporary workPart timeLive inImmediate startRelocationRelocation packageShift workWeekend workAfternoon shift$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 jobHourly payPart time- ...completion of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees... ...first week. This role will be remote BUT regular meetings/trainings... ...years of experience in hospital or insurance related utilization review highly...Remote workReliefWeekend work3 days per week
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