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
- ...A healthcare staffing firm is seeking a skilled Utilization Review RN to join their team. This fully remote position requires a valid PA RN license and prior experience in insurance utilization review. Responsibilities include conducting clinical reviews, applying evidence...Remote work
- ...A leading insurance provider in Omaha, Nebraska is seeking a full-time Utilization Review Nurse to ensure effective management of injured workers' treatments. This role does not require prior utilization review experience and is perfect for skilled nurses looking to transition...Remote workFull timeWork at officeWork from home
- ...CareFirst is seeking a Utilization Review Specialist (RN) to support Government Program lines. This clinical... ...of care, utilizing clinical expertise and critical thinking skills. The ideal... ...populations. This position allows for remote work within the greater Baltimore/Washington...Remote work
- Industrial Asset Management Council, Inc is looking for a Remote RN to join their team. The role requires 2 years of RN experience and Utilization Review expertise, supporting various units in a clinical review capacity. This work-from-home position offers flexible scheduling...Remote jobWork from homeFlexible hours
- ...The Utilization Review Clinician is responsible for reviewing medical records to determine medical... ...health outcomes. By applying clinical expertise, you'll coordinate care with facilities... ...or therapy experience ~ Active RN, OT, or PT license Preferred Qualifications...Remote workFull timeWork experience placementWork at office
- Molina Healthcare in Chandler, Arizona is looking for a RN Utilization Review Nurse. This role focuses on utilizing clinical expertise to ensure documentation meets medical necessity and coding standards. Responsibilities include facilitating medical review for authorization...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
- ...Medix™ is seeking an experienced RN for a Utilization Review role, allowing you to work from the comfort of home. In this contract-to-hire position, you'll review inpatient treatment plans and communicate with medical teams to ensure appropriate care levels. Ideal candidates...Remote workContract workWork from home
- ...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 Able...Remote workContract workWork experience placement
$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX Agency: Mindlance Health Pay: $35 to $45 per hour Shift... ...and quarterly member contact and will include 80% travel. Remote role. Will require a driver’s license. Member...Remote workHourly payFull timeContract workImmediate startShift work3 days per week$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX Agency: Mindlance Health Pay: $35 to $45 per hour Shift... ...and quarterly member contact and will include 80% travel. Remote role. Will require a driver’s license. Member...Remote workHourly payFull timeContract workImmediate startShift work3 days per week- ...CVS Health is looking for a highly skilled Utilization Management Nurse (RN) for a remote position. In this role, you will ensure patients receive appropriate healthcare services through reviews of clinical cases and collaboration with providers. The ideal candidate will...Remote work
- ...A regional healthcare provider in Houston is seeking a Utilization Management Review Nurse. This role involves evaluating the appropriateness of... ...certifications, the UMRN will collaborate with care management and insurance payers. This position offers flexible scheduling and...Remote workFlexible hours
$78k - $92k
...TalentLNX LLC is seeking a Utilization Review Nurse for a remote position focusing on evaluating medical necessity of inpatient and outpatient services... ...for experienced RNs aiming to utilize their clinical expertise without direct patient care. The role involves...Remote work- ...Acentra Health, LLC is seeking a Clinical Reviewer - RN to join their team remotely in the U.S. In this role, you will review patient records for medical... ...2 years of clinical experience, and experience in Utilization Review. Benefits include access to a 401(k) plan and wellness...Remote work
- ...oversee high-quality, patient-centered care through Utilization Review. The role requires an active RN license in Illinois and significant experience in healthcare... ...providers. This position offers the flexibility of remote work while supporting professional growth and a...Remote work
- ...A prominent healthcare provider in Bellaire is seeking a PRN Utilization Management Review Nurse. This role involves evaluating medical services, ensuring appropriate care levels, and collaborating with healthcare teams. Candidates must hold a Bachelor's in Nursing and...Remote workReliefShift work
$65k - $75k
...Piper Companies is seeking a Remote Utilization Management/Review Nurse to evaluate member cases, ensuring medical... .... The role requires clinical expertise and collaboration with providers to... ...ideal candidate will hold an active RN license with relevant experience. The...Remote work$1,966 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 timeWork at officeWork from homeMonday to FridayFlexible hours$45k - $70k
...United States is looking for a Utilization Management Nurse Reviewer to ensure the efficient use... ...and provide clinical expertise. Applicants must have an active LVN/RN license, with a preference for... ...benefits package including health insurance, retirement plans, and paid...Remote work$45 - $50 per hour
...Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing... ...paid vacation and health insurance, this position offers a... ...with an active New York RN license. #J-18808-Ljbffr...Remote workHourly pay$65k - $75k
Gainwell Technologies LLC is seeking a Nurse Reviewer (RN) to perform clinical reviews remotely in the United States. Responsibilities include reviewing... ..., 5+ years of clinical experience, and 2+ years in utilization review or claims auditing. This full-time position...Remote workFull time$69.38k - $92.28k
MVP Health Care seeks a Professional Concurrent Review RN to ensure members receive appropriate care while navigating the healthcare continuum... ...candidates are experienced RNs looking to transition into utilization management, requiring strong clinical judgment and excellent...Remote job$2,700 per week
...Lancesoft is seeking an experienced Utilization Review Registered Nurse for an exciting Travel Nursing... ...No. Pending License accepted: No Fully Remote Position Hospital Highlights Type of... ...of Experience Required: 1 year Certs Required: BLS, WA RN License #J-18808-Ljbffr...Remote workLocal areaImmediate startMonday to FridayShift workWeekend work- ...Epidemiologists seeks a Clinical Review Supervisor to provide... ...clinical staff conducting utilization reviews. This fully remote position is critical in... ...of clinical experience, an RN license, and the ability to... ...Benefits include medical insurance, paid time off, and a retirement...Remote work
- ...in Nevada seeks a Supervisor, Clinical Review to supervise clinical staff conducting utilization reviews. Ideal candidates will have an active RN licensure in Alabama, with 3+ years of... ...skills are crucial. The position offers a remote work option along with comprehensive...Remote work
- Humana is seeking a Utilization Management Behavioral Health Registered Nurse (RN) Intern to join their National Medicaid team... ...involves conducting medical necessity reviews for behavioral health services... ...license. This position supports remote work, providing work-life...Remote jobInternship
- Village Center for Care, Inc. is seeking a self-motivated RN for the role of Utilization Review Nurse in a full-time, hybrid position located in the New York Tri-State Area. The successful candidate will be responsible for assessing member needs and ensuring high-quality...Remote jobFull time
- COMAGINE HEALTH is seeking Clinical Utilization Review Nurses (RN) for a full-time remote position focused on assessing the medical necessity of healthcare services in Alabama. Candidates must hold an active RN license and possess a BA/BS in nursing, alongside a minimum...Remote jobFull time
$34 - $52.7 per hour
...0 facility. This job is REMOTE. FTE: 0.500000 Standard... ..., for a second level review as needed. Facilitates communication... ...is required; Prior utilization management or case management... ...Medical, Dental, Vision, Life Insurance, Short & Long Term Disability...Remote workHourly payTemporary workShift work
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