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
$40.12 - $62.94 per hour
...Sinai Hospital's Utilization Review operates as a distinct specialty service... ...covered by the patient's insurance. The team focuses on appropriate... .... This is a Full-time remote position. Responsibilities... ...: The Utilization Review RN reviews the medical record by...Remote workFull time$35 - $40 per hour
...Registered Nurse (RN) with health plan or payer-side Utilization Management (UM) experience... ...clinical quality review and AI model... ...will have expertise in applying evidence... ...hrs/week Fully Remote Position Pay Range... ...coverage (accident insurance, critical illness...Remote workHourly payLocal areaShift work$40 per hour
...Insurance Or Managed Care Industry Registered Nurse (RN)$40/hour - Contract for 6 months Must reside in TXFull time remote Candidates must be based in TX. RN working... ...initial, concurrent review activities; discharge... ...information regarding utilization management requirements...Remote workContract workWork at office$54.1k - $116.77k
...EST Location: 100% Remote (U.S. only) About... .../CVS Health, is a URAC-accredited medical... ...medical journeys. As a Utilization Management (UM)... ...in Medical Review, you’ll play a vital... ...apply your clinical expertise in a fast-paced, desk... ..., unrestricted RN license in your state...Remote workHourly payFull timeTemporary workLocal areaMonday 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
- ...Cleveland Clinic Health System is seeking an experienced Utilization Management RN Reviewer to work remotely with a focus on admission, concurrent and retrospective reviews. The role supports payer communications, data collection, and clinical decision-making to ensure...Remote workWork at office
- ...Providing timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions, treatment planning, and recovery for injured employees while advocating for effective medical treatment. Key responsibilities...Remote workFull timeWork experience placement
- ...Cincinnati Children e s Hospital Medical Center is seeking a Remote Utilization Review professional to perform admission and continued stay reviews using InterQual, ensuring medical necessity and appropriate level of care. The role collaborates with Admitting, Financial...Remote work
- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant... ...team-oriented environment. Requirements include active RN or LVN licensure, a minimum of two years in utilization...Remote workWork at office
$76k
...NTT DATA is seeking a BPO Clinical Review Specialist in the United States, with remote work available for Florida residents. The role requires an active RN license (Florida or Compact) and at least 3 years of appeals, utilization management, or clinical review experience...Remote work- ...consistently delivering outstanding results. The Opportunity: The RN, Utilization Review performs advanced utilization review functions to ensure... ...Workplaces in Healthcare 2024 Monster Top Workplace for Remote Work 2024 Great Place to Work certified 2023-2024 Innovation...Remote workFull timeLocal area
- ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge planning and utilization review.Responsibilities:• Reviews admissions and service requests within...Remote 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
- ...partner of ours with a need for an experienced RN Case Manager with Utilization Review/UM experience. This position is remote based and requires an activeMA RN license. (... ...that include health, dental, vision, life insurance and 401k Supportive team focused on your needs...Remote workContract workMonday to FridayFlexible hours
- ...HealthEdge Software, Inc. seeks an experienced Utilization Review RN to perform prospective, concurrent and retrospective reviews across inpatient and outpatient services, ensuring medical necessity and appropriate levels of care. The role includes coordinating care...Remote work
$69.39k - $88.61k
...Cincinnati Children’s is seeking an experienced Utilization Review professional for a remote role in the United States. The position supports case management... ...a Bachelor’s degree in a related field, an active RN/Social Work/Clinical Counselor license, and 2+ years of...Remote workFull time$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$97.82k - $132.04k
...mission of redefining the possible in healthcare. The RN, Senior Utilization Review Quality will play an essential role in reviewing and... ...friction and improve patient and client experiences This is a remote position; however, candidates must be willing and able to...Remote workFull timeTemporary workWork at officeLocal area$63.1k - $94.65k
...qualifications. *Must have current compact RN license, or be willing to obtain* Schedule Information: Our Utilization Review team provides coverage seven days a week,... ...Skills, and Abilities Required: This is a remote role which requires access to high-speed internet...Remote workTemporary workPart timeWork at officeLocal areaFlexible hoursShift work$57.24k - $62.18k
...and voluntary life insurance. Critical Illness,... ...-life balance. ~ Remote setting ROLE DESCRIPTION... ...individual will utilize clinical knowledge... ...to a second level reviewer. This individual... ...knowledge of URAC guidelines, Hines policies... ...is not limited to RN, LMSW, LMHC. #...Remote workFull timeTemporary workWork at officeMonday to FridayFlexible hours- ...as life and disability insurance benefits, dental, vision... ...the LTSS department. RN will be responsible for... ...authorization and concurrent review. Provides monthly... ...of treatment setting by utilizing the applicable medical... ...Additional Info: *possible remote opportunity after...Remote workContract workMonday to FridayFlexible hours
- ...Are you an RN looking to transition into or grow your career in Utilization Review? We're seeking a clinically strong... ..., care managers, and insurance payors to obtain... ...independently in a fast-paced, remote environment. Reliable... ...apply your clinical expertise beyond the bedside....Remote workTemporary work10 hours per weekShift workWeekend workAfternoon shift
$63k - $94k
...Remote Utilization Review Registered Nurse (UR RN) Are you an experienced RN looking to transition away from the bedside while still making a massive impact on patient care? We are seeking a dedicated Utilization Review Nurse to join our remote team. In this role, you...Remote workWork at office10 hours per weekFlexible hoursShift workWeekend workAfternoon shift3 days per week- ...Job Description Job Description The utilization review and management (UM) component program... ...Familiarity with healthcare regulations, insurance policies, and quality improvement... ...for lunch This is an in-office, no remote work capability position Travel ~...Remote workWork at office
$81.95k - $110.24k
...mission of redefining the possible in healthcare. The Lead Utilization Review RN is a key contributor to the overall financial, quality, and... ...preferred; Associates degree Nursing required #LI-LS1 #LI-REMOTE Join an award-winning company Five-time winner of “...Remote workFull timeWork at officeLocal area- ...glance Location: Remote Facility: Ascension... ...impact in this role Reviews admissions and service... ...analysis and utilization review reports as necessary... ..., disability and life insurance Time to recharge:... ...bring their skills and expertise every day to reimagining...Remote workFull timeLocal area
- ...glance** **Location:** Remote **Facility:** Saint... ...impact in this role** + Reviews admissions and service... ...statistical analysis and utilization review reports as... ..., disability and life insurance + **Time to recharge:*... ...bring their skills and expertise every day to reimagining...Remote workFull timeLocal area
$35 - $40 per hour
...- $40.00/hr Location Fully Remote Position Summary The Utilization Review Nurse serves as a key liaison in coordinating... ...Current, active nursing license (RN, LPN, or LVN) in good standing... ...community resources. NCQA and URAC experience is a plus....Remote workContract workFlexible hoursWeekend work$71.1k - $97.8k
...caring community The Utilization Management Registered... ...time frames. (i.e. 10 reviews per day?) You will communicate... ...Registered Nurse (RN) license in your state... ...working in a fully remote, metrics-focused role... ...-term disability, life insurance and many other opportunities...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeHome office
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