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 job
- ...seeking a dedicated Registered Nurse for a remote contract position focused on reviewing medical claims within the insurance sector. This role involves validating treatment... ...effectively. Join a dynamic team where your expertise will directly impact healthcare outcomes and...Remote jobContract work
$71.1k - $97.8k
...our caring community The Utilization Management Nurse 2 uses... ...Registered Nurse (RN) in an Enhanced Nurse Licensure... ...authorization, claims review, utilization management... ...healthcare/health insurance environments involving... ...Nationwide Work Style: Remote Travel Requirements: None...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday$35 - $43 per hour
...Ready to turn clinical expertise into life-changing decisions, one review at a time? Why This... ..., and aligned with NCQA/URAC accreditation standards.... ...~ Current, unrestricted RN license in the United States... ...or similar setting) ~ Utilization review/utilization...Remote workHourly payImmediate startMonday to FridayFlexible hours- ## Utilization Review NurseApplyremote type: Hybridlocations: 1301 6th Ave... ...solutions across a range of insurance, reinsurance, payroll, benefits... ...the office and three days remote. Candidates must also have flexibility... ...state-mandated and URAC turnaround requirements*...Remote workWork at officeImmediate startFlexible hours2 days per week
$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- ...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,...Remote work
- Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires...Remote job
- iMPROve Health seeks an RN Reviewer (Workers' Compensation Utilization Review) to perform independent external medical reviews remotely as an independent contractor (1099). The reviewer applies clinical expertise to evaluate cases, ensuring medical necessity and standard...Remote jobFor contractors
- The Utilization Review Nurse gathers demographic and clinical information on... ...and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS... ...state of operation required;RN is required unless local state... ...Account Options Life Insurance Accident Insurance Critical...Remote workMinimum wageWork at officeLocal areaFlexible hours
- ...RN Reviewer (Workers' Compensation Utilization Review) iMPROve Health is seeking an RN Reviewer (Workers' Compensation... ...external medical reviews remotely on an ad hoc basis. As a peer reviewer... ...reviewer, you will apply your clinical expertise to evaluate cases, specific to...Remote jobContract workFor contractorsWork at officeHome office
$67.2k - $85k
...80127, Job Title: BH Utilization Manager RN, Salary: $67,200.00 -... ...Texas Department of Insurance. Through its network... ...Community is accredited by URAC for its health plan... ...and discharge reviews on assigned patients.... ...systems Work Schedule: Remote Other Requirements...Remote workContract workWork experience placement- Position Summary: The RN Integrated Care... ...are required to address utilization review cases. Roles and Responsibilities... ...of medical and insurance industry terminology... ...health programs, NCQA/URAC standards. You have 3... ...Requirements This is a remote position. Our whole...Remote workLive inFlexible hoursWeekday work
- ...Registered Nurse – Utilization Review (Remote) This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care, including Inpatient, Extended Hospital Outpatient, and Observation (OBS). Minimum of 3 years acute medical Care...Remote 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 requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Remote workHourly payPart time$78k - $88k
...Utilization Review Nurse- Remote It takes great medical minds to create powerful solutions that solve some... ...challenges. Join us and put your expertise to work in ways you never imagined possible... ...on clinical guidelines. Maintain RN license and meet continuing education...Remote workFull timeContract workWork at officeWork from homeFlexible hours$65 per hour
...RN – Utilization Review Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule Shift: Day 5x8-Hour (08:00 - 16:30)... ...No Locals accepted? No. Pending License accepted: No Fully Remote Position RTO Restrictions: Please include all RTO at the time...Remote workHourly payLocal areaImmediate startMonday to FridayShift workWeekend 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...Remote workHourly pay$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-LjbffrRemote workHourly pay- ...Fully Remote Utilization Review Position Setting: Fully Remote – Utilization Review Schedule: Full... ...N/A Job Requirements: Active RN license with Multi-State/Compact... ...Collaborate with physicians, case managers, and insurance payers Support denial prevention,...Remote workFull timeMonday to Friday
- ...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
- ...Fully Remote Utilization Review Position Setting: Fully Remote – Utilization Review Schedule: Full... ...Job Requirements: Active RN license with Multi-State/Compact License... ...system (provider-side required) Payer/insurance-only Utilization Management experience...Remote workFull timeMonday to Friday
- ...seeks a Physical Health Registered Nurse to perform clinical reviews for authorization requests and medical necessity. You will reference... ...in NC, five years of clinical experience, including acute care and utilization management experience. #J-18808-Ljbffr Vaya HealthRemote job
- ...Registered Nurse (RN) - Utilization Review Job Description Job Shift:Days Job Type:Full Time The individual... ...of accurate patient demographic and insurance information. Identification and... ...time Job Shift Day Locations Thop Transmountain Campus (Remote) #J-18808-Ljbffr...Remote workFull timeWork at officeFlexible hoursShift work
$35 - $43 per hour
...0/hr Job Title Clinical Review Nurse – Concurrent Review Location: Remote (California only – must... ...CA or hold an active CA RN license) Duration: 12 months... ...Review will perform utilization management functions to... ...Provide subject matter expertise and guidance to utilization...Remote work$35 - $45 per hour
...Position: RN / Utilization Review Nurse Location: Sacramento, CA (ON-SITE) Employment Type: Potential contract to hire Pay Range: $35.00 – $4... ...-paced environment. Comfortable working independently in a remote or office-based setting. Working Conditions May be exposed...Remote workWeekly payContract workWork at officeMonday to Friday$42 per hour
...Ascension Texas Utilization Management Department (Fully Remote) Provides health care services regarding admissions, case management, discharge planning and utilization review. Reviews admissions and service requests within assigned unit for prospective, concurrent...Remote job- ...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
- ...Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate... ...in various reviews and knowledge of URAC/NCQA are a plus. #J-18808-Ljbffr Brighton...Remote jobWork at office
- Cigna Health and Life Insurance Company in California is seeking an Utilization Management Clinical Reviewer to manage an active inpatient caseload from a remote location. You must be an RN licensed in California and available for a Monday-Friday shift 8:00 a.m.-5:00 p....Remote jobMonday to FridayShift work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Review RN - Insurance/URAC Expertise. Be the first to apply!


