Remote Utilization Management Clinical Review Specialist
New England Life Care, Inc.
- Remote job
New England Life Care, Inc. is seeking a full-time Licensed Clinical Review Specialist to work remotely. The role involves conducting utilization management reviews and providing clinical information to ensure patient coverage while delivering high-quality, cost-effective care. The ideal candidate will have a Medical Assistant certification and healthcare experience, with knowledge in care coordination preferred. Strong communication skills are essential for interacting with stakeholders and maintaining confidentiality. #J-18808-Ljbffr New England Life Care, Inc.
- The Council of State and Territorial Epidemiologists is seeking a Clinical Utilization Review Nurse (RN) to conduct utilization management reviews remotely. Candidates must hold a BA/BS in Nursing, possess a current RN license, and have a minimum of 3 years of clinical...Remote jobFull time
- COMAGINE HEALTH is seeking a Clinical Utilization Review Nurse (RN) for a full-time remote position, focused on medical necessity assessments in healthcare. Applicants must have a BA/BS in Nursing and at least 3 years of clinical experience. The role requires strong communication...Remote jobFull timeContract workWork from home
- ...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
- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board... ...with management and providing guidance on clinical questions. This is a unique opportunity to work...Remote workFull timeWork from home
$31 - $35 per hour
Opportunity Overview: The Clinical Review & Correspondence Specialist plays a critical role in supporting utilization management operations by conducting medical necessity reviews,... ...to know about this role: This is a 100% remote role, and requires robust internet speeds...Remote workFull timeFlexible hoursShift work- Overview Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer review. This position is responsible for assessing the medical appropriateness...Work experience placementWork at office
- ...Refer a Friend Back Remote Work from Home Share This... ...Health Plans (JHHP) is the managed care and health services... ...8:00 AM - 5:00 PM As a Utilization Review Registered Nurse for Johns Hopkins... ...the opportunity to use your clinical, managed care, utilization...Remote workFull timeLocal areaWork from homeMonday to FridayDay shift
- ...Detroit Wayne Mental Health Authority is seeking a Clinical Specialist to provide utilization management services. This role involves coordinating care across... ...behavioral healthcare. The position offers flexibility with remote work possibilities under supervisory approval. #J-1...Remote job
- ...Excellus BCBS is hiring for a Utilization Management position based in Albany,... ...ideal candidate will have clinical experience, strong communication... ...pre-service clinical reviews and collaborating with healthcare... ...range and potential for remote work based on departmental...Remote work
- ...supervision of the Director of Utilization Management for the Detroit Wayne... ...Integrated Health Network (DWIHN), Clinical Specialists - Utilization Management... ...management and review of services to consumers.... ...Michigan. This position can work remotely with supervisory approval....Remote workTemporary workWork at office
- ...Humana is offering a remote internship opportunity for a Utilization Management Behavioral Health Registered Nurse (RN). This role is part of the DOW SkillBridge... ...or military spouses. Interns will conduct clinical reviews, communicate with providers, and document findings...Remote workInternship
- ...Quorum Health is seeking a Case Manager - Utilization Review Specialist for a remote role. The Specialist will manage admission reviews, conduct appeals, and identify workflow improvements. This position requires a current RN license and significant experience in healthcare...Remote work
- ...Brigham is seeking a Peer-to-Peer Utilization Review Nurse to join the Central Utilization Management team. This role involves... ...license, and extensive experience in clinical nursing and utilization review. The position offers a remote work model with a flexible schedule...Remote workFlexible hours
- ...physical health services in Town of De Witt, NY. The position demands extensive clinical experience and knowledge of utilization management, with responsibilities including performing clinical reviews and collaborating with providers. Applicants should possess an Associate...Remote work
- ...NYS RN license and 3+ years of clinical experience. Responsibilities include clinical reviews and collaboration with... ...Preferred candidates will have utilization management experience and strong communication... ...on experience, and potential for remote work. #J-18808-Ljbffr...Remote work
- ...healthcare provider in Chicago is hiring a Clinical Care Manager to oversee high-quality, patient-centered care through Utilization Review. The role requires an active RN license... ...This position offers the flexibility of remote work while supporting professional growth...Remote work
$45k - $70k
...A healthcare services company is seeking a Utilization Management Nurse Reviewer to ensure medical services are used appropriately. The role involves... ...nursing license and have at least 2 years of clinical nursing experience, along with strong communication and...Remote work- ...IntePros is seeking a Physician Reviewer to provide remote support for a healthcare organization. The role involves reviewing... ...This position offers a collaborative environment with opportunities to leverage clinical expertise in utilization management. #J-18808-Ljbffr...Remote work
- ...A healthcare management organization is seeking experienced Physician Reviewers to join their Medicare Utilization Management team in a remote position. Responsibilities include reviewing clinical service requests, applying evidence-based guidelines, and collaborating...Remote work
- ...Epidemiologists is seeking a Clinical Review Supervisor to provide... ...of clinical staff conducting utilization reviews and specialty review activities. This fully remote position requires a strong background... ...This role supports quality management initiatives aimed at...Remote work
- ...Territorial Epidemiologists is looking for a Clinical Review Supervisor to oversee clinical staff conducting utilization reviews. This fully remote position requires strong leadership in... ...and a proactive approach to quality management. Key responsibilities include...Remote work
- ...COMAGINE HEALTH is seeking a Clinical Utilization Review Nurse (RN) to conduct utilization management reviews. This full-time role supports high-quality care delivery... ...years of relevant experience. The position is remote, allowing work from any location in the U.S., and...Remote workFull time
- ...Department: Utilization Management Schedule: M-F 8am-5pm Work Location: Remote Benefits for eligible positions generous paid time off paid parental leave... ...management, discharge planning and utilization review. Review admissions and service requests...Remote work
- ...Territorial Epidemiologists is seeking a Clinical Review Supervisor to provide... ...supervision of clinical staff conducting utilization review activities. This fully remote position requires an RN license... ...in patient care and medical management. The role focuses on quality...Remote work
- ...is seeking a Medical Director to oversee inpatient medical necessity reviews and utilization management. This role requires strong analytical and communication skills, as well as 5+ years of clinical experience post-residency. Ideal candidates will have a dedication to...Remote work
- ...A leading independent review organization is seeking a Utilization Management Physician Reviewer for a full-time remote role. Candidates must possess an active Nebraska medical license and have a minimum of 5 years clinical practice experience. Responsibilities include...Remote workFull timeCasual workMonday to Friday
- A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing utilization management, reviewing medical records, and coordinating discharge planning. Candidates must have an active RN license...Remote workContract work
$1,600 - $1,800 per week
...NOW HIRING: Registered Nurse - Utilization Management Location: Buckley AFB & Peterson AFB, Colorado... ...weekends, no holidays, no telehealth/remote work Minimum Qualifications... ...in Utilization Management, Utilization Review, or Case Management ~• Preferred...Remote workContract workImmediate startMonday to Friday- ...Job Description \n Utilization Management Medical Director Oncology\n \n \n \n \n Work Location: REMOTE (work from home)\n \n \n The... ...Medical Director role provides clinical expertise in assessing the... ...management for case review and clinical decision making...Remote workWork from home
$77.96k - $120.37k
...Barbara Cottage Hospital is seeking a Utilization Review Supervisor RN to direct operations within the department. This remote role requires a leader adept in managing a team, ensuring service quality... ..., and at least three years of clinical experience. A comprehensive...Remote job
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