Remote Utilization Management Nurse RN - Appeals Specialist
UnitedHealth Group
- Remote job
UnitedHealth Group’s Optum is seeking an Utilization Management Nurse to review medical records, extract case details, and craft defensible appeal letters under policy guidance. The role supports telecommuting within the United States and follows a Monday–Friday schedule. The ideal candidate holds an Associate’s degree, an unrestricted RN license, 3+ years bedside nursing in acute settings, and proficiency with Microsoft Office and typing 45 wpm. #J-18808-Ljbffr UnitedHealth Group
- ...Cleveland Clinic is seeking an Utilization Management RN Reviewer to support remote operations from home. The role covers admission and concurrent reviews, and ensures medical necessity criteria are applied to hospital stays and discharges. Qualifications include RN...Remote work
- ...service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and... ...resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license... ...clinical practice and knowledge of Utilization Review Guidelines. The...Remote work
- Integra Partners Holdings, Inc. is seeking a full-time remote LPN Utilization Management Nurse to perform pre-service and post-service utilization reviews... ...authorizations, communicate outcomes, and support appeals. It requires strong UM experience in managed care and familiarity...Remote jobFull time
- Integra Partners is seeking an LPN/LVN with experience in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to ensure NCQA-compliant UM program operations...Remote job
$29.7 - $31.8 per hour
...technology-enabled revenue cycle management solutions for health systems... ...The Acute Coding Appeals Specialist integrates medical coding principles... ...the clinical documentation utilized in the decision-making... ...experiences. ~ This is a remote position; however, candidates...Remote workTemporary workWork at officeLocal area- 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
- ...care to our neighbors throughout the region. Organization Utilization Management Job Summary Facilitates optimal reimbursement through accurate... ...is placed in the appropriate level of care setting. Our Nursing Philosophy We believe highly skilled and specialized...Remote jobTemporary workWork experience placementLive outFlexible hours
- ...Job Description Job Description Utility Vegetation Management Specialist Who are we? We’re dedicated to the growth of our employees. We... ...vehicle operation and foot patrol of utility power lines; remote locations as well as urban, city environment; physical...Remote workFull time
- ...Allegheny Health Network seeks an RN Utilization Review professional to obtain... ...authorizations and manage denials for a seamless patient... ...and timely approvals. This remote role requires PA RN licensure... ...within 5 years, and 2–3 years of nursing experience with 1 year in...Remote work
$72.8k - $130k
...an occasional opportunity for remote work based on business needs. As a Sr Utilization Management Nurse in the Springfield MA Regional... ...~ Must be a Registered Nurse (RN) with a current, active, unrestricted... ..., and/or clinical appeal and guidance reviews ~ Must...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- ...mental health issues, the full-time Remote Utilization Review Specialist will manage pre-authorizations and concurrent... ...peer reviews and coordinates urgent appeals as needed Required qualifications... ...equivalent with a state license (e.g., RN, LPN, LCSW, LMHC) preferred...Remote workFull time
- ...offers industry-leading revenue cycle management services for healthcare providers.... ...manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR... ...rewarding environment. This is a fully remote or office/home hybrid position....Remote workWork at officeFlexible hours
- UT Southwestern Medical Center is seeking a Technical Denials Management Specialist II in the Revenue Cycle Department to review, research, and resolve claim denials and appeals for various insurers, while identifying payment trends to maximize collections. This WFH role...Remote jobWork at officeWork from home
$114k - $161k
...Job Title: Principal Consultant Utility Return on Equity & Cost of Capital Specialist Job Location : Marlborough... ...: Hybrid 3 days in office, 2 remote days per week 2025... ...Concentric") is an employee-owned leading management consulting and financial advisory...Remote workWork at officeWork from homeFlexible hours2 days per week- ...Providence California Regional Services is seeking a Senior Utilization Management Assistant for a remote Per Diem role. The 8-hour day shifts provide support within the Care Management team to coordinate patient care. You will work under the supervision of the Regional...Remote jobDaily paidDay shift
- ...growing behavioral healthcare team, the remote Licensed Utilization Review Specialist will ensure clinically appropriate... ...utilization of services, managing the review process from patient admission... ...medical necessity and prepare appeals for denied cases as needed Required...Remote work
$60.2k - $107.4k
...Utilization Management Nurse Optum is a global organization that delivers care, aided by technology to help millions of people live healthier... ...from patient medical records; and craft strongly defensible appeal letters per process instructions and the department's/...Remote jobMinimum wageFull timeWork experience placementLocal areaMonday to FridayFlexible hoursWeekend workAfternoon shift- Cambia Health Solutions is seeking an UM IP Clinical Specialist to support inpatient utilization management. You will receive, research, and act on documentation and requests from diverse sources, collaborating with licensed clinicians to guide appropriate actions and...Remote job
- The University of Texas Southwestern Medical Center is seeking a Technical Denials Management Specialist II to review, research, and resolve claim denials and appeals for various insurers. The role emphasizes follow-up and resolution of denied claims, with no direct billing...Remote job
- Randstad USA is seeking an experienced Prior Authorization Specialist to join our national Utilization Management team. 100% remote role with a Monday-Friday schedule, 8:00 AM - 5:00 PM CST. You will manage authorization queues, verify eligibility, gather medical documentation...Remote jobMonday to Friday
- Providence California Regional Services seeks a Senior Utilization Management Assistant to support the Care Management team. This REMOTE, part-time role offers 8-hour Evening shifts under the supervision of the Regional Director of Care Management. You will perform complex...Remote jobPart timeAfternoon shift
- Elevance Health is seeking an Utilization Management Representative II in Florida. The role involves managing inbound calls, triage, case openings, and authorizations for inpatient and outpatient services. Candidates must reside in Lake Mary, Tampa, or Miami, FL and be...Remote jobWeekend work
- Providence California Regional Services is seeking a Senior Utilization Management Assistant for a remote, per diem role. You will support the Care Management team in coordinating patient care, performing clerical duties, and contributing to efficient care workflows from...Remote jobDaily paid
$80k - $150k
...Job Description Job Description Job Title Asset Management Specialist Location: Remote (United States) FLSA Classification Exempt... ...Management Specialist with experience in CASCADE and ELECTRIC UTILITIES for a REMOTE WORK role for our Utility Services...Remote jobTemporary workWork at officeWork from home$68.89k - $92.14k
...Pay Plan Title: Utilization Management Specialist III Working Title: Utilization Management Specialist... ...68,890- $92,138 Office Location: Remote within North Carolina POSTING DETAILS... ...Specialist (LCAS) Registered Nurse (RN) Must have a valid driver’s license...Remote workFull timeWork at officeLocal areaImmediate startWork from homeFlexible hours- Centene Corporation is seeking a dedicated professional to support the prior authorization request process and assist the utilization management team in Florida. The role ensures timely authorization determinations, documents medical information, and verifies insurance...Remote jobHourly payFull time
- Elevance Health is seeking an Utilization Management Representative II in Florida. The role involves handling incoming calls, triaging cases, authorizing inpatient and outpatient services, and gathering demographic information. The position supports a hybrid/virtual work...Remote job
- Independence Physician Management (IPM) offers a remote Accounts Receivable Specialist role with a required 3-month in-office training for those within commuting... ...unpaid and underpaid claims, research denials, file appeals, and ensure timely collections across multiple...Remote jobWork at office
- ...What You Will Do in This Role: The Utilization Management Specialist provides advanced operational and workflow... ...support to Utilization Review (UR) Nurses to ensure timely, accurate, and... ...is current and complete. *Approved Remote States: Arizona, California, Colorado...Remote job
$46.76 - $51.76 per hour
...references. Follows NCQA Standards and departmental SOPS to manage member assignments. Conducts research and analysis of... ...internal stakeholders. Nice to Have: Prior experience in utilization management, care management, or payer-side review of ABA services...Remote jobWork at office
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Management Nurse RN - Appeals Specialist. Be the first to apply!
- public health registered nurse Newtown Square, PA
- part time rn Newtown Square, PA
- nicu registered nurse Newtown Square, PA
- rn urgent care Newtown Square, PA
- rn skilled nursing facility Newtown Square, PA
- part time clinic rn Newtown Square, PA
- labor delivery registered nurse Newtown Square, PA
- pcu rn Newtown Square, PA
- united nations registered nurse rn Newtown Square, PA
- call center rn Newtown Square, PA



