Remote RN Utilization Review Specialist
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SSM Health in the United States seeks a registered nurse for utilization management to evaluate medical necessity of hospital admissions and procedures. You will ensure payors receive complete clinical information to support services provided and obtain hospital authorization where needed. The role supports day shift operations, requires two years of RN experience, and involves coordinating with payors, physicians, and care teams to optimize patient care and resource use. #J-18808-Ljbffr
- ...seeking experienced nursing professionals to review medical records and ensure appropriate... .... Candidates must have a valid California RN license and at least two years of clinical... ...degree in a related field. The position offers remote work with emphasis on critical thinking...Remote work
- ...NeighborHealth’s SCO RN UM Reviewer role is based in East Boston within the Senior Care Options team. You will review clinical appeals and service authorization needs to ensure medical necessity aligns with CMS standards and organizational determinations. The role requires...Remote work
- ...Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The role involves performing retrospective medical... ...in a relevant medical setting, and the ability to work in a remote environment. Comprehensive benefits are provided, including medical...Remote workContract workWork from home
- ...Coronis Health is seeking a remote Utilization Review Specialist to manage treatment authorization for behavioral health and substance abuse, interfacing with insurance and managed care entities. The role covers pre-certification, concurrent reviews, and appeals with...Remote work
$50k
...the lives of patients and their families What to Expect (Job Responsibilities) Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary treatment team to gather necessary information for concurrent...Remote work- ...providing low-cost RCM solutions to maximize insurance reimbursements quickly and efficiently. They are seeking a Utilization Review Specialist to join their remote team. This role is responsible for performing utilization reviews, managing concurrent reviews, handling...Remote work
- ...Utilization Review Specialist The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients... ...skills. Preferred Qualifications: Registered Nurse (RN) license or equivalent clinical certification....Remote work
$30 - $45 per hour
...consulting agency is seeking an Operations Specialist III for a contract opportunity in Long... ...along with experience in Epic EHR and Utilization Review. The selected candidate will perform... ...program metrics. This position is remote and offers a pay range of $30-$45 per...Remote workHourly payContract work- ...patients-we invest in our people. About the Role: The Utilization Review Specialist plays a critical role in ensuring that healthcare services... .... Preferred Qualifications: Registered Nurse (RN) license or equivalent clinical certification. Experience...Remote workPart time
- ...Utilization Review Specialist The primary purpose of the Utilization Review Specialist is to create and manage the flow of revenue for each client... ...Satisfactory CORI and background check. Satisfactory drug screen Part Time Remote Role Charles River RecoveryRemote workPart timeWork at officeFlexible hours
- ...Utilization Review Specialist | Remote | Full-Time Banyan Treatment Centers is seeking an experienced and detail-driven Utilization Review Specialist... ...health related field Clinical licensure (LCSW, LMHC, LPC, RN, or equivalent) valued but not required Experience...Remote workFull timeTemporary work
$41.6k - $47k
...Utilization Review Specialist At Umpqua Health, we're more than a healthcare organization we're a community-driven Coordinated Care Organization... ...with the ability to stay organized and productive in a remote, independent work environment Proactive communication with...Remote workWork at officeLocal areaImmediate startMonday to FridayFlexible hoursShift work- Gateway Regional Medical Center, Inc. is seeking a full-time Utilization Review Specialist RN responsible for conducting admission and concurrent reviews to avoid payment denials, while managing appeals. This role requires collaboration with interdisciplinary teams to...Full time
$23.76 - $51.49 per hour
...Molina Healthcare is seeking a Registered Nurse (RN) to support clinical member services review and assessment processes. This role involves analyzing... ...hourly pay range between $23.76 and $51.49 and requires adherence to utilization management policies. #J-18808-LjbffrRemote workHourly pay$25.08 - $51.49 per hour
...Provides support for clinical member services review assessment processes. Responsible for... ...the Molina care model. • Adheres to utilization management (UM) policies and procedures.... ...education and experience. • Registered Nurse (RN). License must be active and unrestricted...Remote workHourly payPart timeWork experience placementWork at officeImmediate start$1,949.74 per month
...Registered Nurse Specialty Utilization Review Job ID 17979666 Job Title Utilization Review RN Weekly Pay $1949.74 Shift... ...13 Week(s) Job Description Remote Utilization Review RN responsible for concurrent...Remote workWeekly payShift work$65k - $85k
...Santa Barbara Cottage Hospital is seeking a Utilization Review Specialist (RN) for a remote position, specifically for candidates based in Florida. The ideal candidate will possess a valid Florida RN License and certifications in OASIS and coding. The role involves thorough...Remote work- ...providing telephonic and e-referral case review and authorization of services utilizing established mental health and... ...This position is full-time, fully remote (work from home) and requires some... ...State of Michigan clinical license (RN, LMSW, LP, LPC, or LLP) required....Remote workFull timeWork from homeShift workWeekend workAfternoon shift
$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$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- ...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
- ...you flourish and leaders who care about your success. The Utilization Review RN is responsible for the review of medical records for... ...as required within the market. This position is open to remote/out of state candidates residing in only these states:...Remote work
- ...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
- ...WNS, part of Capgemini, is seeking a remote RN/LPN for utilization review in the United States. The role involves assessing medical necessity, resolving escalations, and maintaining HIPAA-compliant documentation with HealthHelp policies. Requires active nursing license...Remote workWork at office
- ...Fully Remote Utilization Review Position Setting: Fully Remote – Utilization Review Schedule: Full-Time, Monday–Friday Hours: Standard business... ...Patient Volume: N/A Job Requirements: Active RN license with Multi-State/Compact license required Minimum...Remote workFull timeMonday to Friday
$63k - $65k
...Fortune Best Workplaces in Financial Services & Insurance RN Utilization Review As a nurse at Sedgwick, you can build a meaningful and... ...making an impact on the health and well-being of others in a remote work environment. Enjoy flexibility and autonomy in your...Remote workWork experience placementLocal areaFlexible hours- ...Job Title Utilization Review/Case Management – Nurse Department Case Management (Quality) Hours & Shift Requirements Full time position. Hybrid (combination of in person and remote considered) General Summary The Utilization Review/Case Management Nurse is directly responsible...Remote workFull timeShift work
$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) Shift... ...No Locals accepted? No. Pending License accepted: No Fully Remote Position RTO Restrictions: Please include all RTO at the...Remote workHourly payLocal areaImmediate startMonday to FridayShift workWeekend work- " The Utilization Review Specialist is responsible for the assessment and review of the healthcare delivery system with a concentration on tasks that promote cost-effective quality care and cost containment in accordance with various federal and/or state statutes, regulations...Remote workWeekly payContract workWork at officeLocal area
$29.62 - $45.31 per hour
...Department Coordinate and execute the review and research functions required to support... ...Critically assess and prepare all cases for RN/MD review of coverage (medical necessity,... ...inquiries, provider resolutions, etc.) Remote Work This position offers 100% remote work...Remote workMinimum wageFull timeWork experience placementLocal areaShift work
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