Remote RN: Utilization & Clinical Validation Specialist
$60.2k - $107.4kTexas Health Institute
- Remote job
Optum is a global organization that delivers care, aided by technology to help millions live healthier lives. The Utilization Management & Clinical Validation RN role involves reviewing medical records, extracting pertinent details, and crafting evidence-based appeal letters per guidelines. You will enjoy telecommuting from anywhere in the U.S. The salary range for this full-time position is $60,200 to $107,400 annually, with comprehensive benefits and opportunities for career development. #J-18808-Ljbffr Texas Health Institute
- ...Clinical Specialist, Utilization Management Company: Community Health Options Work Type: Remote Employment: Full Time Location: US Seniority: Mid Level Technologies: Microsoft Office... ...support and utilization management; RN license in Maine (or Compact), 2+ years in...Remote workFull timeWork at office
$35.87 - $58.37 per hour
...RN - Clinical Transition Specialist Location: US-IL-Urbana ID: 2026-20622 Category: Nursing Position Type: Full-Time Remote: No Shift: Day Schedule: Full-time Weekend position | Saturday/Sunday... ...of care outside the hospital. Utilizes the five components of case management...Remote workFull timeWork experience placementLocal areaShift workWeekend workWeekday work- .... We are currently looking for a UM Clinical Support Specialist to join our growing team! This is a... ...in supporting the leadership of the Utilization Management team by collecting, analyzing... ...Road, Suite 700, Phoenix, AZ 85020 Remote (MST or PST time zone) Essential Functions...Remote jobWork at officeLocal areaWork from home
$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the Appeals and Grievances Clinical Specialist - RN, LPN... ..., appeals & grievances, claims processing, utilization review, or case management. Understanding of Utilization...Remote jobFull timeMonday to FridayShift work- ...Clinical Systems Validation Specialist This role supports the development, testing, and continuous improvement of clinical information systems used... ...call rotations. Benefits: ~ Full-time position with remote work flexibility. ~ Medical, dental, and vision...Remote workFull timeWork at officeFlexible hoursNight shift
- ...Utilization Manager Registered Nurse (UMRN)Spectrum Healthcare Resources has a need for a Utilization... ...Nurse (UMRN). These will be completely remote positions, working entirely from the... ..., the HCWs must have pertinent clinical experience within the past two (2) years...Remote workFull timeContract workWork at officeWork from homeMonday to Friday
- ...Clinical Specialist, Wound Care SuppliesAsure Wound Solutions is seeking a highly skilled and dedicated Clinical Specialist, Wound Care Supplies to join our team. This is a remote position based in the Providence area and requires experience working in nursing homes or...Remote work
- ...Clinical Specialist, Wound Care SuppliesAsure Wound Solutions is seeking a highly skilled and dedicated Clinical Specialist, Wound Care Supplies to join our team. This is a remote position based in the Great Neck area and requires experience working in nursing homes or...Remote workWork at officeMonday to FridayShift work
$2,210 per week
...Holidays Work-life balance. Remote/hybrid setting (once trained)... ...DESCRIPTION: This individual will utilize clinical knowledge and communication... ...and claim concerns, and validation of criteria. Communicates knowledge... ...but is not limited to RN, LMSW, LMHC. Successful completion...Remote workFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours- $10,000 Sign On Bonus Position Overview The RN Clinical Management Specialist is a qualified professional responsible for collaboration with... ...Homecare Homebase (HCHB) & Oasis experience is requred Valid and acceptable driver’s license with proof of automobile...Remote workFull timeInterim roleWork at officeImmediate startRelocation package
$53.25 - $79.88 per hour
...RN Educator, Ambulatory Services Pay range: $... ...Nursing Administration - Remote/Hybrid - Bend, Oregon (... ...development and clinical practice scope guidance... ...evaluation. The RN Educator utilizes evidence-based... ...after a complete review, validation and prioritization of needs...Remote workMonday to FridayShift workDay shift$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated... ...to obtain, analyze, and accurately document clinical information from medical records in support of utilization...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home$46.6 - $77.67 per hour
...in all 50 states. Through our clinical leadership, expertise and national... ...documentation of education utilizing OCH applications and... ...unrestricted Registered Nurse (RN) license required. Minimum of... ...include a personal vehicle, a valid driver’s license and proof of...Remote jobPart timeLocal areaFlexible hours- ...Guidehealth is seeking an Utilization Management Registered Nurse to perform medical-necessity reviews and... ...treatments, and ensuring timely decisions in a remote work environment. Ideal candidates hold an active IL RN license, have 3+ years in healthcare settings, and...Remote work
$48 - $52 per hour
...they deserve, we'd love to meet you. About the Role The Clinical Clearance Specialist is a fully remote 1099 contractor role within Charlie Health's Clinical Operations / Admissions function. This RN serves as the dedicated clinical reviewer for escalated admissions...Remote workHourly payFor contractorsLocal area- ...Utilization Management Nurse 2Become a part of our caring... ...Management Nurse 2 uses clinical nursing skills to support... ...Registered Nurse (RN) in an Enhanced Nurse Licensure... ...: While this is a remote position, occasional travel... ...decisions only on valid job requirements. This...Remote workTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday
- ...A healthcare recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an active RN license and experience with health plan operations. Responsibilities include evaluating healthcare...Remote workContract work
- ...organization is seeking a Care Manager RN for a remote role primarily serving the state of... ...This per diem position involves crucial utilization management activities, ensuring compliance... ...RN license along with 3 years of clinical experience. The role offers competitive...Remote workHourly payDaily paidDay shift
- ...Humana Inc. is seeking an Utilization Management Nurse 2 to apply clinical nursing skills in coordinating, documenting, and communicating medical services... ...independent decisions aligned with organizational strategy. Remote-friendly, standard hours, with occasional travel. #J-...Remote 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
- ...A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote workFlexible hoursWeekend workDay shift
- ...To support effective utilization management, the full-time remote Utilization Review RN will examine medical records, develop clinical reviews for authorization, and collaborate with interdisciplinary teams to optimize reimbursement and prevent payment denials. Key responsibilities...Remote workFull time
- ...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
$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:... ...? 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- ...RN Utilization Review Review patient medical records to assess the appropriateness and medical... ...and payers to ensure compliance with clinical guidelines, regulatory requirements,... ...hospital-based) ~ Skilled experience with remote work Length of assignment: 13...Remote workShift workWeekend work
$59.5k - $116.6k
...UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services... ...an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate will work...Remote workWeekend work- ...Utilization Management RNThere's no place like Liberty HealthCome... ...for members and within clinical guidelinesMonitor... ...License, (Compact, RN preferred)1–5 years managed... ....Must have a valid driver's license.Proven... ...communicates instructions to remote users.Visit for more information...Remote workWork at office
- ...Utilization Management – Care ManagementScheduleShift: 8:00–16:30 or 9:00–17:30 PST. Weekend rotation: every third weekend. Must commit... ...Christmas Day, New Year's Eve, New Year's Day.Assignment Details100% remote position supporting a centralized UM team for multiple...Remote workWeekend work
$10k
...an ongoing, consortium-wide clinical education program for clinical... ...with minimum 2 years as staff RN in a specialty (ER, ICU, OB,... ...Emergency Room/Trauma and/or Remote Rural experience preferred.... ...measures based on appropriate utilization of standing orders and ACLS....Remote workContract workTemporary workLocal area- ...Overview In this remote position, you will be responsible for utilization management, working Monday through Friday from 8 AM to 4:30 PM, with a rotation every fifth weekend. You will need to have experience with providers and hold a CCM/CMCN certification. Familiarity...Remote workWeekly payMonday to FridayWeekend work
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