Remote RN: Medical Review & Utilization Auditor
$29.05 - $67.97 per hourMolina Healthcare of Illinois
- Remote job
Molina Healthcare is seeking a qualified Registered Nurse with clinical experience to perform utilization reviews and ensure medical necessity of claims. The role involves reviewing medical documentation, facilitating appeals for authorizations, and validating claims coding. The ideal candidate must have at least two years of clinical nursing experience and be proficient in ICD-10 and CPT coding. This position offers a competitive pay rate of $29.05 to $67.97 per hour. #J-18808-Ljbffr Molina Healthcare
- Molina Healthcare in Chandler, Arizona is looking for a RN Utilization Review Nurse. This role focuses on utilizing clinical expertise to ensure documentation meets medical necessity and coding standards. Responsibilities include facilitating medical review for authorization...Remote jobMedical
- ...seeking a qualified Registered Nurse to evaluate medical documentation for authorization and reimbursement. You will review claims, ensure compliance with regulations,... ...experience, with a strong background in utilization review and coding. We offer a competitive compensation...Remote jobMedical
$29.05 - $67.97 per hour
...Healthcare is seeking a Clinical Nurse Reviewer in Albany, NY, responsible for reviewing medical documentation to ensure medical... ...Candidates must hold an active RN license and have at least 2... ...nursing experience, particularly in utilization review. Molina offers...Remote jobMedicalHourly pay- ...is seeking a Registered Nurse to oversee the review of documentation ensuring medical necessity and appropriate level of care, using... ...years of clinical nursing experience, including utilization review, and hold an active RN license. #J-18808-Ljbffr Molina HealthcareRemote jobMedical
$29.05 - $67.97 per hour
...Healthcare in Cincinnati, Ohio, seeks a Clinical Reviewer to leverage clinical knowledge for ensuring medical necessity and appropriate levels of care.... ...of clinical nursing experience, including utilization review, and an active RN license. Molina offers competitive...Remote jobMedicalHourly pay$29.05 - $67.97 per hour
...is looking for a Registered Nurse to facilitate medical reviews and appeals for prior authorizations. The ideal... ...have 2 years of clinical experience, including utilization review and medical claims, and possess a valid RN license. This role focuses on ensuring the medical...Remote jobMedicalHourly pay$29.05 - $67.97 per hour
...Antonio, Texas, to join their team for clinical review responsibilities involving medical necessity and claims processing. This role... ...nursing experience and knowledge in utilization review. Candidates must hold an active RN license and demonstrate proficiency in billing...Remote jobMedicalHourly pay$29.05 - $67.97 per hour
...Healthcare is seeking experienced Registered Nurses for thorough review of medical documentation to ensure compliance with guidelines and... ...appeals, validate medical records, and resolve issues concerning utilization management. Ideal candidates will possess at least two years...Remote jobMedicalHourly pay- ...clinical professional in Miami to perform utilization reviews and ensure proper coding for... ...regulations. The candidate will evaluate medical claims and facilitate appeals, contributing... ...assurance and regulatory compliance. An active RN license is essential, along with...Remote jobMedical
$29.05 - $67.97 per hour
...seeking a qualified clinical review professional in Louisville, Kentucky, focused on ensuring medical necessity and reimbursement accuracy... ...must possess an active RN license and at least 2 years of... ...nursing experience, including utilization review and medical claims review...Remote jobMedicalHourly pay- Molina Healthcare is seeking a qualified RN for clinical review positions in Detroit, Michigan. This role requires clinical knowledge and experience... ...documentation to ensure proper coding, billing, and medical necessity. Candidates must possess at least 2 years of clinical...Remote jobMedical
$29.05 - $67.97 per hour
...Healthcare in Bellevue, WA is looking for a clinical reviewer with at least 2 years of nursing experience. The role involves validating medical records and determining the medical... ...of claims. Candidates should have an active RN license, knowledge of coding, and strong analytical...Remote jobMedicalHourly pay$29.05 - $67.97 per hour
Molina Healthcare in Austin, Texas, is seeking a Clinical Reviewer to assess medical necessity and appropriate levels of care. This role requires an active RN license and offers an hourly pay range of $29.05 to $67.97, influenced by experience and education. The Clinical...Remote jobMedicalHourly pay- ...Medical Review Clinical Appeals Auditor (RN) In October 2025, Machinify acquired Performant and we are now part... ...be necessary. Experience with utilization management systems or clinical... ...ability to work independently in remote setting with minimum supervision and...Remote workMedicalFlexible hours
- ...Medix™ is seeking an experienced RN for a Utilization Review role, allowing you to work from the comfort of home. In this contract-to-hire position... ...'ll review inpatient treatment plans and communicate with medical teams to ensure appropriate care levels. Ideal candidates...Remote workMedicalContract workWork from home
$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX Agency: Mindlance Health... ...contact and will include 80% travel. Remote role. Will require a driver’s license.... ...partner with top-tier hospitals and medical institutions nationwide, helping you...Remote workMedicalHourly payFull timeContract workImmediate startShift work3 days per week- COMAGINE HEALTH is seeking Clinical Utilization Review Nurses (RN) for a full-time remote position focused on assessing the medical necessity of healthcare services in Alabama. Candidates must hold an active RN license and possess a BA/BS in nursing, alongside a minimum...Remote workMedicalFull time
- ...A regional healthcare provider in Houston is seeking a Utilization Management Review Nurse. This role involves evaluating the appropriateness of medical services based on necessity and promoting quality care outcomes. The candidate must have a Bachelor's in Nursing and...Remote workMedicalFlexible hours
- ...A prominent healthcare provider in Bellaire is seeking a PRN Utilization Management Review Nurse. This role involves evaluating medical services, ensuring appropriate care levels, and collaborating with healthcare teams. Candidates must hold a Bachelor's in Nursing and...Remote workMedicalReliefShift work
$65k - $75k
...Technologies LLC is seeking a Nurse Reviewer (RN) to perform clinical reviews remotely in the United States. Responsibilities include reviewing medical records, documenting findings, and... ...clinical experience, and 2+ years in utilization review or claims auditing. This...Remote workMedicalFull time- ...Have you ever looked a medical bill and immediately... ...is looking for a Nurse Auditor who wants to make their... ...client savings by reviewing medical bills from a nurse... ...compliance, over-utilization, and erroneous charges... ...situations. Qualifications RN (or LPN) with active...Remote workMedicalCasual workWork at officeImmediate startFlexible hours
- Humana is seeking a Utilization Management Behavioral Health Registered Nurse (RN) Intern to join their National Medicaid... ...role involves conducting medical necessity reviews for behavioral health services... ...license. This position supports remote work, providing work-life...Remote jobMedicalInternship
- ...classified as hybrid, onsite or remote. While the majority of... ...of member utilization and prediction of future... ...designated clinical resource to review High Cost Claimants to... ...’ experience as an RN analyst or auditor in Utilization Review, Medical Claim Review and/or Care...Remote workMedicalFull timeWork experience placement1 day per week
- ...Management Council, Inc is looking for a Remote RN to join their team. The role requires 2 years of RN experience and Utilization Review expertise, supporting various units in a... ...flexible scheduling with benefits that include medical, dental, and retirement contributions...Remote jobMedicalWork from homeFlexible hours
- Acentra Health, LLC is seeking a Clinical Reviewer - RN to join their team remotely in the U.S. In this role, you will review patient records for medical necessity and collaborate with... ...clinical experience, and experience in Utilization Review. Benefits include access to a...Remote jobMedical
$47.06k - $70.24k
...healthcare solutions provider is seeking a Utilization Review Nurse in Fort Worth, TX. This remote role involves analyzing medical bill appropriateness, documenting findings,... ...claims examiners. Candidates must have a current RN license and at least four years of clinical...Remote jobMedical- ...The Utilization Review Clinician is responsible for reviewing medical records to determine medical necessity. This includes conducting patient evaluations, managing... ...clinical nursing or therapy experience ~ Active RN, OT, or PT license Preferred Qualifications...Remote workMedicalFull timeWork experience placementWork at office
$78.5k - $90k
...to health plans. The Medical Review Nurse (Home Health) primarily... ...experienced medical auditors and coders performing... ...00 – $90,000. Work is remote in a fast paced... ...Abilities Experience with utilization management systems or... ...Qualifications Active unrestricted RN license in good...Remote workMedicalFor contractorsWork at officeHome officeShift work$30 - $34 per hour
...healthcare services company is seeking an experienced Utilization Review Nurse to work remotely. The ideal candidate must hold an active LVN license in... ...management. Responsibilities include approving or denying medical services based on established criteria. Competitive...Remote jobMedicalHourly pay$34 - $52.7 per hour
...0 facility. This job is REMOTE. FTE: 0.500000 Standard... ..., for a second level review as needed. Facilitates communication... ...is required; Prior utilization management or case management... ...Academic Partnership with the Medical College of Wisconsin Referral...Remote workMedicalHourly payTemporary workShift work
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