Remote RN - Clinical Utilization Reviewer (Alabama)
Palo Verde Community College District
Comagine Health seeks Clinical Utilization Review Nurses (RN) to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This full-time, remote position requires Alabama licensure and focuses on compliant, cost-effective care within contract guidelines. Applicants must be an active RN in Alabama with at least 3 years of direct patient care experience and a BA/BS in Nursing. Experience in long-term care, provider relations, and PA reviews is valued. #J-18808-Ljbffr
- ...Comagine Health is seeking a Clinical Utilization Review Nurse (RN) licensed in Alabama to assess medical necessity and quality of care through prospective, concurrent... ..., and retrospective reviews. This full-time, remote position supports compliant, cost-effective care aligned...Remote workFull timeContract work
- ...improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role... ...professionally. Position Overview We are seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess the medical necessity and quality of...Remote workFull timeContract work
$45 - $50 per hour
...looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical... ...of accredited nursing programs with an active New York RN license. #J-18808-Ljbffr...Remote workHourly pay- Palmetto GBA is seeking an experienced RN for remote utilization review to evaluate medical claims using established criteria and guidelines. The role... ...position requires active RN licensure and 2+ years of clinical experience, with strong communication and analytical skills...Remote jobWork from homeHome office
- ...subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim reviews... ...decisions and supports utilization review across multiple services. The position is remote, full-time, with standard hours... ...associate degree, and 2+ years of clinical RN experience required. #J-1...Remote jobFull time
- ...Registered Nurse to perform medical reviews using clinical information and established guidelines... ...decisions and supporting medical claims and utilization practices from a remote location in South Carolina, Georgia, North Carolina or Alabama. Responsibilities include educating...Remote job
- 1 week ago Be among the first 25 applicants Job Title:Clinical Review Nurse (RN) - Utilization Management Location:Oregon or bordering states Duration:... ...Future Opportunities) Clinical Program Coordinator RN *Remote* Clinical Program Coordinator RN *Remote* Medford, OR $...Remote workContract work
$32 - $33 per hour
...situation fit into our culture. We have an opening for a: RN - Clinical Field Reviewer (Remote in Montana) The RN Clinical Field Reviewer is a remote... ..., practice cultural humility with each client, and utilize evidence-based practice as a foundation for our interventions...Remote workFull timeTemporary workLocal area$88k - $93k
Profile Remote work opportunities are available in the following states: AK, AR... ...encouraged to apply. Job Summary The Utilization Management Clinical Review nurse reviews and makes decisions... ...Experience Required: Active, unrestricted RN license U.S. Citizen Ability to...Remote workContract workTemporary workInterim roleWork at officeLocal areaShift work- Spectrum Healthcare Resources seeks a Utilization Manager Registered Nurse (UMRN) to work entirely from home in a fully remote role. The nurse will review cases, educate patients on... ...schedule of 8 hours per day, requiring an RN with a Bachelor's degree, state licensure...Remote jobWork from homeMonday to Friday
$70k - $120k
...Fully Remote : Clinical Documentation Specialist Job Description... ...concurrent and retrospective reviews of medical records to ensure... ...complete clinical documentation. Utilize clinical knowledge and expertise... ...Qualifications Registered Nurse (RN) with a current license from...Remote workLocal areaMonday to Friday- ...RN - Utilization Management ID 2026-25367 Category... .... These will be completely remote positions, working entirely... ...Nurse's home. The Nurse will be reviewing cases, educating patients on... ...the HCWs must have pertinent clinical experience within the past two...Remote workFull timeContract workWork at officeWork from homeMonday to Friday
- CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home role... ...and benefit coordination, requiring an active RN license and hospital experience. Responsibilities include reviewing medical necessity, coordinating with providers...Remote jobWork from home
$50k
...Department Overview The Clinical Documentation Specialist will... ...concurrent and retrospective review of provider documentation, query... ...of patient records in a remote setting. The Registered Nurse... ...physicians and nursing as needed. Utilizes software systems (including...Remote workFull timePart time- ...RN / Medical Reviewer / Remote Job Details Professional Discipline : Registered Nurse Specialty : Utilization Review Employment Type : Full Time City :... ...eligibility regarding benefits and clinical criteria and assess and monitor...Remote workFull timeContract workLocal areaShift work
$40.12 - $62.19 per hour
...Sinai Hospital's Utilization Review operates as a distinct specialty service... ...ensure hospital stays are clinically appropriate and fully covered... ...information. This is a Full-time remote position.... ...: The Utilization Review RN reviews the medical record by...Remote workFull time- ...delivering care supported by technology to help millions live healthier lives. The Clinical Appeals RN defends MassHealth prior authorization decisions and conducts pre-service reviews, working with managers and peers. Based in Massachusetts with telecommute options for...Remote job
- UnitedHealth Group seeks an experienced SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims. The role requires documenting determinations and maintaining screening criteria, contributing to efficient, compliant health...Remote job
- ...R1 RCM is seeking an experienced Utilization Review Author (RN) for our Physician Advisory Team. The role involves first-level admission and continued stay reviews using InterQual/MCG criteria and requires hospital-based UR or Case Management experience. The position offers...Remote workFlexible hours
$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- ...Occupational Therapist to deliver on Cohere’s therapy programs by reviewing medical information and applying evidence-based guidelines. This remote role supports a fast-paced review team and requires clinical acumen and effective communication. You’ll perform timely...Remote job
$38.46 - $43.27 per hour
...Clinical Reviewer As the Clinical Reviewer, you will be responsible for... ...to: Performing case reviews utilizing regulatory guidelines criteria... ...NY office. Ability to work remotely one day per week after... ...Nurse, required (open to any RN state license). Graduate...Remote workHourly payFull timeFor contractorsWork at office1 day per week- NTT DATA, Inc. in Tampa, Florida seeks a BPO Clinical Review Specialist to perform clinical and medical necessity reviews supporting member... ...compliance with NCQA standards and Medicaid guidance. This remote Florida role offers benefits including medical, dental and vision...Remote job
- ...RN Utilization Review Review patient medical records to assess the appropriateness and medical... ...and payers to ensure compliance with clinical guidelines, regulatory requirements, and... ...hospital-based) ~ Skilled experience with remote work Length of assignment: 13...Remote workShift workWeekend 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
$40 - $42 per hour
...Slate Healthcare is seeking a local contract nurse RN Utilization Review for a local contract nursing job in Fort Myers, Florida. Job Description... ...week Shift: 8 hours, days Employment Type: Local Contract ✨ REMOTE RN UTILIZATION REVIEW OPPORTUNITY ✨ 100% REMOTE ROLE – RN...Remote workHourly payContract workPart timeWork experience placementLocal areaImmediate startMonday to FridayShift workWeekend work- ...HealthHelp is seeking a remote Utilization Review clinician (RN/LPN/LVN) to support medical necessity determinations across client programs. You will... ...years in utilization review or case management, strong clinical knowledge, and proficiency with Microsoft Office and healthcare...Remote workWork at office
- ...guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment. Primary Responsibilities: Clinical Case Reviews - 75% Perform clinical review of professional (or facility) claims vs. medical...Remote jobContract workWork at officeLocal areaMonday to Friday
$2,175 per week
...Genie Healthcare is seeking a travel nurse RN Utilization Review for a travel nursing job in Fort Myers, Florida. Job Description & Requirements... ...highly preferred Must be computer literate and have prior remote-work experience Candidate must provide their own computer/equipment...Remote workPart timeWork experience placementImmediate startShift work- ...Ascension Sacred Heart Hospital is seeking a nurse to join our Utilization Management team in a remote role. You will perform prospective, concurrent, and retrospective reviews to ensure medical necessity and alignment with reimbursement policies. Join a multidisciplinary...Remote work
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