Remote Utilization Management Nurse - Clinical Review
Brighton Health Plan Solutions
Brighton Health Plan Solutions is seeking an Utilization Management Nurse to perform medical necessity and benefit reviews remotely. The role requires current LPN licensure and expertise in CMS/MCG criteria with experience in inpatient/outpatient reviews. The successful candidate will collaborate with healthcare partners, triage cases, and prepare determinations for medical director oversight, ensuring regulatory compliance and quality standards are met. #J-18808-Ljbffr
- Devoted Health is seeking a Clinical Guide on our Outpatient Utilization Management team to review outpatient authorization requests using evidence-based criteria and... ...navigating the healthcare system. This full-time remote role offers multiple schedules and requires collaboration...Remote jobFull time
- ...Description Job Description: Manager of Clinical Utilization Management - Denial... ...CAPosition Type: Hybrid (85% remote, 15% onsite in Northridge,... ...daily tasks, performance reviews, and any necessary disciplinary... ...an accredited Registered Nursing Program; RN preferred.2....Remote workPermanent employmentFull timeTemporary workFlexible hours
- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board... ...with management and providing guidance on clinical questions. This is a unique opportunity to work...Remote workFull timeWork from home
- WNS is seeking a clinically trained reviewer to perform utilization reviews and case management activities. The role requires RN or LVN/LPN licensure and at least two years... ...terminology. The candidate will work remotely, coordinate with providers and clients, and help...Remote job
- Devoted Health is seeking a Clinical Guide on our Outpatient Utilization Management team. This remote, full-time role focuses on clinical review of outpatient authorization requests using evidence-based criteria and CMS requirements to ensure appropriate care. The ideal...Remote jobFull time
- Integrated Management Strategies (IMS) is seeking an experienced Sr Review Coordinator to join our healthcare consulting... .... This role is fully remote within the US and focuses on utilization review of plans of... ...act as a resource for non-clinical reviewers, and ensure...Remote jobContract workWork from home
- ...part of our mission and join our team! As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise and judgement along with... ...of meeting deadlines. Previous utilization management experience is preferred. In addition to prior...Remote jobLocal area
$140 - $145 per hour
...Oscar is hiring a Physician Reviewer to join our Utilization Management Team. You will determine the medical appropriateness... ..., and pharmacy services by reviewing clinical information and applying evidence-based guidelines. This remote role is open to candidates in the...Remote workHourly payWeekend work$219k - $286.9k
Oscar Health is hiring a Physician Reviewer to join our Utilization Management team. You will determine the medical appropriateness... ..., and pharmacy services by reviewing clinical information and applying evidence-based guidelines. This remote role in the United States offers work...Remote jobWork from home- ...UnitedHealth Group is seeking a Utilization Review Nurse, RN to perform inpatient utilization management in California. The role... ...based guidelines. In addition to clinical duties, you will document decisions... ...cases. The position may offer remote work options and requires...Remote workMonday to FridayWeekend work
$29 - $52 per hour
...UnitedHealth Group's Optum unit is seeking a Utilization Review Nurse, RN to perform inpatient utilization management with evidence-based guidelines and medical necessity... ...coordinate patient care. The position offers remote work options for those in Pacific or Mountain...Remote workHourly payWeekend work- A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing utilization management, reviewing medical records, and coordinating discharge planning. Candidates must have an active RN license...Remote workContract work
- ...seeks a Physical Health Registered Nurse to perform clinical reviews for authorization requests and medical... ...focused on member care within a managed care framework. The position requires... ...experience, including acute care and utilization management experience. #J-18808-Ljbffr...Remote job
$42 per hour
...Ascension Texas Utilization Management Department (Fully Remote) Provides health care services regarding admissions, case management, discharge planning and utilization review. Reviews admissions and service requests within assigned unit for prospective, concurrent...Remote job- Brighton Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate with partners, and ensure timely, compliant documentation and communications...Remote jobWork at office
$71.1k - $97.8k
...a part of our caring community The Utilization Management Nurse 2 uses clinical nursing skills to support the coordination... ...in prior authorization, claims review, utilization management, or other... ...: US Nationwide Work Style: Remote Travel Requirements: None Work at Home...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday$1,600 - $1,800 per week
...Now Hiring: Registered Nurse Utilization Management Location: Buckley AFB & Peterson AFB, Colorado... ...weekends, no holidays, no telehealth/remote work Minimum Qualifications U.S... ...Utilization Management, Utilization Review, or Case Management Preferred Certifications...Remote workContract workImmediate start- 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
$65k - $75k
Piper Companies is seeking a Remote Utilization Management/Review Nurse to evaluate member cases, ensuring medical necessity and appropriate healthcare service utilization. The role requires clinical expertise and collaboration with providers to make high-quality care...Remote job- ...facilities to ensure high-quality care in a remote environment, with rotating weekend utilization review coverage. The candidate should have 1-2 years in utilization management, 3-5 years clinical experience, and a current Texas nursing license along with #J-18808-Ljbffr...Remote job
- University of Miami Health System seeks a full-time Utilization Review Case Manager to work remotely. The role reviews patient charts for prior authorization, concurrent and retrospective utilization, coordinating with the care team for timely and appropriate care. You...Remote jobFull time
- ...IntePros is seeking a Physician Reviewer to provide remote support for a healthcare organization. The role involves reviewing... ...This position offers a collaborative environment with opportunities to leverage clinical expertise in utilization management. #J-18808-Ljbffr...Remote work
$219k - $286.9k
...Physician Reviewer - Utilization Management Remote Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team.... ...inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines....Remote workFull timeLocal areaWork from homeHome officeWeekend work- ...A healthcare management organization is seeking experienced Physician Reviewers to join their Medicare Utilization Management team in a remote position. Responsibilities include reviewing clinical service requests, applying evidence-based guidelines, and collaborating...Remote work
- ...Oak Street Health is seeking a Full-Time Utilization Management Physician Reviewer to provide accurate coverage determinations for inpatient and outpatient services, applying UM criteria, clinical judgment, and internal policies. You will coordinate with care teams to...Remote workFull time
- Currently seeking a Utilization Management RN . Please see details and... ...below: Position is remote - candidate must reside... ...active PA license or a Nurse Licensure Compact to include... ...will evaluate members’ clinical conditions through medical record review to determine medical...Remote workImmediate startDay shift
- ...A leading independent review organization is seeking a Utilization Management Physician Reviewer for a full-time remote role. Candidates must possess an active Nebraska medical license and have a minimum of 5 years clinical practice experience. Responsibilities include...Remote workFull timeCasual workMonday to Friday
- ...To support effective utilization management, the part-time Senior Utilization Review Specialist will conduct concurrent and retrospective reviews of... ...payer authorization while collaborating with clinical teams in a fully remote capacity. Key Responsibilities Perform concurrent...Remote workPart time
- ...Description Job Description The utilization review and management (UM) component program... ...are medically necessary, clinically appropriate, evidence-... ...~ Registered nurse with active, unincumbered... ...This is an in-office, no remote work capability position...Remote workWork at office
- ChenMed LLC seeks a physician with strong clinical and UM background to cover delegated utilization management across multiple territories. The role requires residency... ...2+ years in hospital medicine, with utilization review experience preferred. You will coordinate with...Remote job
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