Remote Clinical Review Nurse - Utilization
Centene Corporation
Now hiring: Remote Clinical Review Nurse - Utilization in Remote at Centene Corporation. Job type: Full-Time. Review the complete description and requirements below to determine if this opportunity is the right fit for you. Posted: Oct 21, 2026. Centene is seeking a Clinical Review Nurse for a remote role supporting members in Pennsylvania. The candidate will perform concurrent reviews, assess care necessity, and contribute to discharge planning, leveraging case management or utilization management experience. The position offers day-shift, full-time work with competitive pay and benefits, and the chance to impact patient care across the network. RN licensure and acute care experience are required. #J-18808-Ljbffr
- ...Job Description: Manager of Clinical Utilization Management - Denial Compliance... ...Position Type: Hybrid (85% remote, 15% onsite in Northridge,... ...managing daily tasks, performance reviews, and any necessary... ...from an accredited Registered Nursing Program; RN preferred. 2....Remote workPermanent employmentFull timeTemporary workFlexible hours
- ...Medix is seeking a highly skilled Utilization Review Nurse Specialist for a fully remote role in the United States. The RN will assess medical necessity and... ...Experienced RNs with ICU/ED/OR background, strong clinical judgment, and a mindset that embraces AI tools to streamline...Remote work
- ...Summary: Work Mode: 100% Remote - MS (candidates can... ...medical necessity reviews of inpatient admissions... ...stays. Apply clinical criteria and guidelines... ...determinations within nursing scope. Identify discharge... ...ensure appropriate utilization, regulatory compliance...Remote workHourly payFlexible hoursShift workWeekend work
- ...Position Title Clinical Review Nurse - Concurrent Review Work Location Remote (EST preferred but will consider CST) Assignment Duration 6 months Work... ...in health management systems according to utilization management policies and guidelines Works with...Remote workWeekend work
- ...Position Title: Clinical Review Nurse - Concurrent Review Work Location: Remote-MS CST Assignment Duration: 3 Months Contract to Hire Work Schedule:... ...to the member. Background & Context: The Utilization Management team review members who are currently...Remote workContract workFlexible hoursWeekend work
- ...Position Title: Clinical Review Nurse - Prior Authorization Work Location: Remote; nationally sourced within approved U.S. states. Must be available during standard... ...team supports timely, accurate, and compliant utilization review to help members receive medically...Remote workWork at officeMonday to Friday
$27.02 - $48.55 per hour
...have the flexibility to work remotely from their home anywhere... ...Missouri. This team performs clinical reviews for medical and behavioral health... ...interdepartmental teams on utilization processes to promote high... ...from an Accredited School of Nursing or Bachelor's degree in Nursing...Remote workFull timePart timeWork at officeWork from homeMonday to FridayFlexible hours$27.02 - $48.55 per hour
...Business Area: Clinical & Care Management Job Type... ...Performs concurrent reviews, including determining... ...This position is fully remote/work from home, and will... ...hold a compact nursing licensure. Experience... ...systems according to utilization management policies and...Remote workHourly payFull timePart timeWork at officeMonday to FridayFlexible hours$34 - $35 per hour
...Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical Nurse - Work from Home... ...Conducts telephonic and concurrent review of hospitalizations and extended... ...Clinical Review Nurse- Prior Authorization Remote Registered Nurse (Remote Patient...Remote workFull timeWork at officeWork from homeNight shift- ...A healthcare organization is seeking a Clinical Review Nurse – Concurrent Review to perform utilization management functions remotely. The role requires conducting concurrent reviews, collaborating with medical teams, and ensuring quality healthcare outcomes. Candidates...Remote workWork at office
$37 - $39 per hour
...Immediate need for a talented Clinical Review Nurse - Concurrent Review. This is a 06+months contract... ...term potential and is located in U.S(Remote). Please review the job description... ...is preferred ~ Familiarity with utilization management processes is a plus ~...Remote workContract workLocal areaImmediate startWeekend work- ...from an Accredited School of Nursing or Bachelor's degree in Nursing... ...of related experience. Clinical knowledge and ability to analyze... ...preferred. Knowledge of utilization management processes preferred... ...necessity and clinical reviews of authorization requests to...Remote workFlexible hours
- ...Health Corporation is seeking an RN Concurrent Review Nurse to join a remote team delivering inpatient clinical expertise to ensure medically necessary care across... ..., 5+ years inpatient nursing, and 2+ years in utilization management or discharge planning, with an Associate...Remote workWork from homeMonday to FridayWeekend work
- ...Position Title: Clinical Review Nurse - Prior Authorization Work Location: Remote - PST and CST (No CA and NY candidates please) Assignment Duration: 12 Months... ...in InterQual/ Milliman, One Note, knowledge of Utilization Management (policies/regulations), at least 1...Remote workFlexible hoursShift work
- ...Sick Leave Summary Statement The Clinical Review Nurse is responsible for reviewing and... ...decisions on the coverage, medical necessity, utilization and appropriateness of care per... ...Employer." This opportunity is open to remote work in the following approved states:...Remote workPermanent employmentTemporary workWork at officeLocal areaImmediate start
$36.49 - $41.49 per hour
...Job Overview: The Clinical Medical Review Nurse handles day to day review of professional... ...the descriptive or medical information utilizing the CPT and HCPCS manuals. Keeps... ...and written communication skills. Remote EMR access experience is essential....Remote workWork at office$44 per hour
...Clinical Review Nurse - Prior Authorization Various, NV Clinical Review Nurse - Prior Authorization... ...NV All On-site Location: Fully Remote – Prefer Candidates reside in NV, but... ...and/or interdepartmental teams on utilization processes to promote high quality and...Remote workPermanent employmentContract workLive inShift work- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are... ...clinical decisions on the coverage, medical necessity, utilization and appropriateness of care per national and local policies...Remote workPermanent employmentWork at officeLocal area
- ...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... ...with management and providing guidance on clinical questions. This is a unique opportunity to work from...Remote workFull timeWork from home
- ...Job Title: Clinical Review Nurse - Concurrent Review Location: Remote Duration: 12 months XXXX: XXXXXXXXXXX/hr. on w2 Scheule: 10am -7pm CST... ...records in health management systems according to utilization management policies and guidelines. Works...Remote workHourly payShift work
- ...************* \n \n Title: HEDIS Clinical Medical Review Nurse \n Location: Columbia, MD 21044... ...months \n Work Location: Primarily Remote (Hybrid focus for candidates residing... ...first two weeks of assignment. \n Utilize EMR systems (such as Epic, Athena)...Remote workContract workWork at officeLocal area
- ...Comagine Health is seeking a Clinical Reviewer with LCSW/LPC/LCPC licensure for a remote, Oregon-based role requiring travel to Salem and surrounding areas.... ...diverse populations. The position emphasizes utilization review, documentation, and collaboration with stakeholders...Remote workWork from home
- ...Allegheny Health Network seeks an RN Utilization Review professional to obtain pre-certifications... ...of care and timely approvals. This remote role requires PA RN licensure (or multi... ...certification within 5 years, and 2–3 years of nursing experience with 1 year in utilization...Remote work
- ...A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and collaborating with teams to meet...Remote workContract work
- ...States is seeking an Inpatient Utilization Management Clinician to evaluate... ...across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and experience with InterQual... ...management to ensure timely reviews, document outcomes, and...Remote workFull time
- ...Gainwell Technologies LLC is looking for a Utilization Review Nurse to work remotely in Maine. You will conduct reviews for medical necessity and appropriateness of services, utilizing clinical criteria and guidelines. Qualified candidates should have an active Maine...Remote workFlexible hours
- ...leading healthcare solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services.... ...accredited nursing degree and experience in utilization review. Competitive pay and remote flexibility offered. #J-18808-Ljbffr...Remote work
- ...Pre-Authorization Registered Nurse for a remote, full-time role based in Virginia. The RN will review prior authorization requests,... ...settings, and educate providers on utilization and management processes.... ...at least two years of varied clinical nursing experience in acute,...Remote workFull time
- ...Registered Nurse – Utilization Review (Remote) Position Overview: 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). Required Qualifications...Remote work
- ...BJC HealthCare is seeking a registered nurse to join a remote Utilization Review team. The role supports multiple hospital units with no patient communication, and it is designed for local remote work with weekend rotation. Responsibilities include applying Interqual criteria...Remote workLocal areaWeekend work
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