Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Remote Clinical Review Nurse - Utilization

Full-time

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

Vacancy posted 8 hours ago
Similar jobs that could be interesting for youBased on the Remote Clinical Review Nurse - Utilization in Remote vacancy
  •  ...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 work
    Permanent employment
    Full time
    Temporary work
    Flexible hours

    Vivo HealthStaff

    Burbank, CA
    a month ago
  •  ...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

    Medix

    United States
    2 days ago
  •  ...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 work
    Hourly pay
    Flexible hours
    Shift work
    Weekend work

    Axelon

    United States
    4 days ago
  •  ...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 work
    Weekend work

    Spectraforce Technologies

    Charleston, SC
    4 days ago
  •  ...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 work
    Contract work
    Flexible hours
    Weekend work

    Spectraforce Technologies

    Jackson, MS
    2 days ago
  •  ...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 work
    Work at office
    Monday to Friday

    Spectraforce Technologies

    Jacksonville, FL
    5 days ago
  • $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 work
    Full time
    Part time
    Work at office
    Work from home
    Monday to Friday
    Flexible hours

    Centene Corporation

    Kansas City, MO
    2 days ago
  • $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 work
    Hourly pay
    Full time
    Part time
    Work at office
    Monday to Friday
    Flexible hours

    Centene Corporation

    Olympia, WA
    2 days ago
  • $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 work
    Full time
    Work at office
    Work from home
    Night shift

    Broadpath Inc

    United States
    4 days ago
  •  ...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 work
    Work at office

    IMCS Group

    United States
    2 days ago
  • $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 work
    Contract work
    Local area
    Immediate start
    Weekend work

    Pyramid Consulting

    Tampa, FL
    6 days ago
  •  ...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 work
    Flexible hours

    Mindlance

    United States
    2 days ago
  •  ...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 work
    Work from home
    Monday to Friday
    Weekend work

    CVS Health

    Jackson, MS
    2 days ago
  •  ...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 work
    Flexible hours
    Shift work

    Spectraforce Technologies

    Houston, TX
    1 day ago
  •  ...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 work
    Permanent employment
    Temporary work
    Work at office
    Local area
    Immediate start

    Novitas Solutions

    United States
    2 days ago
  • $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 work
    Work at office

    Cynet Systems

    Baltimore, MD
    3 days ago
  • $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 work
    Permanent employment
    Contract work
    Live in
    Shift work

    ESR Healthcare

    United States
    5 days ago
  •  ...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 work
    Permanent employment
    Work at office
    Local area

    American Recruiting and Consulting Group

    United States
    2 days ago
  •  ...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 work
    Full time
    Work from home

    ExamWorks

    United States
    3 days ago
  •  ...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 work
    Hourly pay
    Shift work

    Pacer Group

    Remote
    3 days ago
  •  ...************* \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 work
    Contract work
    Work at office
    Local area

    nTech Workforce

    Reston, VA
    17 days ago
  •  ...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 work
    Work from home

    Comagine Health

    United States
    2 days ago
  •  ...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

    Highmark Health

    United States
    2 days ago
  •  ...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 work
    Contract work

    IntePros

    United States
    3 days ago
  •  ...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 work
    Full time

    Well Sense Health Plan

    United States
    5 days ago
  •  ...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 work
    Flexible hours

    kozmetickesluzby.vecnakraska.sk - Jobboard

    Caribou, ME
    4 days ago
  •  ...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

    Medix

    United States
    3 days ago
  •  ...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 work
    Full time

    Humana

    United States
    2 days ago
  •  ...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

    3B Healthcare, Inc.

    Torrance, CA
    5 days ago
  •  ...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 work
    Local area
    Weekend work

    BJC HealthCare

    United States
    3 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Clinical Review Nurse - Utilization. Be the first to apply!