Remote Clinical Review Supervisor - Utilization & Quality
Comagine Health
Comagine Health in Oregon is seeking a Supervisor, Clinical CM to provide operational supervision of clinical staff performing utilization reviews and specialty reviews using InterQual criteria. You will mentor reviewers, ensure medical necessity decisions are accurate, and maintain regulatory compliance while coordinating with internal and external stakeholders.
This role supports a flexible remote work model with occasional on-site collaboration, based out of Oregon, serving diverse healthcare
#J-18808-Ljbffr- ...Description Job Description: Clinical Supervisor, UM Denial Compliance... ...Position Type: Hybrid (85% remote, 15% onsite in Burbank, CA)... ...essential in ensuring a high-quality, efficient, and compliant denial... ...managing daily tasks, performance reviews, and disciplinary actions....Remote workPermanent employmentTemporary work
- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold... ...and providing guidance on clinical questions. This is a unique opportunity... ...home while contributing to quality medical reviews. #J-18808-...Remote workFull timeWork from home
- ...the underserved community, is currently seeking a driven Clinical Supervisor – Utilization Review to join our mission to provide compassionate services... ...both licensed and unlicensed clinicians, ensuring high-quality care for clients while supporting the professional growth...SuggestedLocal areaImmediate startShift work
$275k - $315k
...Medical Director of Utilization Management Summary:... ...leadership position as the Clinical Lead for a prominent... ...clinical strategy, quality improvement, and cost-... ...services, complex case reviews, appeals, and peer-to-... ...a hybrid schedule (3 days remote / 2 days onsite)...Remote workFull timeWork at officeMonday to FridayShift work2 days per week$35 - $45.94 per hour
...Utilization Review Nurse Hi, we're Oscar. We're hiring a Utilization Review... ...You will report into the Supervisor, Utilization Review. Work Location: This is a remote position, open to candidates... ...for requested services using clinical judgment and Oscar Clinical Guidelines...Remote workHourly payWork from homeHome officeWeekend work$180 per hour
...REMOTE MEDICAL DIRECTOR – UTILIZATION MANAGEMENT & APPEALS $180/hour | W-2 Contract | Monday... ...for a physician who enjoys clinical decision-making, medical necessity review, and appeals oversight without... ...to ensure appropriate, high-quality, and medically necessary...Remote workContract workWork at officeMonday to Friday- ...Remote Drug Utilization Review Pharmacist Safe & Cost-Effective Medication Use Work from home analyze medication use patterns, apply clinical guidelines, and collaborate with providers all from home.... ...requirements, and contributing to quality-improvement initiatives and...Remote jobWork from home
$223.8k - $313.1k
...on medical background and reviews health claims. The... ...dedicated to advancing the quality of inpatient care through clinical expertise and thoughtful... ...or those experienced in Utilization Review are encouraged to... ...Travel: While this is a remote position, occasional travel...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayWeekend work$240k - $250k
...Medical Director Utilization Management We are looking... ...medical and surgical clinical areas to deliver on Cohere... ...of services by reviewing clinical information and... ...perspectives. This is a remote-first role that may... ...care to improve the quality of patient outcomes...Remote workFlexible hours- ...Refer a Friend Back Remote Work from Home Share This... ...8:00 AM - 5:00 PM As a Utilization Review Registered Nurse for Johns... ...the opportunity to use your clinical, managed care, utilization... ...partners to drive improved quality and better health outcomes for...Remote workFull timeLocal areaWork from homeMonday to FridayDay shift
- ...experienced physician leader for a remote Medical Director, Utilization Management (Home Health,... ...serve as the primary clinical authority for home health... ...medical necessity reviews for Medicare Advantage populations... .... Policy & Quality Improvement Contribute...Remote workFull timeContract workPart timeLocal areaWork from home
- Humana Inc. is seeking a Medical Director to review complex inpatient and post-acute cases,... ...review.Responsibilities include clinical decision-making, mentoring, and participating in discharge planning, quality and utilization reviews. Travel to Humana offices may be...Remote job
- ...Centene Corporation seeks a Behavioral Health Utilization Review professional to perform clinical reviews and assess the appropriateness of mental health and substance use services. This fully remote role supports Ambetter / Marketplace, reviewing requests for inpatient...Remote work
- ...Technician to support retail pharmacy operations remotely. This role involves processing prescriptions, performing prior authorization reviews, and coordinating care for patients.... ...pharmacy, ideally with experience in utilization review. A strong knowledge of insurance processes...Remote work
- ...Medical Director Utilization Management Location: Remote Preference EST or nearby Pittsburgh PA, NY, WV Duration: 6+ Months Contract... ...accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically using Medical...Remote workContract workPrivate practice
- ...Northpoint Recovery Holdings, LLC is seeking a licensed Utilization Review Specialist to ensure clinically appropriate care, discharge planning, and cost-effective utilization across the treatment continuum. You will lead reviews of admissions, stays, discharges, and...Remote work
- ...Centene Corp. is seeking an Utilization Review Clinician - Behavioral Health to conduct clinical reviews for mental health and substance use services, ensuring appropriate... ...level of care for Oregon Medicaid in a fully remote role. The position follows a Monday–Friday 8–...Remote workMonday to Friday
$140k - $175k
...that works. Created by clinical experts in the field... ...Director of Clinical Quality serves as Equip's primary... ...findings, and peer review outcomes Provide oversight... ...payor partners on utilization management processes... ...compliance staff) in a remote or telehealth setting....Remote workWork at officeLocal areaWork from homeHome officeFlexible hours- ...Centene Corporation is seeking a remote Behavioral Health Utilization Review Specialist to assess care for mental health and substance use, reviewing authorization requests and inpatient cases across various settings. The role emphasizes collaboration with providers, medical...Remote work
$65k - $78k
...Utilization Review Nurse- Remote job at Gainwell Technologies LLC. North Carolina. It takes great medical... ...of services, following clinical criteria, coverage policies, and contract... ...necessity and appropriateness, meeting quality and production goals. Use clinical...Remote workFull timeContract workWork at officeWork from homeFlexible hours- ...Authorization Registered Nurse for a remote, full-time role based in Virginia. The RN will review prior authorization requests,... ..., and educate providers on utilization and management processes. Requirements... ...at least two years of varied clinical nursing experience in acute,...Remote workFull time
$77.96k - $120.37k
...Diagnostic Related Groups (DRG) Clinical Supervisor is responsible for... ...validation (clinical/coding) reviews of medical records and/or other... ...determination. This is a remote position. ESSENTIAL FUNCTIONS... ...overall integrity of the quality of diagnosis and procedure codes...Remote workMinimum wageFull timeContract workWork at officeLocal areaFlexible hoursNight shift- ...Medical Director of Utilization Management to join a... ...role in ensuring the clinical integrity of inpatient and post-acute care reviews, evaluating medical necessity... .... Location: 100% Remote Schedule: Full-Time... ...the American Board of Quality Assurance and...Remote workFull timeMonday to Friday
- ...Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This remote, part-time role focuses on obtaining and maintaining insurance... ...care organizations, and collaborating with clinical teams. The ideal candidate has prior utilization...Remote workPart timeWeekend work
$115.9k - $165.6k
...Summary The Senior Medical Review Manager is a senior... ...of physicians, nurses, and clinical review professionals to ensure high-quality medical necessity reviews, utilization management, and regulatory... ...this role United States remote opportunity Video cameras...Remote workFull timeWork at officeFlexible hours- ...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
- ...Centene is seeking a Nursing professional to perform concurrent reviews from a home-based setting, ensuring appropriate care levels... ...coordinating with Medical Affairs and educating providers on utilization processes. Schedule is Mon-Fri, 8am-5pm Central with rotating...Remote work
- ...A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards.... ...contract role offers a chance to manage healthcare quality efficiently while working remotely. #J-18808-Ljbffr...Remote workContract work
- ...TriWest Healthcare Alliance seeks a Utilization Management Clinical Review nurse to evaluate and authorize beneficiary care, focusing on cost-effective, appropriate utilization of Behavioral Health and Medical/Surgical services. Responsibilities include preauthorization...Remote work
- ...Job Title In this position you will be reviewing patient charts to determine if pre-elective surgical cases... ...coding certification required. Minimum 3-5 years of clinical experience preferred. Previous utilization management or case management experience preferred....Remote workFull timeMonday to Friday
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