Remote CA RN - Utilization Management & Care Coordination
Cigna Health and Life Insurance Company
- Remote job
Cigna Health and Life Insurance Company in California is seeking an Utilization Management Clinical Reviewer to manage an active inpatient caseload from a remote location. You must be an RN licensed in California and available for a Monday–Friday shift 8:00 a.m.–5:00 p.m. PST. The role involves applying clinical guidelines, coordinating safe transitions across care, collaborating with members, families, providers and internal partners. #J-18808-Ljbffr Cigna Health and Life Insurance Company
- Evry Health is seeking an RN Integrated Care Coordinator (UM) to provide comprehensive care... ...high-quality care in a remote environment, with rotating weekend utilization review coverage. The candidate... ...have 1-2 years in utilization management, 3-5 years clinical experience...Remote job
- CVS Health is seeking an Utilization Management Nurse Consultant to coordinate, document and communicate... ...medical necessity and timely care within regulatory guidelines. Requires active RN license, 3+ years RN... ...+ year of MS Office use; remote work with a Mon-Fri 8:00am...Remote job
- ...is the largest chronic care management (CCM) service provider... ...an LPN Personal Care Coordinator is to care for patients... ...-time, full-benefits remote role. All necessary equipment... ...Maintaining proper utilization. Achieving a... ...Qualifications: Current active CA license and an active...Remote workFull timeWork at officeMonday to FridayDay shift
$29 - $52 per hour
Optum is seeking a Utilization Review Nurse, RN, to lead inpatient utilization management, applying evidence-based guidelines and criteria to determine medical necessity... ..., with ability to work PST/MST hours or remotely in the U.S. Compensation ranges from $29.00-$52...Remote jobHourly pay$35 - $45 per hour
...Position: RN / Utilization Review Nurse Location: Sacramento, CA (ON-SITE) Employment Type... ..., and compliant care decisions in accordance... .... Assist with coordination of peer reviews... .... Support case management activities and identify... ...in a remote or office-based setting...Remote workWeekly payContract workWork at officeMonday to Friday- Humana is seeking a Utilization Management Nurse 2 to apply clinical nursing skills in coordinating, documenting and communicating medical... ...benefit determinations. This remote role may require occasional travel... ...to ensure optimal member care and outcomes. 40 hours per...Remote job
- UnitedHealth Group is seeking a Utilization Review Nurse, RN to perform inpatient utilization management in California. The role involves reviewing inpatient criteria,... ...Directors for complex cases. The position may offer remote work options and requires working a Monday-...Remote jobMonday to FridayWeekend work
$42 - $55 per hour
...Full-Time Rn Case Manager (Rn) Opportunity DaVita... ...Integrated Kidney Care (IKC) is looking for... ...us in Fresno, CA. As a DaVita Integrated... ...team to coordinate and facilitate quality... ...Location: Hybrid-Remote. Work from home (telehealth... ...~1+ years of utilization management experience...Remote jobFull timeWork from homeHome officeMonday to FridayFlexible hours- ...standard of patient care we strive for.... ...Clinical Program Coordinator, RN, provides vital education... ...weekly meetings. Manages clinical data... ...collaborative research and utilizing education and... .... Hybrid Remote = must currently live... ...degree preferred. CA RN state License required...Remote workLive inLocal areaRelocation
- ...Northern Light Health is seeking a dedicated Care Manager, RN to lead patient-centered care coordination across the continuum and develop safe discharge plans... ...transitions in care, patient experience, and resource utilization while promoting continuity and education....Remote work
- Moda Health is seeking a dedicated care coordination professional to ensure timely, appropriate care for members. You will interact with... ...and providers to develop and monitor treatment plans and manage utilization reviews. The role is a full-time, work-from-home position...Remote jobFull timeWork from home
$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance... ...outpatient services Quality of care concerns Interfacingroutinely... ...reliable and user-friendly. Care Coordination & Quality Support Initiatingreferrals...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home$90k - $110k
...reimagining pediatric chronic care, starting with ADHD. After... ...now on Obesity and Overweight management. Our clinical model is tech-... ...Summary The Nurse Care Coordinator Lead (RN) is an integral member of Clarity... .... Note this is a fully remote position. Key Responsibilities...Remote jobFull timeContract work- ...Utilization Management RNThere's no place like Liberty HealthCome... ...to ensure appropriate care for members and within... ...if requiredAssess and coordinate discharge planning with... ...Nurse License, (Compact, RN preferred)1–5 years... ...communicates instructions to remote users.Visit for more...Remote workWork at office
- L.A. Care Health Plan in Los Angeles, CA seeks an Utilization Management Nurse Specialist RN II to coordinate and approve referrals that meet criteria. You will monitor inpatient admissions, conduct telephonic or onsite reviews, and collaborate with on-site staff to discharge...
- ...reference standardized criteria and coordinate with physician peers when needed. This... ...multidisciplinary team focused on member care within a managed care framework. The position requires... ...experience, including acute care and utilization management experience. #J-18808-...Remote job
- UnitedHealth Group is seeking an Inpatient Utilization Management Nurse, RN for a fully remote role serving the Sacramento area.... ...requires 3+ years in acute care and 1+ year in utilization... ...authorization decisions, and care coordination. The ideal candidate will stay current...Remote job
$101.72k - $198.36k
...California - Ability to work remote, but selected candidate... ...position requires California RN Licensure. Candidates must... ...of the following functions: utilization management, care management, behavioral health... ...facilitating, planning and coordinating integrated delivery of care...Remote workContract workWork experience placementWork at officeLocal area$39 - $40 per hour
...Healthcare Recruiter at The Judge Group Utilization Management Registered Nurse (RN) Type: 6-Month Contract W2 Location: Remote - but MUST reside in one of the... ...responsible for evaluating healthcare services, coordinating care, and ensuring members receive high-...Remote workDaily paidContract workMonday to FridayShift workWeekend work- Optum seeks an RN Utilization Manager to lead the DSNP clinical team in Washington, DC, coordinating HCBS reviews and care planning for members in home-based settings. You will partner with medical directors, providers, and plans to ensure high-quality utilization outcomes...Work from home
- ...RN Coordinator Utilization Management The RN Coordinator Utilization Management will review submitted authorization requests for medical necessity, appropriateness of care, and benefit eligibility. This position reviews applicable guidelines regarding payment and coverage...Work at officeWork from homeHome officeMonday to Friday
- ...recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an... ...include evaluating healthcare services and coordinating care for members. Join a dynamic team and make a meaningful...Remote jobContract work
- ...Group is seeking an Inpatient Care Management Nurse to ensure proper utilization of health services by assessing member needs and coordinating care. Based in Phoenix, AZ with a fully remote work style, the role... ...acute settings and an active RN license. You will perform...Remote job
- SSM Health is seeking a Manager of RN Utilization Management to oversee system-wide UM activities... ...with strategic leadership to optimize care coordination, utilization review, and regulatory... ...continuum of care. The position is fully remote with a preference for candidates in...Remote jobWeekend work
- ...California is seeking a Supervisor of Utilization Management to oversee operations of the... .... You'll manage staffing, coordinate referrals, and facilitate team meetings. A California RN license is required. This... ...focuses on improving patient care and operational efficiency....Remote job
- IntusCare is seeking a Utilization Management (UM) Manager to lead the UM nurse team supporting a PACE... ...criteria across cases to optimize care and efficiency. The role blends hands-... ...staffing, coaching, QA, and cross-functional coordination with clients and the contracted...Remote job
- ...Performs care coordination services for assigned recipients who are eligible for home health services (Home Health Visits, PPEC, Personal... ...validate UR or forward to 2nd level reviewer. Provides first level utilization review for all inpatient and outpatient services requiring...Remote workContract work
$39.83 - $59.74 per hour
...Create Impact. Empathy and care are at the heart of North’s... ...bias. About this position The Utilization Management RN, under the supervision of... ...to assist with care coordination and support the delivery of... ...hours Call Requirement: None Remote or On-site:Hybrid Remote- Must...Remote workFull timeContract workFor contractorsFor subcontractorLive inWork at officeShift work$75.3k - $135.4k
...professional on our Medical Management/Health Services... ...ensure appropriate care to members.... ...-day activities of utilization management team. Monitors... .../Certification RN - Registered Nurse... ...Licensure required CA RN LICENSE REQUIRED... ...approach to work with remote, hybrid, field or...Remote workFull timePart timeWork at officeFlexible hours- ...seeking an experienced healthcare services leader to direct multidisciplinary teams in utilization management, care management, and behavioral health. The role emphasizes coordinating integrated care across the continuum while aligning with senior leadership on...Remote job
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