Remote RN: Pharmacy Pre-Cert & Utilization Review
Quantum
Quantum Corporation is seeking a Pre-Cert Pharmacy Review Nurse, RN for their healthcare navigation team. The role involves reviewing specialty medications and collaborating with multidisciplinary teams to ensure quality care for members, either on-site in Dublin, OH, or remotely within the United States. The ideal candidate will possess a Bachelor’s degree in nursing and at least two years of nursing experience, ideally with a focus on managed care. Strong critical thinking and communication skills are essential for this role. #J-18808-Ljbffr
$2,700 per week
...Lancesoft is seeking an experienced Utilization Review Registered Nurse for an exciting Travel... ...Pending License accepted: No Fully Remote Position Hospital Highlights Type of... ...Years of Experience Required: 1 year Certs Required: BLS, WA RN License #J-18808-Ljbffr...Remote workLocal areaImmediate startMonday to FridayShift workWeekend work$30 - $38 per hour
...A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment... ...per week with responsibilities such as providing reviews for pre-certification requests, processing appeals, and working...Remote workHourly payPart time$30 - $38 per hour
...Responsibilities Job Summary We are seeking Utilization Review Nurse RN to join our team on a part‑time basis,... ...for all outpatient and ancillary pre‑certification requests for medical... ...communication skills to successfully perform in a remote healthcare environment. Ability to...Remote workHourly payFull timePart timeWork at officeMonday to FridayWeekend work- A recruitment agency is seeking a Pre-Certification RN to evaluate clinical conditions and determine medical necessity for services. This remote position requires an active RN license in PA or a Compact license, along with a minimum of 3 years of acute care clinical experience...Remote job
- ...Medix™ is seeking an experienced RN for a Utilization Review role, allowing you to work from the comfort of home. In this contract-to-hire position, you'll review inpatient treatment plans and communicate with medical teams to ensure appropriate care levels. Ideal candidates...Remote workContract workWork from home
- ...Industrial Asset Management Council, Inc is looking for a Remote RN to join their team. The role requires 2 years of RN experience and Utilization Review expertise, supporting various units in a clinical review capacity. This work-from-home position offers flexible scheduling...Remote workWork from homeFlexible hours
- ...Health Plans, Mail Order Pharmacies, Medical Billing... ...of treatment setting by utilizing the applicable medical... ...services denied. Conducts pre-certification, inpatient... ...appropriateness of treatment setting reviews to ensure compliance... ...have clear and active RN license in the state of...Private practiceImmediate start
- ...100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals... ...Registered Nurse with Utilization Review experience professional looking... ...: As the Utilization Review RN, you would be responsible for... ...years of experience in UM, UR, pre-authorization, concurrent...Private practiceMonday to Friday
$30 - $32 per hour
...: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories... ...an experienced Registered Nurse with Utilization Review or Concurrent Review experience looking... ...you! Daily Responsibilities: Conducts pre-admission, concurrent and retrospective...Private practiceWeekend workWeekday work$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX Agency: Mindlance Health Pay: $35 to $45 per hour Shift... ...and quarterly member contact and will include 80% travel. Remote role. Will require a driver’s license. Member...Remote workHourly payFull timeContract workImmediate startShift work3 days per week$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX Agency: Mindlance Health Pay: $35 to $45 per hour Shift... ...and quarterly member contact and will include 80% travel. Remote role. Will require a driver’s license. Member...Remote workHourly payFull timeContract workImmediate startShift work3 days per week- ...CVS Health is looking for a highly skilled Utilization Management Nurse (RN) for a remote position. In this role, you will ensure patients receive appropriate healthcare services through reviews of clinical cases and collaboration with providers. The ideal candidate will...Remote work
$55.24 - $92.02 per hour
Utilization Review—RN US-Remote Requisition ID: 2026-39874 Position Category: Nursing - Care Management Job Type: ONA union represented Position... ...Specifically, the UM Nurse does the following: Reviews pre‑admissions for correct classification and admission order....Remote workHourly payFull timePart timeWork at officeNight shiftWeekend work3 days per week- ...A healthcare staffing firm is seeking a skilled Utilization Review RN to join their team. This fully remote position requires a valid PA RN license and prior experience in insurance utilization review. Responsibilities include conducting clinical reviews, applying evidence...Remote work
- ...NeuroPsychiatric Hospitals is seeking a Utilization Review Nurse (RN) to coordinate patient services across multiple hospitals. The role supports... ...collaborating with teams for better outcomes. Located remotely with a preference for candidates in Indiana, Michigan, or...Remote work
$60.2k - $107.4k
...Stryker Corporation is looking for a Utilization Review Nurse, RN, based in California. As part of this role, you'll manage inpatient utilization... ...clinical guidelines. The position offers the flexibility of remote work within the U.S., alongside responsibilities like...Remote work- ...Humana is offering a remote internship opportunity for a Utilization Management Behavioral Health Registered Nurse (RN). This role is part of the DOW SkillBridge Internship and is... ...military spouses. Interns will conduct clinical reviews, communicate with providers, and document...Remote workInternship
$69.38k - $92.28k
...MVP Health Care seeks a Professional Concurrent Review RN to ensure members receive appropriate care while navigating the healthcare... ...Ideal candidates are experienced RNs looking to transition into utilization management, requiring strong clinical judgment and excellent communication...Remote work- COMAGINE HEALTH is seeking Clinical Utilization Review Nurses (RN) for a full-time remote position focused on assessing the medical necessity of healthcare services in Alabama. Candidates must hold an active RN license and possess a BA/BS in nursing, alongside a minimum...Remote workFull time
$2,210 per week
...Paid Holidays Work-life balance. Remote/hybrid setting (once trained)... ...: This individual will utilize clinical knowledge and communication... ...decision to a second level reviewer. This individual interfaces with... ...includes but is not limited to RN, LMSW, LMHC. Successful...Remote workFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours- ...BJC HealthCare (New) is seeking a remote RN with Utilization Review experience. This role involves evaluating the appropriateness and efficiency of hospital resources to ensure quality patient care. Candidates must have 2 years of RN experience and live within one hour...Remote work
- ...Village Center for Care, Inc. is seeking a self-motivated RN for the role of Utilization Review Nurse in a full-time, hybrid position located in the New York Tri-State Area. The successful candidate will be responsible for assessing member needs and ensuring high-quality...Remote workFull time
$23.76 - $51.49 per hour
...Molina Healthcare is seeking a Registered Nurse (RN) to support clinical member services review and assessment processes. This role involves analyzing... ...hourly pay range between $23.76 and $51.49 and requires adherence to utilization management policies. #J-18808-LjbffrRemote workHourly pay- ...oversee high-quality, patient-centered care through Utilization Review. The role requires an active RN license in Illinois and significant experience in healthcare... ...providers. This position offers the flexibility of remote work while supporting professional growth and a...Remote work
- ...Humana is offering a remote internship for a Utilization Management Behavioral Health Registered Nurse (RN) Intern. This role supports the National Medicaid team, focusing on clinical reviews and patient care. Candidates must be transitioning military service members...Remote workInternshipWork at officeWeekday work
- ...Description We are seeking an experienced Utilization Review Nurse to join our team in a hybrid role... ..., Nassau County (Hybrid: In Office/Remote) Schedule: Monday to Friday, 8:30 AM - 5... ...coordination meetings. Qualifications Active RN license in the state of New York....Remote workWork at officeMonday to FridayFlexible hours
$47.06k - $70.24k
A healthcare solutions provider is seeking a Utilization Review Nurse in Fort Worth, TX. This remote role involves analyzing medical bill appropriateness, documenting... ...claims examiners. Candidates must have a current RN license and at least four years of clinical...Remote work- ...TurningPoint Healthcare Solutions is seeking a Utilization Review Nurse to join their team in a fully remote role. The ideal candidate must be a Licensed Nurse Practitioner (LPN) or Registered Nurse (RN) with strong critical thinking skills and attention to detail. The...Remote work
- ...in Nevada seeks a Supervisor, Clinical Review to supervise clinical staff conducting utilization reviews. Ideal candidates will have an active RN licensure in Alabama, with 3+ years of... ...skills are crucial. The position offers a remote work option along with comprehensive...Remote work
$75k
...WNS Global Services is seeking a fully remote Utilization Review Nurse to perform inpatient reviews and ensure compliance with medical necessity... ...communicate effectively with physicians. The ideal candidate has an RN license, at least two years of experience in acute care, and...Remote workWork at office
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