Remote RN Reviewer: Utilization & Quality Review
HCSC Group
New York, NY
- Remote job
Health Care Service Corporation is hiring a Nurse Liaison I for Utilization Management & Quality Review. This remote nationwide role supports clinical review activities, benefit determinations and medical necessity assessments, ensuring compliant, well-documented coverage decisions. The position requires an RN with an unrestricted license, 3 years of clinical experience (2 in UM/QR), strong analytical and communication skills, and willingness to travel with a valid Illinois driver’s license. #J-18808-Ljbffr HCSC Group
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote RN Reviewer: Utilization & Quality Review in New York, NY vacancy
- ...Health Care System is seeking a Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer to coordinate the efficient utilization of... ...care resources for CCHP members and ensure timely, quality care throughout the continuum.Working with the Department...Remote jobQuality
- Location Remote - TX Department Utilization Shift First Shift (United States of America) Standard Weekly... ...to assure the timely provision of quality care throughout the continuum of care... .../Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate...Remote workQualityShift workDay shift
- ...the Cleveland Clinic Health System team, and The Power of Every One. Job Title Utilization Management RN Reviewer Location Cleveland Facility Remote Location Department Utilization And Quality Assur-Weston Hospital Job Code 000446 Shift Days Schedule 7:30am-4:00pm Job...Remote workQualityFull timeWork at officeShift workWeekend work
- Coastal Care Services, Inc. is seeking an LPN licensed Utilization Management Nurse Reviewer for a work-from-home opportunity serving the Miami, FL area... ...physicians, patients and families to assure cost-effective, high-quality #J-18808-Ljbffr Coastal Care Services, Inc.Remote jobQualityWeekday work
- ...Role Overview Our Utilization Management Reviewers evaluate medical necessity for inpatient... ...turnaround times, quality benchmarks, and efficiency... ...Ability to obtain additional RN licensure across the enterprise... ...work solutions include remote options, hybrid work schedules...Remote workQualityMonday to FridayFlexible hoursWeekend work
AmeriHealth Caritas
Newtown Square, PA1 day ago - ...As a Behavioral Health Utilization Management Reviewer , you'll play a vital role... ...coordination activities that promote quality, cost-effective, evidence-... ...– this position is fully remote. Candidate must hold... ...Psychologist Registered Nurse (RN) with behavioral health...Remote workQualityHourly payFull time
Baystate Health
United States1 day 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... ...is a unique opportunity to work from home while contributing to quality medical reviews. #J-18808-Ljbffr...Remote workQualityFull timeWork from home
ExamWorks
United States1 day ago - ...Great Place to Work" company is seeking a Physician to provide utilization review services for the Group Health Department. This role... ...cases on or before the due date and time. Assist with quality assurance of reports prior to submission to clients. Maintain...Remote workQuality
Dane Street
United States3 days ago - Comagine Health is seeking a Clinical Reviewer with LCSW/LPC/LCPC licensure for a remote, Oregon-based role requiring... ...populations. The position emphasizes utilization review, documentation, and... ...with stakeholders while supporting quality initiatives. #J-18808-Ljbffr Comagine...Remote jobQualityWork from home
- Comagine Health is seeking a Clinical Reviewer to work remotely from Oregon with travel across the... ..., ensuring timely decisions and high-quality care. The role requires licensure, 3... ...behavioral health, and familiarity with utilization review. #J-18808-Ljbffr Comagine HealthRemote jobQuality
$219k - $286.9k
...Remote Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around a full stack... ...medical reviews that meet Oscar's stringent quality parameters. Provide clinical...Remote workQualityFull timeFor contractorsLocal areaWork from homeRelocationHome officeWeekend workOscar-Health-
Arizona14 hours ago- ...nationally recognized Independent Review Organization (IRO), is expanding its... ...Compensation Board Certification to conduct Utilization Reviews. This is a fully remote, non-clinical role offering... ...physicians to ensure high-quality, evidence-based clinical decisions...Remote workQualityPrice workExtra incomeFor contractorsFlexible hours
$230k
...ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something... ...time. Company: Oak Street Health Title: Utilization Management Physician Reviewer Location: Fully Remote Hours: full time, Monday - Friday, 8am -5pm...Remote workQualityHourly payFull timeLocal areaMonday to FridayCVS Health
United States1 day ago$52 - $56 per hour
...that uses both. We're hiring a contract RN for a New York health plan (Medicare... ...necessity judgment you built in utilization management. 100% remote (U.S.) | Contract | $52-$56/hr based... ...end: intake, investigation, clinical review, decision and notification Apply medical...Remote jobContract workAfternoon shift- Oak Street Health is seeking a Utilization Management Physician Reviewer for a fully remote, full-time role. You will apply UM criteria and clinical judgment to... ...guidelines. Benefits are competitive and focused on quality care. #J-18808-Ljbffr Oak Street Health, part of...Remote jobQualityFull time
- ...nationally recognized Independent Review Organization (IRO), is... ...medical necessity of services Utilize state-specific workers’ compensation... ..., supplemental income Fully remote - work from anywhere You control... ...physicians to ensure high-quality, evidence-based clinical decisions...Remote workQualityPrice workExtra incomeFor contractors
$68.64k - $72.8k
...Opportunity Overview: The RN Reviewer position is a crucial role... ...to ensure appropriate, high-quality care Collaborate with Medical... ...collaboration skills across remote teams Customer-focused... ...Solid understanding of utilization and case management programs...Remote workQualityHourly payFull timeFlexible hoursShift workWeekend work- In this remote contract role, the physician reviews clinical service requests from members and providers, applying... ..., procedures, and continuous quality improvement activities. Provide clinical... ...review. Preferred Experience in utilization review, case review, or related...Remote workQualityFull timeContract workWeekend workWeekday work
- Utilization Reviewer (RN)- Full Time, Days, 8 AM - 4 PM, Morristown Morristown, NJ, United States Trending Job Description 1.Provides timely... ...who enters one of our facilities will receive the highest quality care delivered at the right time, at the right place, and at...QualityHourly payFull timeTemporary workPart timeFor contractorsFor subcontractorFlexible hoursShift work
$65k - $85k
...Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning... ...and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team... ...Managers, and field clinicians Support quality assurance and regulatory compliance...Remote workQualityMonday to FridayWeekend workWeekday workConcierge Home Care
United States1 day ago- PruittHealth is seeking a PRN Registered Nurse (RN) ICD-10 and Oasis Reviewer to join PruittHealth @Home. The role... ...and ICD-10 certification, with remote home health work available in GA/SC/... ...and Oasis reviews to ensure high-quality outcomes. The ideal candidate brings...Remote jobQualityReliefWork from home
$45 - $50 per hour
...for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical... ...nursing programs with an active New York RN license. #J-18808-Ljbffr kozmetickesluzby...Remote jobQualityHourly pay- ...Details POSITION SUMMARY - RN Utilization Review POSITION DUTIES - Review patient... ...-based) ~ Skilled experience with remote work LENGTH OF ASSIGNMENT -... ...helping healthcare organizations provide quality patient care that continually evolves...Remote workQualityTemporary workShift workWeekend work
Trinity Clinics AMN
Fort Myers, FL2 days ago - PruittHealth Corporation is seeking a Registered Nurse (RN) ICD-10 and Oasis Reviewer for home health services. This REMOTE role requires you to reside in GA, NC, or SC and... ...care under the Oasis process, ensuring quality patient outcomes in home settings while aligning...Remote jobQuality
- American Health Plans in Franklin, TN is seeking a Utilization Review Nurse to assess medical necessity and quality of care across pre-service, concurrent, and... ...access to necessary services. This role requires an RN license, experience in utilization management, knowledge...Remote jobQuality
- Guidehealth is seeking a Utilization Management Registered Nurse (RN) for a fully remote, full-time position. The role involves... ...medical necessity criteria to reviews, documenting findings, and interfacing... ..., and participation in quality initiatives. #J-18808-Ljbffr GuidehealthRemote jobQualityFull time
- PruittHealth @Home is seeking a PRN Registered Nurse (RN) ICD-10 and Oasis Reviewer for remote home health services. Must live in Georgia, North Carolina... ...a leading post-acute care provider and help deliver quality care where patients choose to be. The team emphasizes preceptorship...Remote jobQualityReliefLive inFlexible hours
$47.03 - $63.48 per hour
...mission of redefining the possible in healthcare. The RN, Senior Utilization Review Quality will play an essential role in reviewing and ensuring... ...and improve patient and client experiences This is a remote position; however, candidates must be willing and able...Remote workQualityTemporary workWork at officeLocal area$63.1k - $94.65k
...next steps. Our partner is looking for a Utilization Review RN based in the United States. Join... ...operations. In this part-time, remote role, you will apply your clinical expertise... ...denials. You will also contribute to quality improvement initiatives, regulatory compliance...Remote workQualityTemporary workPart timeWork at officeWork from homeFlexible hoursShift workAfternoon shiftJobgether
United States1 day ago- Medix™ is seeking an experienced Registered Nurse (RN) to join our Utilization Review team in a remote capacity. The role evaluates medical necessity, reviews... ...utilization and regulatory compliance, while delivering high-quality patient outcomes. #J-18808-Ljbffr Medix™Remote jobQuality
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN Reviewer: Utilization & Quality Review. Be the first to apply!
Related searches