Remote Utilization Management RN — Health Plan
WPS Health Solutions
- Remote job
WPS Health Solutions in the United States is seeking an experienced Utilization Management RN to evaluate medical necessity and authorize services for our Health Plan. This role uses clinical judgment and evidence-based criteria to support quality care while controlling costs. Remote work is available in many states; expect collaboration with Medical Directors, documentation of case summaries, and monitoring the Utilization Management queue to meet productivity standards. #J-18808-Ljbffr WPS Health Solutions
- ...healthcare recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an active RN license and experience with health plan operations. Responsibilities include evaluating healthcare...Remote workHealth InsuranceContract work
- ...Summary ~ Samaritan Health Plans (SHP) provides health insurance... ...Communities Together. This is a remote position in which we are... ...experience: ~ ~ Health plan utilization management ~ Medicare and Medicaid... ...Current unencumbered Oregon RN License required within 90...Remote workHealth Insurance
- WPS Health Solutions is seeking an Utilization Management RN to evaluate medical necessity and efficiency for health plan services. The role involves authorizing appropriate services and escalating... ...are not met. The position supports remote work in approved states, including...Remote jobHealth Insurance
- WPS Health Solutions is seeking an experienced Utilization Management RN to evaluate medical necessity, authorize services, and coordinate... ...patient care for our Health Plan. You will review cases against... ...to medical directors. This remote-friendly role requires strong clinical...Remote jobHealth Insurance
- TEXAS INDEPENDENCE HEALTH PLAN INC is hiring a Utilization Management Nurse to work remotely in Texas. This position requires evaluating inpatient and outpatient services, ensuring compliance with CMS requirements, and collaborating with healthcare professionals. The ideal...Remote jobHealth Insurance
$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... ...ideal for a nurse with recent experience in health plan operations and utilization review. You will...Remote workHealth InsuranceDaily paidContract workMonday to FridayShift workWeekend work- WellSense Health Plan is seeking an Inpatient Utilization Management Clinician to evaluate inpatient treatments, ensuring medical... ...health outcomes. This fully remote role involves supporting care transitions... .... Candidates must have an active RN license and at least 2 years of...Remote jobHealth Insurance
$35 - $40 per hour
...offerings for clinical, case management, member engagement,... .... Job title: RN Utilization Management Reviewer... ...Supports (LTSS), and Home Health (HH) Applies... ...clinical teams on service planning as needed Works... ...This is a fully remote work at home role. You...Remote workHealth InsuranceHourly payTemporary workCurrently hiringMonday to FridayFlexible hoursWeekend work$75k - $100k
Description Our Utilization Management RN (Registered Nurse) evaluates efficiency, appropriateness... ...medical services, and procedures for our Health Plan. This role uses clinical knowledge to... .... Work Location We are open to remote work in the following approved states...Remote workHealth InsuranceFor contractorsWork at officeLocal areaImmediate start$39.83 - $59.74 per hour
...Utilization Management RN Robbinsdale, MN Posting Date: Jul 10 2026... ...13995 Why North Memorial Health? At North Memorial Health... ...Retirement Match or Pension Plan, based on workgroup eligibility... ...Call Requirement: None Remote or On-site: Hybrid Remote-...Remote workHealth InsuranceFull timeContract workPart timeFor contractorsFor subcontractorLive inWork at officeShift workWeekend work$39.83 - $59.74 per hour
...Our health system encompasses two hospital locations in Robbinsdale... ...Retirement Match or Pension Plan, based on workgroup... ...bias. About this position The Utilization Management RN, under the supervision of the... ...hours Call Requirement: None Remote or On-site: Hybrid Remote- Must...Remote workHealth InsuranceFull timeContract workFor contractorsFor subcontractorLive inWork at officeShift work$34.98 - $42.85 per hour
...Utilization Management Nurse I, RN Huntington Beach Office - Huntington Beach, CA 9... ...Full Time Description Remote in California only Are... ...growing Medicare Advantage plans with an incredible 112%... ...business. Clever Care Health Plan is proud to be an Equal...Remote workHealth InsuranceHourly payFull timeWork at office- ...Brighton Health Plan Solutions, LLC is seeking an Utilization Management Nurse to perform medical necessity reviews remotely. Licensed LPN with strong MS Office skills will review clinical criteria, coordinate with care partners, and document determinations in compliance...Remote workHealth Insurance
- ...Centene Corp. is seeking a Supervisor, Utilization Management (RN) to lead and supervise our Clinical Review team. This role focuses on ensuring... ...offers competitive pay and comprehensive benefits including health insurance, 401K, and flexible work arrangements. #J-18808-Ljbffr...Remote workHealth InsuranceFlexible hours
- ...company in Washington is seeking a Utilization Management Nurse Reviewer. The role involves assessing... ...offers a competitive salary range, remote work options, and a comprehensive benefits package including health insurance, retirement plans, and performance bonuses. #J-18808-...Remote workHealth Insurance
- ..., and monitoring the utilization of behavioral health (BH) or physical health... ...closely with Case Management to address member needs... ...departmental needs. Plans, implements, and... ...degree and active NYS RN license required. Bachelor... ...be opportunity for remote work within all jobs...Remote workHealth InsuranceContract workWork at office
- ...tuition assistance, 403(b), remote work United States,... ...: Johns Hopkins Health Plans, Hanover, MD 21076 Category... ...AM - 5:00 PM As a Utilization Review Registered... ...to use your clinical, managed care, utilization... ...Unencumbered Registered Nurse (RN) license in Maryland (...Remote workHealth InsuranceFull timeMonday to FridayDay shift
$71.1k - $97.8k
...Job Summary The Utilization Management Registered Nurse uses clinical... ...Facility (SNF), Home Health, and Durable Medical... ...Compact Registered Nurse (RN) license in your state... ...review for a health plan or acute care setting.... ...working in a fully remote, metrics‑focused role....Remote workHealth InsuranceBi-weekly payTemporary work$40 per hour
...Job Title: Utilization Management LPN Allmed Benefits: Vision Insurance, Health Insurance, Dental Insurance and 401(k) Pay Rate: $... ...maintaining compliance with health plan and regulatory requirements.... ...Ability to work independently in a remote environment Additional...Remote workHealth InsuranceWeekly payContract workCasual workMonday to Friday$2,210 per week
...leader in personalized managed health care, focused on what's... ...spending also available! 401k plan with company match,... ...Work-life balance. Remote/hybrid setting (once trained... ...: This individual will utilize clinical knowledge and... ...but is not limited to RN, LMSW, LMHC. Successful...Remote workHealth InsuranceFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours$45k - $70k
A healthcare management firm is seeking a Utilization Management Nurse Reviewer to ensure efficient use of medical services. The role involves... ...,000 to $70,000 USD and includes benefits such as health insurance, 401k plans, and paid time off. #J-18808-Ljbffr Dane Street,...Remote jobHealth Insurance- Brighton Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate with partners, and ensure timely, compliant documentation and communications with...Remote jobHealth InsuranceWork at office
- ...Corporation is looking for a Utilization Review Supervisor RN to direct operations in... ...Cucamonga. The role includes managing day-to-day operations,... ...handling HR matters. This remote position requires strong communication... ...include comprehensive health coverage and 401K options....Remote jobHealth Insurance
$70k - $75k
Guidehealth seeks an experienced Utilization Management Registered Nurse to perform UR activities and document... ...ensuring timely, compliant reviews. Remote work option; salary range $70,000-$75,000 annually. Benefits include health coverage, 401(k) match, PTO, parental leave...Remote jobHealth Insurance- The Council of State and Territorial Epidemiologists is seeking a Clinical Utilization Review Nurse (RN) to conduct utilization management reviews remotely. Candidates must hold a BA/BS in Nursing, possess a current RN license, and have a minimum of 3 years of clinical...Remote jobHealth InsuranceFull time
$75.3k - $135.4k
...Clinical Review Supervisor for its Medical Management/Health Services team in New York. The role involves overseeing the utilization management team, ensuring quality and regulatory... ...must have a nursing degree and valid RN licensure, along with at least four years of...Remote jobHealth InsuranceFlexible hours- Comagine Health is seeking a Clinical Manager, Care Management to lead a team in utilization management from a fully remote position in the U.S. The ideal candidate will have extensive experience in clinical settings and will be responsible for clinical quality, operational...Remote jobHealth Insurance
$75.3k - $135.4k
...professional on our Medical Management/Health Services team. Centene... ...-to-day activities of utilization management team.... ...License/Certification RN - Registered Nurse - State... ...1K and stock purchase plans, tuition reimbursement... ...approach to work with remote, hybrid, field or...Remote workHealth InsuranceFull timePart timeWork at officeFlexible hours$85k - $105.34k
...UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3... ...Exempt About Umpqua Health At Umpqua Health,... ...The Utilization Management Nurse evaluates clinical... ...with Oregon Health Plan (OHP), Medicare, and... ...Active, unrestricted RN license (BSN or MSN)...Remote workHealth InsuranceFull timeWork at officeLocal areaImmediate startMonday to Friday- Centene is seeking a Supervisor of Utilization Management to lead the Prior Authorization,... ...regulatory compliance. The position offers remote work in Missouri with a full-time day shift, competitive pay, health insurance, 401K and stock plans, tuition reimbursement, paid time...Remote jobHealth InsuranceFull timeDay shift
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