Remote Utilization Management Clinician for Impactful Care
PacificSource
- Remote job
PacificSource Utilization Management Clinician is sought to support members remotely from Florida, Tuesday through Saturday. You will collaborate with physicians, nurses, social workers and other professionals to coordinate care, assess benefits, and promote cost-effective utilization. The role requires a RN or related license, 3 years nursing/behavioral health experience, and knowledge of ICD/CPT codes. You will document case notes, perform concurrent reviews, and assist with discharge planning #J-18808-Ljbffr PacificSource
- Vālenz Health® is seeking a Utilization Management Nurse for a fully remote role. You will oversee and manage UM processes to ensure appropriate, necessary, and cost-effective care for plan participants, reviewing prospective, concurrent, and retrospective reviews. You...Remote job
$29.1 - $62.32 per hour
...Registered Nurse (RN) – Utilization Management Make a difference in healthcare from a clinical review and care coordination perspective. We are seeking an experienced Registered... ...strong RN looking to expand your impact beyond direct patient care, we'd love to hear...Remote workHourly payFull timeTemporary workWork at officeWork from homeAfternoon shift$32.01 - $68.55 per hour
...Registered Nurse (RN) – Utilization Management Join a dynamic healthcare team and make an impact on patient care from wherever you work. We are seeking an experienced Registered Nurse (RN) to support our 24/7 Utilization Management operations. In this role, you will...Remote workHourly payFull timeTemporary workWork at officeWork from homeAfternoon shift- ...is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will... ...healthcare services and coordinating care for members. Join a dynamic team and make a meaningful impact in patient advocacy while maintaining a...Remote jobContract work
$29.1 - $62.32 per hour
...Registered Nurse (RN) – Utilization Management Remote | Afternoon/Evening Shifts Available | 24/7 Operations Are you an... ...helping ensure members receive the appropriate care and benefits while making a meaningful impact on healthcare outcomes. What You'll Do...Remote workHourly payFull timeTemporary workWeekend workAfternoon shift$85k - $105.34k
...Utilization Review Nurse Remote Ability to travel on-site to 3031 NE Stephens St... ...community-driven Coordinated Care Organization (CCO)... ...Purpose The Utilization Management Nurse evaluates clinical service... ...in making a meaningful impact, empowering healthier lives...Remote workFull timeWork at officeLocal areaImmediate startMonday to Friday$39 - $40 per hour
...Recruiter at The Judge Group Utilization Management Registered Nurse (RN) Type:... ...Contract W2 Location: Remote - but MUST reside in one of... ...healthcare services, coordinating care, and ensuring members... ...Ready to make a meaningful impact—without sacrificing work-life...Remote workDaily paidContract workMonday to FridayShift workWeekend work$94.9k - $130.5k
Become a part of our caring community The Manager, Utilization Management Nursing utilizes clinical nursing skills... .... Use your skills to make an impact Required Qualifications Active Licensed... ...basic technical difficulties in a remote environment. Ability to work...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome office$26.01 - $68.55 per hour
Utilization Management Nurse - Precertification RN Remote | Full-Time | Weekday Schedule Are you a clinically strong Registered... ...appropriate, high-quality care through the precertification process... ...expertise in a non-bedside role Make an impact on healthcare quality and member...Remote workHourly payFull timeTemporary workLocal areaWeekday work- ...Job Description Job Description Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We are looking for a nurse just like... ...stays, outpatient surgeries, outpatient tests, care, etc. Review requests and match up to an...Remote workFull timeWork at office
- ...Utilization Manager Registered Nurse (UMRN) Spectrum Healthcare Resources has a need for a Utilization... ...Nurse (UMRN). These will be completely remote positions, working entirely from the... ..., educating patients on appropriate care and managing health care costs for the...Remote workFull timeContract workWork at officeWork from homeMonday to Friday
$72.8k - $130k
...Sr Utilization Management Nurse Optum is a global organization that delivers care, aided by technology to help millions of people live healthier... ...opportunities. Come make an impact on the communities we serve... ...occasional opportunity for remote work based on business needs....Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home role in the EST time zone. The position... ...necessity, coordinating with providers, and ensuring timely care while meeting state and federal requirements. Strong documentation...Remote jobWork from home
$85.7k - $128.54k
...breaking the mold in conventional health care, committed to serving seniors and those... ...for growth and innovation. Utilization Management Nurse Lead Responsibilities Reviews reporting... ...other pertinent information that would impact the overall program compliance or achievement...Remote jobImmediate start$248.5k - $373k
...medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that is changing the way clinicians work... ...together.You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some...Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home- CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home, full-time position open to MST/PST residents... ...activities, ensuring timely, safe, and appropriate care for members. In this role you will review medical necessity,...Remote jobFull timeWork from home
- ...Texas is seeking a BCBA with LBA in good standing to provide direct care and clinical oversight in a collaborative, pediatric setting.... ...settings, supervising RBTs and developing individualized plans. Remote-friendly elements include three work-from-home days monthly,...Remote workWork from homeMonday to Friday
- PacificSource is seeking an RN/case-management oriented professional to collaborate with physicians, nurses, social workers and... ...healthcare services for members. You will assess benefits and utilization, document care plans, and support discharge planning across inpatient,...
- ...Licensed UM Nurse for a full-time remote position, who will review... ...necessity, apply CMS and Milliman Care Guidelines, and collaborate... ...additional expertise is needed Utilize CMS guidelines and Milliman... ...pre-service UM experience in a managed care environment Active, valid...Remote workFull time
- ...Utilization Management Registered Nurse (UM RN) We're seeking a dedicated and detail-oriented Utilization... ...while supporting transitions of care and ensuring patients receive appropriate... ...(LCD/NCD policies). This is a fully remote opportunity requiring discipline, accuracy...Remote work
- Netsmart is seeking a Registered Nurse with solid utilization management experience to perform ED utilization reviews and admissions screening... ...authorization. The successful candidate will bring 3+ years of acute care experience, knowledge of InterQual/MCG guidelines, and...Remote job
$100k
...Date Opened 02/28/2026 Job Type Contract Industry Health Care Work Experience 1-3 years Salary $100,000 Remote Job Job Description This is a remote position. The Utilization Management (UM) Nurse is responsible for conducting clinical reviews and assessing...Remote workContract workWork experience placement- ...Hospital is seeking a licensed practical nurse to join BHPS Utilization Management as a remote reviewer of medical necessity and benefit determinations.... ...ability to work independently in a fast-paced managed care environment. #J-18808-Ljbffr Santa Barbara Cottage HospitalRemote job
- ...About The Role BHPS provides Utilization Management services to its clients. The Utilization Management... ...’s benefit coverage while working remotely. Primary Responsibilities •... ...ensure timely review of services and care. • Provides referrals to Case management...Remote workContract workWork at office
- Appworkshub is seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this role, you will conduct... ...utilization reviews, support transitions of care, and ensure compliance with Medicare Advantage regulations...Remote job
- Valenz, a remote-first health services platform in the United States, seeks a Utilization Management Nurse to oversee the UM process for plan participants, ensuring appropriate, necessary, and cost-effective care. You will review prospective, concurrent, and retrospective...Remote job
- Valenz Health is seeking a Utilization Management Nurse to oversee and manage the UM process, ensuring... ...of high-quality, cost-effective care for plan participants. You will review... ...URAC, and other regulators. This fully remote role requires a US-based location, strong...Remote job
- ...is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Utilization Management and Clinical Validation RN will review patient... ...and guidelines. This role is remote from anywhere in the U.S. with an unrestricted...Remote job
- ...seeking a Registered Nurse for a temporary Utilization Management role. You will ensure prior... ...comply with contracts and participate in UM care programs. Required are an active CA RN... ...substitute for experience. Hybrid work and remote- interview options are offered. #J-188...Remote jobTemporary work
$59.5k - $116.6k
UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services... ...requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate will...Remote jobWeekend work
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