Remote RN: Medical Review & Utilization Auditor
$29.05 - $67.97 per hourMolina Healthcare of Illinois
- Remote job
Molina Healthcare in Cincinnati, Ohio, seeks a Clinical Reviewer to leverage clinical knowledge for ensuring medical necessity and appropriate levels of care. You will handle clinical reviews regarding documentation and claims, particularly for denied authorizations. Ideal candidates will have at least 2 years of clinical nursing experience, including utilization review, and an active RN license. Molina offers competitive compensation and benefits, with pay ranging from $29.05 to $67.97 hourly. #J-18808-Ljbffr Molina Healthcare
$29.05 - $67.97 per hour
...Healthcare is seeking a Clinical Nurse Reviewer in Albany, NY, responsible for reviewing medical documentation to ensure medical... ...Candidates must hold an active RN license and have at least 2... ...nursing experience, particularly in utilization review. Molina offers...Remote jobMedicalHourly pay$29.05 - $67.97 per hour
...Antonio, Texas, to join their team for clinical review responsibilities involving medical necessity and claims processing. This role... ...nursing experience and knowledge in utilization review. Candidates must hold an active RN license and demonstrate proficiency in billing...Remote jobMedicalHourly pay$29.05 - $67.97 per hour
...seeking a qualified clinical review professional in Louisville, Kentucky, focused on ensuring medical necessity and reimbursement accuracy... ...must possess an active RN license and at least 2 years of... ...nursing experience, including utilization review and medical claims review...Remote jobMedicalHourly pay- ...clinical professional in Miami to perform utilization reviews and ensure proper coding for... ...regulations. The candidate will evaluate medical claims and facilitate appeals, contributing... ...assurance and regulatory compliance. An active RN license is essential, along with...Remote jobMedical
$80k - $90k
...Responsibilities*** Performs clinical reviews on medical records to maintain subject... ...necessary.* Experience with utilization management systems or... ...to work independently in remote setting with minimum supervision... ...*** Active unrestricted RN license #J-18808-Ljbffr...Remote workMedicalFlexible hours- ...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... ...'ll review inpatient treatment plans and communicate with medical teams to ensure appropriate care levels. Ideal candidates...Remote workMedicalContract workWork from home
- 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 workMedicalFull time
- ...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... ...flexible scheduling with benefits that include medical, dental, and retirement contributions...Remote workMedicalWork from homeFlexible hours
- ...BJC HealthCare (New) is seeking a remote RN with Utilization Review experience. This role involves evaluating the appropriateness and efficiency of... ...offers comprehensive benefits from the first day, including medical, dental, and retirement contributions. Ideal candidates...Remote workMedical
$47.06k - $70.24k
...healthcare solutions provider is seeking a Utilization Review Nurse in Fort Worth, TX. This remote role involves analyzing medical bill appropriateness, documenting findings,... ...claims examiners. Candidates must have a current RN license and at least four years of clinical...Remote workMedical- ...We are seeking an experienced Utilization Review Nurse to join our team in a... ...Nassau County (Hybrid: In Office/Remote) Schedule: Monday to Friday,... ...to ensure appropriate use of medical resources. Evaluate patient... ...meetings. Qualifications Active RN license in the state of New...Remote workMedicalWork at officeMonday to FridayFlexible hours
$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 requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Remote workMedicalHourly payPart time$75k
...WNS Global Services is seeking a fully remote Utilization Review Nurse to perform inpatient reviews and ensure compliance with medical necessity criteria. This role requires strong... ...with physicians. The ideal candidate has an RN license, at least two years of experience...Remote workMedicalWork at office$30 - $34 per hour
...healthcare services company is seeking an experienced Utilization Review Nurse to work remotely. The ideal candidate must hold an active LVN license in... ...management. Responsibilities include approving or denying medical services based on established criteria. Competitive...Remote workMedicalHourly pay$75k
...seeking a dedicated Registered Nurse for inpatient utilization review responsibilities. This role requires performing medical necessity reviews and collaborating with... ...informed decisions. Candidates must hold an active RN license and have experience in acute care settings...Remote workMedical$2,210 per week
...and benefits, including medical, dental, vision, long-... ...Holidays Work-life balance. Remote/hybrid setting (once... ...: This individual will utilize clinical knowledge and... ...to a second level reviewer. This individual interfaces... ...but is not limited to RN, LMSW, LMHC. Successful...Remote workMedicalFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours- ...Epidemiologists is seeking a Clinical Review Supervisor to provide... ...supervision of clinical staff conducting utilization review activities. This fully remote position requires an RN license and relevant experience in patient care and medical management. The role focuses on...Remote workMedical
$75k
...seeking a Registered Nurse for the role of Utilization Review Specialist. The position involves... ...Successful candidates must possess an active RN license and have at least two years of... ...annually, with additional benefits including medical, dental, and paid time off. #J-18808-...Remote jobMedical- Humana is seeking a Utilization Management Behavioral Health Registered Nurse (RN) Intern to join their National Medicaid... ...role involves conducting medical necessity reviews for behavioral health services... ...license. This position supports remote work, providing work-life...Remote jobMedicalInternship
$78.5k - $90k
...to health plans. The Medical Review Nurse (Home Health) primarily... ...experienced medical auditors and coders performing... ...00 – $90,000. Work is remote in a fast paced... ...Abilities Experience with utilization management systems or... ...Qualifications Active unrestricted RN license in good...Remote workMedicalFor contractorsWork at officeHome officeShift work$57.28 - $88.92 per hour
...Description RN Utilization Review - Remote. This position is Per Diem and will work 8-hour, Day shifts. Provide prospective, retrospective... ...CA ministries. Conduct clinical reviews and review medical records daily during admission for all payers, as required...Remote workMedicalDaily paidMinimum wageLocal areaShift workDay shift$51.43 - $79.84 per hour
...Overview Description – This is a remote role. You MUST live in the state... ...to be considered. Care Manager RN, Per diem / On call, Day shift. The Utilization Review (UR) Nurse has a strong clinical... ...in Utilization Management (UM), medical necessity and patient status...Remote workMedicalDaily paidLive inShift workDay shift$30 - $38 per hour
...Responsibilities Job Summary We are seeking Utilization Review Nurse RN to join our team on a part‑time basis... ...assessments and review for the medical necessity of treatment requests and... ...skills to successfully perform in a remote healthcare environment. Ability to perform...Remote workMedicalHourly payFull timePart timeWork at officeMonday to FridayWeekend work- ...Nurse Auditor Have you ever looked a medical bill and immediately noticed something was wrong? Were you itching... ...and maximize client savings by reviewing medical bills from a nurse... ...treatment, fee schedule compliance, over-utilization, and erroneous charges. We pride ourselves...Remote jobMedicalImmediate start
- Oregon Health & Science University is seeking a part-time Utilization Review RN to work remotely. This role involves assessing the medical necessity of hospital admissions and ongoing stays while ensuring compliance with clinical guidelines. You will collaborate with various...Remote jobMedicalPart time
- ...for clinical member services review assessment processes. Responsible... ...verifying that services are medically necessary and align with... ...Molina care model. Adheres to utilization management (UM) policies and... ...experience. Registered Nurse (RN). License must be active and...Remote jobMedical
- Comagine Health is looking for a Clinical Utilization Review Nurse (RN) to perform remote assessments on the medical necessity of healthcare services. This full‑time position involves managing utilization reviews and ensuring compliance with clinical policies for quality...Remote jobMedicalFull time
$35 - $45 per hour
Position: RN / Utilization Review Nurse Location: Sacramento, CA (ON-SITE) Employment Type: Potential... ...role is responsible for reviewing medical records, treatment requests, and clinical... ...Comfortable working independently in a remote or office-based setting. Working...Remote workMedicalWeekly payContract workWork at officeMonday to Friday- ...insurance provider in Omaha, Nebraska is seeking a full-time Utilization Review Nurse to ensure effective management of injured workers'... ...transition into a new area. Responsibilities include reviewing medical treatment requests, advocating for injured workers, and maintaining...Remote workMedicalFull timeWork at officeWork from home
- ...City, LLC is looking for an experienced Utilization Review Nurse for a hybrid role based in Uniondale... ...utilization reviews, evaluate patient medical records, and collaborate with healthcare... ...The ideal candidate will hold an active RN license in New York, with a minimum of 2...Remote workMedical
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