Remote Utilization Management RN — Care Coordination
Humana
- Remote job
Humana is seeking an Utilization Management Nurse 2 to coordinate, document, and communicate medical services and benefit determinations. The role requires clinical nursing expertise, independent decision-making, and strong telephonic communication in a remote setting. The candidate will interpret clinical data to support patient outcomes, collaborate with internal teams, and operate across multiple systems while following established guidelines. #J-18808-Ljbffr Humana
- ...Humana Inc. is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and determinations for medical services and benefit... ...Utilization Management team, focusing on post-acute care services including SNF, Home Health and DME....Remote work
$26.01 - $68.55 per hour
...Health is seeking a Registered Nurse (RN) for Utilization Management. You will review clinical... ...determinations, apply guidelines, and coordinate care with providers to ensure appropriate care. This full-time role offers remote work from home in the United States,...Remote jobHourly payFull timeWork from home- CVS Health seeks a Registered Nurse (RN) for Utilization Management to ensure appropriate care through clinical review and coordination. You will review information, apply guidelines, and collaborate with providers to support optimal patient outcomes. Ideal candidates...Remote jobFlexible hours
- ...experienced Registered Nurse (RN) to join our Utilization Management team. You will help... ...members receive the right care at the right time through... ...clinical review and care coordination. Active RN license and 2+... ...weekends, and holidays, in a remote-capable environment...Remote jobFlexible hoursAfternoon shift
- Highmark Health is seeking a remote Care Manager RN to support utilization management and care coordination. The role requires weekend availability (Saturday and Sunday) plus three weekdays, focusing on reviewing services, applying criteria, and improving member outcomes...Remote jobWeekend workWeekday work
- Highmark Health is seeking a full-time, remote Care Manager with weekend availability to support utilization management and care coordination across Saturday, Sunday and three weekdays... ..., and resolving quality issues. Required RN licensure (PA or multi-state via eNLC) and...Remote jobFull timeWeekend workWeekday work
- CVS Health in the United States is seeking a Registered Nurse (RN) for its Utilization Management team. You will review clinical information to support coverage determinations and care recommendations, applying guidelines, policies, and professional judgment across the...Remote job
- Highmark Health is seeking a full-time Remote Utilization Management/Case Management RN. The role reviews care appropriateness, applies criteria for resource use, refers to Health Coach/case management when needed, and analyzes data to improve provider and member satisfaction...Remote jobFull timeWeekend workWeekday work
- Highmark Inc. is seeking a full-time remote Health Care Manager to implement effective utilization management strategies, review care appropriateness, and identify opportunities for Health Coach/case management referrals. This role requires weekend availability (Saturday...Remote jobFull timeWeekend workWeekday work
- Highmark Health is seeking a full-time remote RN Care Manager to implement utilization management strategies and oversee care management reviews. The role includes collaborating with providers, coaching members, and improving provider and member satisfaction. Weekend availability...Remote jobFull timeShift workWeekend workWeekday work
- ...We are currently hiring for an LPN Utilization Management Coordinator I to join BlueCross BlueShield of South... ...30am – 5:00pm and will be fully remote . The candidate may be required to report... ...and collaborating with Managed Care Coordinators as appropriate. Educates...Remote workFull timeFor contractorsWork experience placementCurrently hiringWork at officeLocal areaMonday to Friday
- ...recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an... ...include evaluating healthcare services and coordinating care for members. Join a dynamic team and make a meaningful...Remote workContract work
- ...Humana is seeking a Utilization Management Nurse 2 to apply clinical nursing skills in coordinating and documenting medical services and benefit... ...Degree in nursing, an active compact RN license, and at least three years of geriatric care experience, with strong...Remote work
$101.72k - $198.36k
...California - Ability to work remote, but selected candidate... ...position requires California RN Licensure. Candidates must... ...of the following functions: utilization management, care management, behavioral health... ...facilitating, planning and coordinating integrated delivery of care...Remote workContract workWork experience placementWork at officeLocal area- Humana is seeking a Utilization Management Nurse 2 to support coordination, documentation, and communication of medical services and benefit determinations. The... ...operates Monday-Friday, 8:00am-5:00pm ET, with remote/work-from-home options and occasional travel to Humana...Remote jobWork from homeMonday to Friday
$70k - $75k
Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance... ...services Quality of care concerns Interfacing routinely... ...reliable and user-friendly. Care Coordination & Quality Support Initiating...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home- CVS Health is hiring an experienced Registered Nurse (RN) for Utilization Management to ensure appropriate care at the right time through evidence-based review and coordination. This role supports 24/7 operations and may require evenings, weekends, and holidays from a...Remote jobWork from homeWeekend workAfternoon shift
$71.1k - $97.8k
...Horizons in Indiana is seeking a Care Coordinator 2 (Field Care Manager 2) who will assess and... .... Highlights Location: Remote, IN Schedule: Full-time, Monday... ...eligible for Medicare. Utilize various strategies to... ...Licensed Registered Nurse (RN) in the state of Indiana without...Remote workFull timeTemporary workWork from homeRelocation packageMonday to Friday$70.2k - $120.4k
...personalized health care experiences and partner... ...care, where coordinated, quality service is the... ...member feels valued.The Utilization Review RN will review and document... ...policies and utilization management and/or clinical... ...requiredThis position is a Remote role. To be eligible...Remote workWork experience placement$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... ...responsible for evaluating healthcare services, coordinating care, and ensuring members receive high-...Remote workDaily paidContract workMonday to FridayShift workWeekend work- ...Behavioral Health Utilization ManagerBehavioral Health Utilization Manager will perform concurrent and... ...the appropriate level of care. Notifies Medical... ...turnaround times.Assists in the coordination of care of hospitalized... ...systems Work Schedule: Remote Other Requirements:...Remote workContract workWork experience placement
$75k - $100k
...Utilization Management RN (Registered Nurse) evaluates efficiency, appropriateness... ...Location We are open to remote work in the following... ...Services objectives of quality care and reasonable cost. Would... ...experience managing and coordinating care effectively for case managed...Remote workFor contractorsWork at officeLocal areaImmediate start$38.91 - $60.31 per hour
...Colorado For This Fully Remote Position... ...balances quality of care with efficiency, cost... .... Provides case management and/or consultation... .... Assesses and coordinates patient's discharge... ...Registered Nurse (RN). Minimum... ...Preferred: 3 years of utilization or case management...Remote workFull timeTemporary workLocal areaFlexible hoursShift work- ...is seeking a nurse to support utilization management. The Utilization Management Nurse 2 coordinates, documents and communicates medical... ...Degree in Nursing, an active RN license in a compact state, and... ...experience including geriatric care, plus #J-18808-Ljbffr HumanaRemote job
- HonorHealth is seeking a Utilization Review RN Specialist to review and monitor health care utilization, ensuring medical necessity... ...outpatient settings. You will coordinate reviews for Medicare, AHCCCS,... ...payers, working with the Care Management team to optimize resource use...Remote jobDaily paid
- ...experienced Registered Nurse for a remote Utilization Management Nurse Consultant role focused on... ...collaborate with providers to coordinate treatment plans, ensuring appropriate care and utilization. The position requires 3+ years RN experience, an active RN license,...Remote job
$38 - $40 per hour
...Title: RN -- Review Analyst Location: Remote Duration: 12 months with possible... ...and retrospective utilization reviews for... ...of stay, level of care, and intensity of services... ...outreach, and coordinate care across the healthcare... ...Utilization Management (UM) , Case Management...Remote workHourly payWork at officeMonday to FridayShift work- ...Description Job Description The utilization review and management (UM) component program... ...the appropriate level of care, while supporting... ...necessity of treatments and coordinate care effectively # Data... ...This is an in-office, no remote work capability position...Remote workFull timeWork at office
- Humana is seeking an Utilization Management RN - Physical Health to support coordination, documentation, and communication of medical... .... This full-time role is remote with periodic travel to Humana'... ...to apply nursing expertise to care coordination and benefit processes...Remote jobFull timeWork at office
- ...Registered Nurse (RN) Contract We are hiring a Remote RN Review Analyst (Utilization Management) - Remote Michigan.... ...intensity of service and level of care, including appeal requests... ...establish care plans and coordinate care through the health care...Remote workContract workLocal areaFlexible hours
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