Remote Utilization Review RN: Care & Compliance Leader
Medix™
- Remote job
Medix™ is seeking an experienced Registered Nurse (RN) to join our Utilization Review team in a remote capacity. The role evaluates medical necessity, reviews levels of care, and supports denial prevention and appeals across the continuum of care. The ideal candidate will collaborate with physicians, care managers, and payers to promote appropriate resource utilization and regulatory compliance, while delivering high-quality patient outcomes. #J-18808-Ljbffr Medix™
- ...Job TitleIn this remote role, you will perform utilization reviews, ensuring compliance with clinical guidelines and patient care standards. Collaborate with interdisciplinary teams to assess patient needs and facilitate care coordination. Your expertise in medical necessity...Remote work
- ...Description Job Description The utilization review and management (UM) component... ...delivered at the appropriate level of care, while supporting regulatory compliance and organizational risk... ...lunch This is an in-office, no remote work capability position Travel...Remote workWork at office
$44.7 per hour
...The Utilization Review (UR) RN evaluates the medical necessity appropriateness and... ...MCG criteria ensuring compliance with CMS regulations and payer... ...to support safe efficient care transitions and optimize reimbursement... ...union covered position Remote Work : No...Remote workHourly payPart timeShift workNight shiftWeekend workAfternoon shift- Evry Health is seeking an RN Integrated Care Coordinator (UM) to provide comprehensive care coordination and drive... ...facilities to ensure high-quality care in a remote environment, with rotating weekend utilization review coverage. The candidate should have 1-2 years in...Remote job
- ...A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and collaborating with teams to meet...Remote workContract work
- ...RN Utilization ReviewReview patient medical records to assess the appropriateness and medical... ...coordinating with providers and payers to ensure compliance with clinical guidelines, regulatory... ...hospital-based)Skilled experience with remote workLength of assignment: 13 weeksShift...Remote workWeekend work
- A healthcare provider is seeking a Utilization Review Nurse to coordinate resources and ensure efficient delivery of home health care. This role involves monitoring patient admissions and ongoing care while ensuring adherence to guidelines. The ideal candidate will have...Remote jobContract work
$40 - $50 per hour
Utilization review Registered Nurse ( Post service Medical Review... ...(08:00 AM - 05:00 PM) Remote in California 6+... ...Summary: The Facility Compliance Review team reviews post... ...appropriate level of care. Also, you will be reviewing... ...a current California RN License Requires at...Remote workContract workWork at officeLocal areaShift work- ...seeking a Pre-Authorization Registered Nurse for a remote, full-time role based in Virginia. The RN will review prior authorization requests, determine appropriate care settings, and educate providers on utilization and management processes. Requirements include an...Remote workFull time
- ...Authorization Nurse to review prior authorization requests for appropriate care and setting, applying guidelines... ...-making abilities. Remote position from LA with a... ...8-hour shifts. Active RN license in Louisiana... ...; health plan or utilization management background is...Remote workShift work
- ...Comagine Health is seeking Clinical Utilization Review Nurses (RN) licensed in Alabama for a remote, full-time role. You will assess medical necessity and quality... ...retrospective reviews to support compliant, cost-effective care. Experience in Medicaid criteria, long-term...Remote workFull time
$63.1k - $94.65k
...Our partner is looking for a Utilization Review RN based in the United States.... ...operations. In this part-time, remote role, you will apply your... ...patient admissions, and ensure care aligns with established... ...improvement initiatives, regulatory compliance, and effective care...Remote workTemporary workPart timeWork at officeWork from homeFlexible hoursShift workAfternoon shift- ...BJC HealthCare is seeking a registered nurse to join a remote Utilization Review team. The role supports multiple hospital units with no patient communication, and it is designed for local remote work with weekend rotation. Responsibilities include applying Interqual criteria...Remote workLocal areaWeekend work
- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and... ...providers to ensure compliant patient care. The role emphasizes adherence to HIPAA... ...environment. Requirements include active RN or LVN licensure, a minimum of two...Remote workWork at office
- Utilization Review Nurse Auditor (33034)# Utilization Review Nurse... ...Auditor (33034)Fully Remote • Mount Laurel, NJ 080... ...and approving care that is medically necessary... ...that all work is in full compliance with client... ...time off, and 401k.******RN******LPN******LVN*****...Remote workLocal areaMonday to Friday
$31.94 - $43.92 per hour
...Description Job Description Care Coordination Perform... ...planning discussions Utilization Management Review medical necessity & admission... ...(rehab, home care, etc.) Compliance & Documentation Follow regulatory... ...) OR Option 2: 3+ years RN in: Med/Surg...Relocation packageShift workWeekend workAfternoon shift- ...Description: Manager of Clinical Utilization Management - Denial Compliance Location: Burbank, CA... ...Type: Hybrid (85% remote, 15% onsite in Northridge,... ...daily tasks, performance reviews, and any necessary disciplinary... ...Nursing Program; RN preferred. 2. Minimum of...Remote workPermanent employmentFull timeTemporary workFlexible hours
- CorVel Corporation is seeking a Utilization Review Case Manager for a fully remote role in the United States. The position requires current nursing licensure... ..., decision-making on certification/denial, and careful documentation. Strong communication and organizational...Remote job
- ...RN – Utilization ReviewSeven Healthcare are seeking a dedicated RN – Utilization Review specialist for a travel assignment in Fort Myers, FL. This remote position requires expertise in utilization management, making it an excellent opportunity for experienced nurses to...Remote workWork experience placementFlexible hours
- Broadway Ventures is seeking a Medical Reviewer (1099 contract) on a remote basis for the United States. The role... ...accuracy and QA is required. Minimum RN licensure and 2+ years in clinical work, including home health or utilization review, are essential; ICD coding proficiency...Remote jobContract workWork from home
- CorVel in the United States is seeking a Utilization Review Case Manager to gather demographic and clinical information, certify medical necessity... ...length of stay for inpatient and outpatient treatment. This remote role requires strong CPT/ICD coding knowledge, meticulous...Remote job
- ...TEEMA is seeking a Registered Nurse for a remote role with Arizona hours (1st shift). You will review medical records for quality, safety, and utilization issues, identify PQIs, and support QA... ...Directors. Must hold an active RN license, have 3+ years of clinical experience...Remote workDay shift
- ...Guidehealth is seeking a Utilization Management Registered Nurse (RN) for a fully remote, full-time position. The role involves applying medical necessity criteria to reviews, documenting findings, and interfacing with providers and members to ensure timely, compliant...Remote workFull time
$65k - $85k
...Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning... ...growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health... ...clinical documentation for accuracy and compliance Audit OASIS documentation and care...Remote workMonday to FridayWeekend workWeekday work$2,005 per week
...Country Nurses is seeking a travel nurse RN Utilization Review for a travel nursing job in Fort Myers,... ...Extension (UR EXT) specialist for a remote position. This role involves conducting... ...providers to ensure appropriate patient care and resource utilization. The position...Remote workTemporary workZero hours contractMonday to FridayShift workWeekend work- ...Authorization Nurse to review and approve prior authorization... ...judgment across care settings. The role... ...adherence to guidelines in a remote environment. Candidates should hold an active RN license in Virginia or... ...and familiarity with utilization management and discharge...Remote job
- HonorHealth in Phoenix is seeking an Utilization Review RN Specialist to review and monitor utilization, ensuring medically necessary care and appropriate discharge planning within Medicare, AHCCCS, Self-pay, and other payer guidelines. The ideal candidate has an RN license...Remote job
$63k - $65k
...career with us, experience our caring culture, and enjoy work-... ...Services & Insurance Utilization Review RN As a nurse at Sedgwick, you... ...well-being of others in a remote work environment. Enjoy flexibility... ...treatment utilization and compliance. Evaluates need for and...Remote workWork experience placementFlexible hours$2,150 per week
...seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing... ...payers to ensure compliance with clinical guidelines... ...experience with remote work LENGTH OF... ...provide quality patient care that continually... ...travelers. As an industry leader, AMN Healthcare...Remote workTemporary workZero hours contractImmediate startShift workNight shiftWeekend work$2,038 per week
...Solutions is seeking a travel nurse RN Case Management for a travel... ...for a Registered Nurse - Utilization Review for a Travel contract. Job... ...literate; experience working remote; degree accreditation... ...processes, ensuring appropriate care and documentation. Collaborate...Remote workPermanent employmentContract workZero hours contractReliefLocal areaShift workRotating shift
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