Remote Utilization Review Nurse - Medical Necessity & Denials
Penn Medicine, University of Pennsylvania Health System
- Remote job
Penn Medicine is seeking an Utilization Review Nurse in Bala Cynwyd, PA. The role supports timely and accurate utilization review to determine medical necessity, admissions, and resource use within the centralized Utilization Management department. Responsibilities include collaborating with physicians, case management, revenue cycle, and interdisciplinary teams to ensure proper level-of-care determinations and required authorizations, while maintaining compliant documentation. #J-18808-Ljbffr Penn Medicine, University of Pennsylvania Health System
- ...Utilization Review Medical Appeals Nurse - USRN NTT DATA Services is currently seeking... ...data to determine medical necessity for services in accordance... ...and recommend approvals/denials based on determination level... ...shift timings - US daytime ~ Can work remotely...Remote workMedicalShift work
$30.64 - $45.8 per hour
...Utilization Review Nurse The Utilization Review Nurse gathers demographic... ...treatment, certifies the medical necessity and assigns an appropriate... ...and of CorVel. This is a remote position. Essential Functions... ...certification or denial of treatment Documents...Remote workMedicalHourly payFull timeWork at officeLocal areaFlexible hours$30 - $40 per hour
...RN Clinical Review Nurse (Utilization Review Nurse)The Clinical Review... ...appeals by examining medical records and clinical... ...ensures that medical necessity for services is... ...preservice authorization denials and retrospective claim... ...Type:This is a fully remote position.Application...Remote workMedicalContract workTemporary work$30 - $40 per hour
...Job Title: RN Clinical Review Nurse (Utilization Review Nurse) Job... ...appeals by examining medical records and clinical... ...ensures that medical necessity for services is determined... ...authorization denials and retrospective claim... ...Type This is a fully remote position....Remote workMedicalContract workTemporary work$30.64 - $45.8 per hour
...The Utilization Review Nurse gathers demographic and clinical information on... ...treatment, certifies the medical necessity and assigns an appropriate... ...and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS... ...certification or denial of treatment Documents...Remote workMedicalHourly payMinimum wageFull timeWork at officeLocal areaFlexible hours- ...Remote Utilization Review Registered Nurse (UR RN) Nexus Health Systems is seeking an experienced... ...patients receive medically necessary, high-quality... ...reviews to determine medical necessity and appropriate level of... ...authorizations, denials, appeals, and level-of-care...Remote jobMedicalWork at office
- ...Utilization Management Registered Nurse Duration: 6 Month Contract (Possibility... ...utilization review and prior authorization... ...management, medical necessity review, prior authorization... ...for complex cases, denial recommendations,... ...independently in a remote environment. Comfortable...Remote workMedicalContract work
- ...Utilization Review Nurse We are seeking a detail-oriented and experienced... ...Review Nurse to evaluate the medical necessity, appropriateness, and... ...clinical guidelines. Assist with denial prevention, appeals, and... ...management department. Remote, hybrid, or on-site opportunities...Remote workMedicalWork at office
- ...leading academic medical center means collaboration... ...Department: Corp Utilization Management... ...Bala Cynwyd, PA/ remote Summary The Utilization Review Nurse is responsible for... ...determination, medical necessity review, and... ...authorization management, denial prevention, and...Remote workMedical
- Molina Healthcare is seeking a Remote Medical Review Nurse (LVN/LPN) for PST schedule in the United States... ...documentation to ensure medical necessity and appropriate level of care, with focus... ...with CMOs and medical directors on denial decisions and denials/modifications...Remote jobMedicalShift work
- ...leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and...Remote workMedicalFull time
$35 - $45.94 per hour
...Utilization Review Nurse Remote Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our... ...perform frequent case reviews, check medical records and speak with care providers... ...Complete medical necessity reviews and level of care reviews for...Remote workMedicalHourly payWork from homeHome officeWeekend work$90k - $107k
...Brigham Health Plan Holding Company, Inc. is seeking a Remote UM Nurse to support network adequacy review and authorization activities for members in ACO,... ...to review prior authorization requests, assess medical necessity, and render decisions within scope. The position offers...Remote workMedical- ...Job Title This position is fully remote, however, you must reside in the State of Texas The position... ...working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan....Remote workMedicalContract work
- ...applicants This is full-time remote, but candidates must... ...care industry using medically accepted criteria to validate the medical necessity and appropriateness of... ...and timely medical review of claims suspended for... ...skills. ~ Registered Nurse (RN) with unrestricted...Remote workMedicalFull timeContract work
- ...Management Location: 100% Remote Schedule: M-F 9:00am... ...Works with the Utilization Management team primarily... ...responsible for inpatient medical necessity/utilization review and other utilization management... ...IL State Registered Nursing (RN) license in good standing...Remote workMedicalContract work
$40 per hour
...in TX Full time remote Candidates must... ...industry using medically accepted criteria... ...validate the medical necessity and appropriateness... ..., concurrent review activities; discharge... ...information regarding utilization management... ...facilities. Registered Nurse (RN) with valid,...Remote workMedicalFull timeContract workWork at office- ...tuition assistance, 403(b), remote work United States,... ..., MD 21076 Category: Nursing Schedule: Day Shift... ...:00 AM - 5:00 PM As a Utilization Review Registered Nurse for Johns... ...member benefits and medical criteria to determine... ...authorization and/or denial of covered services with...Remote workMedicalFull timeMonday to FridayDay shift
$35 - $43 per hour
...00/hr Job Title Clinical Review Nurse – Concurrent Review Location: Remote (California only – must reside... ...Concurrent Review will perform utilization management functions to ensure... ...planning, concurrent reviews, and medical necessity determinations in alignment...Remote workMedical$78k - $88k
...Utilization Review Nurse- Remote It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us... ...concurrent, and retrospective reviews for medical necessity and appropriateness of services, following clinical...Remote workMedicalFull timeContract workWork at officeWork from homeFlexible hours- ...Currently seeking a Utilization Management RN .... ...below: Position is remote - candidate must... ...active PA license or a Nurse Licensure Compact... ...three (3) years of Medical/Surgical experience... ...medical record review to determine medical necessity for services. Using...Remote workMedicalImmediate startDay shift
$35 - $40 per hour
...$40.00/hr Location Fully Remote Position Summary The Utilization Review Nurse serves as a key liaison in coordinating... ...with company policy. Assess medical documentation to determine the... ...to clinicians on medical necessity, homebound status, visit utilization...Remote workMedicalContract workFlexible hoursWeekend work- ...Utilization Management Review Nurse (UMRN) The Utilization Management Review Nurse (... ...required to evaluate the necessity, appropriateness, and efficiency... ...of the utilization of medical services procedures and facilities... ...with payers to reconcile denials and reconsiderations,...Remote workMedicalWork experience placementWork at officeFlexible hoursWeekend work
- ...Utilization Review Nurse This position has a remote option for those living close and will be able to come into the... ...coverage for the service and if it is medically necessary. Promote quality,... ...requested services for medical necessity based upon evidence-based...Remote workMedicalFull time
$34 - $40 per hour
...pay range $34.00/hr - $40.00/hr Remote (Compact Licensure Required) - Open... ...Medix is seeking an experienced Utilization Review Nurse to support our mission of improving... ...provider documentation to determine medical necessity for continued care in accordance with...Remote workMedicalFull time- ...seeking a licensed Practical Nurse (LPN/LVN) experienced in managed... ...pre-service and post-service utilization reviews and appeals for DMEPOS, working with our Medical Director in a NCQA-compliant UM... ...review benefit and medical necessity criteria, coordinate with clinical...Remote workMedical
$30 - $40 per hour
...changing decisions, one review at a time? Why... ...waiting on an answer to the Medical Director who depends... ...Conduct medical-necessity reviews: Evaluate requested... ...of an accredited nursing program (ADN or diploma... ...similar setting) ~ Utilization review/utilization management...Remote workMedicalHourly payImmediate startMonday to FridayFlexible hours- ...Responsibilities Responsible for utilization review work for emergency... ...evaluate electronic medical records of emergency... ...screen for medical necessity using InterQual or... .../or medical/surgical nursing At least 2 years... ...Expectations Comfortable with remote work arrangements and...Remote workMedicalFor contractorsWork at office
- ...great opportunity for a local remote position. Schedule PRN... ...: ~2 years of staff nurse experience performing care for... ...hospitalized patients. ~2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity. ~ Must live within one...Remote workMedicalReliefLocal areaMonday to FridayFlexible hoursShift work
- ...care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to... ...Program JOB SUMMARY: The Utilization Review Nurse is to assess the medical necessity and quality of healthcare services...Remote workMedicalFull timeTemporary workLocal area
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