Remote Utilization Review Specialist (RN/LPN)
Ampcus Inc - IT Consulting Services
- Remote job
Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires knowledge of managed care, strong communication skills, and the ability to handle confidential PHI while coordinating with medical directors and other teams. Remote work is offered nationwide. #J-18808-Ljbffr Ampcus Inc
- Ensemble is seeking Virtual Utilization Review Specialists to join our remote team. You will evaluate medical necessity, coordinate with physician advisors... ...utilization of resources. Must hold an unrestricted RN or LPN license and have 3+ years of acute care nursing...Remote job
- HonorHealth in Arizona seeks an Utilization Review RN Specialist to review and monitor utilization for cost-effective, high-quality care. This role... ...and a strong collaboration with physicians and care teams. Remote work is available after training. #J-18808-Ljbffr...Remote job
- TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews, assisting...Remote job
$65k - $85k
...Job Description Job Description Utilization Review Specialist (RN) – Remote $65K–$85K | OASIS & Coding Certified | Florida RN License Required Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning Potential At Concierge Home...Remote workMonday to FridayWeekday work- ...an Appeals and Grievances Clinical Specialist to manage member complaints and... ...case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities... ...practice and knowledge of Utilization Review Guidelines. The position offers a...Remote work
- Ascension Sacred Heart Hospital is seeking a nurse to join our Utilization Management team in a remote role. You will perform prospective, concurrent, and retrospective reviews to ensure medical necessity and alignment with reimbursement policies. Join a multidisciplinary...Remote job
- Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The role involves performing retrospective medical... ...experience in a relevant medical setting, and the ability to work in a remote environment. Comprehensive benefits are provided, including...Remote jobContract workWork from home
- ...Utilization Review Specialist The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients... ...skills. Preferred Qualifications: Registered Nurse (RN) license or equivalent clinical certification....Remote work
- ...patients-we invest in our people. About the Role: The Utilization Review Specialist plays a critical role in ensuring that healthcare services... .... Preferred Qualifications: Registered Nurse (RN) license or equivalent clinical certification. Experience...Remote workPart time
$39.4 - $53 per hour
...Advancement This position pays: RN pay scale $39.40 - $53/hr based on experience LPN pay scale $32.65 - $46.90/hr... ...We are seeking Virtual Utilization Review Specialists to join our team.... ...Abilities Required: This is a remote role which requires access to...Remote workTemporary workWork at officeLocal areaMonday to FridayWeekend work- Spectrum Healthcare Resources seeks a Utilization Manager Registered Nurse (UMRN) to work entirely from home in a fully remote role. The nurse will review cases, educate patients on... ...schedule of 8 hours per day, requiring an RN with a Bachelor's degree, state licensure...Remote jobWork from homeMonday to Friday
- ...Seeking an experienced and detail-driven Utilization Review Specialist, the full-time remote position will manage a caseload of 50-75 patients, conducting admission and continuing-stay reviews, coordinating authorizations, and serving as a liaison between clinical operations...Remote workFull time
- ...Alliance Health is seeking a UM Clinical Specialist-LTSS for full-time remote work, NC-based. You will perform utilization reviews and authorizations for I/DD and TBI waivers, ensuring services meet clinical guidelines and are provided in the least restrictive setting....Remote workFull time
- ...integrating, and monitoring the utilization of behavioral health (BH) or... ...cases to the Medical Director for review. Refer to and work closely... ...Associates degree and active NYS RN license required. Bachelors... ...There may be opportunity for remote work within all jobs posted by...Remote workContract workWork at office
$29.62 - $45.31 per hour
...Department Coordinate and execute the review and research functions required to support... ...Critically assess and prepare all cases for RN/MD review of coverage (medical necessity,... ...inquiries, provider resolutions, etc.) Remote Work This position offers 100% remote work...Remote workMinimum wageFull timeWork experience placementLocal areaShift work- ...ABA Utilization Review SpecialistSpectrum Billing Solutions offers industry-leading revenue cycle... ...to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR... ...rewarding environment. This is a fully remote or office/home hybrid position.Your Responsibilities...Remote workWork at officeFlexible hours
$70k - $100k
...of the Surgery Partners network, is seeking an experienced Utilization Review Specialist to join its team in Addison, Texas. This position is ideal... ...is a hybrid opportunity offering the flexibility of three remote workdays per week while maintaining an onsite presence two...Remote workContract work2 days per week- ...Utilization Review Specialist RN PRN Utilization Management Dept. PRN Any Variable Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals...Full timeTemporary workReliefWork at officeFlexible hours
- ...reporting, and occasional travel within Arkansas to perform site reviews. Required: Diploma/Associate’s degree in nursing and AR RN licensure; 3 years clinical nursing experience. Desirable: QA/Utilization Review or coding experience; strong IT skills and HIT/EHR #J-18...
- ...Job Description Job Description Position Summary The PACE Utilization Review Specialist – RN oversees clinical utilization management for participants enrolled in the Program for All-Inclusive Care for the Elderly. The position ensures that services are medically...Work at office
- ...knowledge and a current Arkansas licensure as a RN. Preferably experienced in the use of ICD... ...written format with the Medical Staff, review organizations, administration and others... ...control system to assure effective utilization of hospital facilities and services. Assist...Work at office
- Mass Digital Health is seeking a Utilization Review Nurse in Quincy, Massachusetts. This role involves evaluating patients for appropriate admission... ...coordination. This position requires at least two years of RN experience in care management or utilization management. The...
- Excellus BCBS in New York seeks a Utilization Management professional to coordinate behavioral... ...services for members. You will perform clinical reviews, ensure medical necessity, and... ...Requirements include an associates degree with NYS RN license and at least three years of UM...Work at office
- Health Business Solutions LLC seeks an experienced Utilization Review Nurse in New York to provide clinical guidance, drive appropriate level of... ...criteria, and collaborate with insurers on denials. Requires RN license (US multi-state/compact), BSN preferred, 2+ years UR experience...
- .... Ready to join our quest for better? Job Description The RN Utilization Specialist reflects the mission, vision, and values of NM, adheres to... ...expertise in hospital utilization. The RNUS through regular reviews and audits and collaboration with the clinical team, facilitates...For contractorsCasual workWork at officeLocal areaRelocation package
- UofL Health is seeking an RN for Utilization Review in Louisville, KY. The role supports the Utilization Management process, reviews medical necessity, and coordinates care across interdisciplinary teams to ensure appropriate utilization and patient outcomes. The ideal...
- Spectrum Billing Solutions is seeking an ABA Utilization Review (UR) Specialist to join their team. This fully remote or hybrid position involves reviewing clinical information and obtaining authorizations for ABA services. Candidates should have 3-5 years of relevant...Remote job
- HUMBLE VASCULAR SURGICAL CENTER INC in Addison, Texas, is seeking a dedicated RN Case Manager to oversee utilization reviews and discharge planning. The role involves ensuring compliance with medical necessity guidelines while collaborating with physicians and interdisciplinary...
- A healthcare organization in Texas is seeking an RN Utilization Review Coordinator to perform utilization reviews and ensure medical necessity compliance. The role involves collaborating with healthcare teams, managing denial appeals, and supporting discharge planning....Full time
- Telligen is seeking a Senior Review Coordinator to conduct utilization reviews and medical management for various services. The role involves mentoring teammates... ...quality standards. Ideal candidates must hold an active RN license in Maryland, possess a relevant four-year degree...Casual work
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