Remote RN Case Manager — Utilization & Denial Specialist
Tampa General Hospital
- Remote job
Tampa General Hospital is seeking an Utilization Management Nurse (UMN) to ensure patients receive appropriate care levels using national criteria. You will conduct admission, concurrent, and retrospective reviews, collaborate with physicians and payers, and support timely authorizations while maintaining CMS compliance. Role requires Florida RN licensure and at least 3 years of nursing experience. Remote or hybrid work options may apply, with a focus on efficient patient flow and denial #J-18808-Ljbffr Tampa General Hospital
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...Utilization Review Specialist (RN) – RemoteAt Concierge Home Care, we are growing and looking for an experienced... ...Review Specialist (RN) to join our remote home health team.This role is ideal... ...with Branch Directors, Clinical Managers, and field cliniciansSupport quality...Remote workMonday to FridayWeekend work- Northwestern Medicine Catherine Gratz Griffin Lake Forest Hospital is seeking a Part-Time Case Manager, RN to support Utilization Review remotely. This casual role provides staffing coverage with no set schedule, and requires availability weekdays and weekends. Shifts are...Remote jobPart timeCasual workFlexible hoursShift workWeekend workWeekday work
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- CVS Health Corporation is seeking an experienced Registered Nurse (RN) to support our 24/7 Utilization Management operations. This remote role requires clinical expertise to review cases, assess medical necessity, coordinate care and ensure members receive appropriate,...Remote job
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...Description **This is a remote casual position supporting Utilization Review at Catherine Gratz Griffin... ...6a to 6p or 6p to 6a. ** The Case Manager, RN (PT)reflects the mission, vision,... ...for appeal assistance. Supports Denials Lead RN on Appeals insurance denials...Remote workHourly payDaily paidWork experience placementCasual workLocal areaRelocation packageFlexible hoursRotating shiftWeekend workWeekday work- ...integrating, and monitoring the utilization of behavioral health (... .... Refers appropriate cases to the Medical Director... ...work closely with Case Management to address member needs... ...degree and active NYS RN license required.... ...may be opportunity for remote work within all jobs posted...Remote workContract workWork at office
- CorVel Corporation is looking for a Telephonic Case Manager to coordinate resources and develop personalized care plans for ill or injured individuals. This remote position requires a California RN Nursing License and involves communicating with physicians and assessing...Remote jobFull time
- ...NeighborHealth’s SCO RN UM Reviewer role is based in East Boston within the Senior Care Options team. You will review clinical appeals... ...determinations. The role requires collaboration with RN Case Managers and the Medical Director to support timely decisions and effective...Remote work
- ...to support patient admissions. Candidates must have a valid California RN license and at least two years of clinical experience or a Master's degree in a related field. The position offers remote work with emphasis on critical thinking and problem-solving skills. #J-1...Remote work
$55k - $70k
...We are looking for a Utilization Review (UR) Specialist in Boca Raton, FL... ...both clinical quality management and financial viability... ...experience. Remote hires and applicants... ...issues and minimize denials. Facility Collaboration... ...Communication & Case Management Maintain...Remote workFull timeWork at office- ...Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. The incumbent conducts initial, concurrent and... ...while avoiding treatment delays and authorization denials. They are accountable for a designated patient caseload...Remote workFull timeTemporary workWork experience placementWorldwide
- ...ABA Utilization Review SpecialistSpectrum Billing... ...revenue cycle management services for healthcare... ...Review (UR) Specialist to our growing... ...This is a fully remote or office/home hybrid... ...authorization denials including referral... ...ongoing authorization cases.Collaborate and...Remote workWork at officeFlexible hours
- ...United States is seeking a Denials Management Specialist to join our remote team. This role focuses on... ...You will collaborate with Case Management and Billing to improve... ...have nursing experience, RN license, and 2–5 years in case/un utilization management with exposure to...Remote work
- ...Utilization Review Specialist The Utilization Review Specialist plays a critical... ..., insurance companies, and case managers to facilitate timely approvals... ...: Registered Nurse (RN) license or equivalent... ...continuation, modification, or denial of services based on clinical...Remote work
- ...Children's Hospital is seeking a utilization review professional to evaluate behavioral health cases, ensuring medical necessity... ...retrospective reviews, denial management, documentation, and data analysis... ...training, the position offers remote work from home options. #J-1...Remote jobWork at officeWork from home
- ...About the Role: The Utilization Review Specialist plays a critical role in ensuring... ..., insurance companies, and case managers to facilitate timely... ...Qualifications: Registered Nurse (RN) license or equivalent... ..., modification, or denial of services based on clinical...Remote workPart time
- Blue Cross Blue Shield of Arizona needs a clinical expert for managing member and provider appeals. This remote position requires strong accuracy, knowledge of compliance timelines, and a focus on customer service. Applicants should possess a healthcare-related degree and...Remote job
- ...Case Manager/Utilization Review Nurse At The CORE Institute, we are dedicated to taking care of you... ...in resource use, care delays, and claim denials for reporting purposes. Education:... ...unrestricted Arizona Registered Nurse (RN) license. Certification in Health Care...Part time
$32 - $48 per hour
Utilization Review Specialist RN Full-Time | Case Management | Gateway Regional Medical Center | Granite City, Illinois Gateway Regional Medical Center is hiring... ...reviews for medical necessity Working to prevent denials from all payers through timely review and...Full timeWeekend workWeekday work$32 - $48 per hour
...health. Position Overview The Utilization Review Specialist RN assumes responsibility and... ...to ensure the prevention of denials from all payers, as well as coordination and management of appeals for accounts... ...Specialist RN Department: Case management Location: Gateway...Hourly payFull time- ...Insurance Support-Utilization Case Manager Mass General Brigham relies on a wide... ...for managing and preventing denials and the department expert... ...preferred. ~ Registered Nurse (RN) License for the State of... ...and Schedule: Fully remote Per Diem shifts will be variable...Remote workHourly payDaily paidWork at officeMonday to FridayShift workWeekend workDay shift
- Utilization Review (UR) Specialist Location: Chadds Ford, Pennsylvania (Hybrid / Remote Eligible) Job Type: Full-Time Schedule:... ...Utilization Review Specialist manages the full lifecycle... ..., minimize denials, and support accurate... ...utilization review, case management, or behavioral...Remote workFull timeMonday to FridayFlexible hours
$28.83 - $46.14 per hour
...Job Title Denial Management Specialist Job Description Wage Range: $28.83... ...experience in denial management, utilization review or prior... ...billing and reimbursement Remote in Washington State only Posted... ...with departments including Case Management, Coding, and Health...Remote workHourly payContract workFlexible hoursShift work- ...Utilization Review Specialist RN PRN Utilization Management Dept. PRN Any Variable Lexington Health is a comprehensive network... ...length of stay. Assists with denial management. Reviews physician medical... ...letters of non-coverage in cases where the admission or continued...Full timeTemporary workReliefWork at officeFlexible hours
$65k - $68k
...WHAT YOU WILL DO As the Internal Case Manager (PCP Specialist) you will be responsible for ensuring... ...document and keep data, and access and utilize database records. Participates in... ...environment combining in office and remote work is required. Current requirements...Remote workFull timePart timeWork at office- Health Business Solutions LLC seeks an experienced Utilization Review Nurse in New York to provide clinical guidance, drive appropriate... ...utilization criteria, and collaborate with insurers on denials. Requires RN license (US multi-state/compact), BSN preferred, 2+ years...
- Molina Healthcare is seeking a Registered Nurse with utilization management and appeals review experience to assess medical necessity and appropriate... ...medical directors, and assisting with complex claims and denial decisions while maintaining compliance with state #J-18808-...Day shift
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