Remote Utilization Nurse - Clinical Review & Authorization
Socket.dev
- Remote job
Devoted Health is seeking a Clinical Guide on our Outpatient Utilization Management team to review outpatient authorization requests using evidence-based criteria and CMS requirements. You will help ensure appropriate care settings and support members navigating the healthcare system. This full-time remote role offers multiple schedules and requires collaboration with providers and internal teams to document decisions, meet turnaround times, and escalate when needed. #J-18808-Ljbffr Socket.dev
- Akido Labs is looking for a Clinical Review Nurse in California to manage prior authorization requests. This role ensures compliance with clinical guidelines and... ...license and have 3-5 years of experience in clinical utilization management. Key responsibilities include...Suggested
- ...part of our mission and join our team! As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise and judgement along with... ...procedures that require medical necessity authorization. We are seeking individuals who enjoy a challenge...Remote jobLocal area
- ...Analyzes all prior authorization requests to determine... ...Accredited School of Nursing or Bachelor's degree... ...experience. Clinical knowledge and ability... ...preferred. Knowledge of utilization management processes... ...and clinical reviews of authorization requests...Remote work
- WNS is seeking a clinically trained reviewer to perform utilization reviews and case management activities. The role requires RN or LVN/LPN licensure and at... ...and insurance terminology. The candidate will work remotely, coordinate with providers and clients, and help ensure...Remote job
- Brighton Health Plan Solutions is seeking an Utilization Management Nurse to perform medical necessity and benefit reviews remotely. The role requires current LPN licensure and expertise in CMS/MCG criteria with experience in inpatient/outpatient reviews. The successful...Remote job
- ...A healthcare staffing company is seeking a Clinical Review Nurse for Prior Authorization Review. This remote role demands conducting reviews, collaborating with healthcare teams, and ensuring compliance. Candidates need an active RN license and 2–4 years experience in...Remote workContract work
- Devoted Health is seeking a Clinical Guide on our Outpatient Utilization Management team. This remote, full-time role focuses on clinical review of outpatient authorization requests using evidence-based criteria and CMS requirements to ensure appropriate care. The ideal...Remote jobFull time
- Comagine Health is seeking a Clinical Utilization Review Nurse (RN) for a remote, full-time role based primarily in Alabama. You will assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews, ensuring compliance with clinical...Remote jobFull timeContract work
- Centene Corporation is seeking a clinical professional on our Medical Management/Health Services team to review prior authorization requests and determine medical necessity for NY members... ...and cost-effective care, with flexible remote/hybrid/work options. #J-18808-Ljbffr...Remote jobFlexible hours
- ...Description Job Description: Clinical Supervisor, UM Denial... ...Type: Hybrid (85% remote, 15% onsite in Burbank... ...tasks, performance reviews, and disciplinary actions... ...accredited Registered Nursing Program; RN preferred.... ...five years in prior-authorization, appeals & grievance,...Remote workPermanent employmentTemporary work
$78k - $88k
...development. Summary We are seeking a skilled Utilization Review Nurse to conduct prior authorization, prospective, concurrent, and retrospective reviews... ...and appropriateness of services, following clinical criteria, coverage policies, and contract guidelines...Remote workFull timeContract workWork at officeWork from homeFlexible hours- ...a Recruitment Manager to assess and analyze clinical service requests, verify member benefits, and process prior authorizations. Candidates must have an Illinois state RN license... ...or medical clinic settings. This is a fully remote position, offering work within a...Remote work
- ...solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-... ...Responsibilities include processing authorization requests, ensuring compliance with... ...review. Competitive pay and remote flexibility offered. #J-18808-Ljbffr...Remote work
$66.83k - $111.38k
...Sentara Health Plansis hiring a Utilization Review Nurse/ RN for Imaging/Commercial- Remote!Status: Full-time,permanent... ...Conducts primary functions of prior authorization, inpatient review, concurrent... ...criteria (CMS, state, medical policy, clinical criteria). Facilitates...Remote workPermanent employmentFull timeTemporary workWork from homeShift workDay shift- ...R1 RCM is seeking an experienced Utilization Review Author (RN) for our Physician Advisory Team. The role involves first-level admission and continued stay reviews using InterQual/MCG criteria and requires hospital-based UR or Case Management experience. The position offers...Remote workFlexible hours
$71.1k - $97.8k
...of our caring community The Utilization Management Nurse 2 uses clinical nursing skills to support the coordination... ...years of experience in prior authorization, claims review, utilization management, or... ...US Nationwide Work Style: Remote Travel Requirements: None...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday$30 - $34 per hour
...A healthcare services company is seeking an experienced Utilization Review Nurse to work remotely. The ideal candidate must hold an active LVN license in California and have experience in outpatient utilization management. Responsibilities include approving or denying...Remote workHourly pay- Vaya Health seeks a Physical Health Registered Nurse to perform clinical reviews for authorization requests and medical necessity. You will reference standardized... ...of clinical experience, including acute care and utilization management experience. #J-18808-Ljbffr Vaya HealthRemote job
- ...Management Location: 100% Remote Schedule: M-F 9:0... ...and analyze clinical service requests... ...Process prior authorization determinations within... ...Works with the Utilization Management team... ...necessity/utilization review and other... ...State Registered Nursing (RN) license in good...Remote workContract work
- ...seeking an experienced Utilization Management (UM) Registered Nurse to support outpatient utilization review and prior authorization activities for a leading... ...authorization, and outpatient clinical review. This role is... ...work independently in a remote environment....Remote workContract work
- 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 jobContract work
- Sentara Health Plans is seeking an experienced Utilization Review Nurse (RN) for Imaging/Commercial with remote work eligibility. The role covers prior authorization, inpatient and concurrent review, and coordination of care across benefits and contracts. A Virginia-compact...Remote jobFlexible hoursWeekend work
- University of Maryland Medical System seeks a Utilization Review Nurse for weekend shifts in Towson, MD. The... ...care levels while supporting prior authorizations. You will work with UR/MCG guidelines... ...credentials. Training is partly remote with onsite start as needed. #J-1880...Remote jobShift workWeekend work
$78k - $88k
Gainwell Technologies is seeking a skilled Utilization Review Nurse to perform prior authorization across prospective, concurrent, and retrospective reviews for medical necessity, documenting findings and ensuring policy compliance. This home-based role supports providers...Remote job$34 - $35 per hour
...Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical Nurse... ...procedures requiring authorization. Conducts telephonic and concurrent review of hospitalizations and extended... ...Nurse- Prior Authorization Remote Registered Nurse (Remote...Remote workFull timeWork at officeWork from homeNight shift$65k - $75k
...Description • Performs utilization review of cases to determine if the... ...special handling. • Performs clinical reviews according to the... ...requirements in collaboration with Nursing Management. • Keeps... ...CST - 7:00pm CST Location: Remote Compensation Disclosure...Remote workWork at officeLocal areaMonday to Friday- 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...Remote job
- University of Miami Health System seeks a full-time Utilization Review Case Manager to work remotely. The role reviews patient charts for prior authorization, concurrent and retrospective utilization, coordinating with the care team for timely and appropriate care. You...Remote jobFull time
- ...Utilization Review NurseSentara Health Plans Community Care... ...a Utilization Review Nurse.The Utilization Review... ...primary functions of prior authorization, retrospective review... ..., medical policy, clinical criteria).... ...that are available as remote work, Sentara Health...Remote workTemporary work
- ...Clinical Review Nurse - Remote ARC Group has multiple positions open for Clinical Review Nurses!... ...must currently have PERMANENT US work authorization. SUMMARY STATEMENT The Clinical... ...on the coverage, medical necessity, utilization and appropriateness of care per...Remote workPermanent employmentWork at officeLocal area
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Nurse - Clinical Review & Authorization. Be the first to apply!
- holistic nurse practitioner New York, NY
- trainee nurse practitioner New York, NY
- nursing home nurse practitioner New York, NY
- nurse practitioner - women's health New York, NY
- gastroenterology nurse practitioner New York, NY
- nurse practitioner-internal medicine New York, NY
- oncology nurse practitioner New York, NY
- neonatal nurse practitioner locum tenens New York, NY
- pediatric nurse practitioner New York, NY
- clinical nurse New York, NY


