Remote RN: Utilization Management & Appeals
$60.2k - $107.4kIntelliResume
- Remote job
UnitedHealth Group is seeking a Registered Nurse with at least 3 years of bedside nursing experience to support appeals, data extraction, and HIPAA-compliant communications. This full-time position is remote within the United States and offers a pay range of $60,200 to $107,400 annually. The role uses templates and medical literature references, requires advanced Microsoft Office skills, and emphasizes collaboration across departments to meet quality and productivity goals. #J-18808-Ljbffr IntelliResume
- UnitedHealth Group's Optum is seeking a Utilization Management Nurse to review patient records and craft defensible appeal letters in accordance with OPAS guidelines. This role... ..., compliant reviews. The position requires an RN license and an associate degree, plus 3+ years...Remote jobMonday to Friday
- ...applicable patients as stated in system utilization management plan. Oversees Clinical Review... ...days for first week. This role will be remote BUT regular meetings/trainings require... ...assistance and/or clinical support to aid in appeal process.Serves as resource to Case...Remote workReliefWeekend work3 days per week
- ...Detroit, Michigan Registered Nurse (RN) Contract We are seeing a Michigan RN Utilization Manager. This is a 100% remote position in Michigan. Job Description... ...of service and level of care, including appeal requests initiated by providers,...Remote workContract workLocal areaFlexible hours
$38.91 - $60.31 per hour
...Colorado For This Fully Remote Opportunity Location... ...criteria. Provides case management and/or consultation... ...and concurrent denials appeals. Collaborates closely... ...as a Registered Nurse (RN). 3 years of relevant... ...Preferred: 3 years of utilization or case management experience...Remote workFull timeTemporary workLocal areaFlexible hoursShift work- ...Behavioral Health Utilization ManagerBehavioral Health Utilization Manager will perform concurrent and discharge reviews on... ...platform, adhering to BH UM and Appeals policies and procedures. Meets required... ...telephone systems Work Schedule: Remote Other Requirements: Able to work...Remote workContract workWork experience placement
$60.2k - $107.4k
...Utilization Management & Clinical Validation Rn Optum is a global organization that delivers care, aided by technology to help millions of people live... ...patient medical records; and craft strongly defensible appeal letters per process instructions and the department's...Remote jobMinimum wageFull timeWork experience placementLocal area$60.2k - $107.4k
...Utilization Management Nurse Optum is a global organization that delivers care, aided by technology to help millions of people live healthier... ...from patient medical records; and craft strongly defensible appeal letters per process instructions and the department's/...Remote jobMinimum wageFull timeWork experience placementLocal areaMonday to FridayFlexible hoursWeekend workAfternoon shift$29 - $52 per hour
...Utilization Management Nurse Rn Optum Insight is improving the flow of health data and information to... ...management, denial prevention, and appeals support when appropriate. This role... ...'ll enjoy the flexibility to work remotely from anywhere within the U.S. as you...Remote jobHourly payDaily paidMinimum wageFull timeWork experience placementLocal areaShift workWeekend workWeekday work- ...CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home role in the EST time zone. The position supports... ...management and benefit coordination, requiring an active RN license and hospital experience. Responsibilities include...Remote workWork from home
$72.8k - $130k
...Sr Utilization Management Nurse Optum is a global organization that delivers... ...occasional opportunity for remote work based on business needs... ...Qualifications: ~ Registered Nurse (RN) with a current, active,... ..., and/or clinical appeal and guidance reviews ~ Must...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area$84.56k - $126.84k
...Regular Job Overview The Utilization Review RN participates as a member of... ...Department Name: Utilization Management Job Status: part time, 24... ...position will be primarily remote but there may be occasions... ...cycle staff to assist with appeals. 7. Maintains and demonstrates...Remote workTemporary workPart timeLive inImmediate startRelocationRelocation packageShift workWeekend workAfternoon shift- ...Utilization Manager Registered Nurse (UMRN)Spectrum Healthcare Resources has a need for a Utilization Manager Registered Nurse (UMRN). These will be completely remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases, educating patients...Remote workFull timeContract workWork at officeWork from homeMonday to Friday
$40.5 - $64.8 per hour
...Description **This is a remote casual position supporting Utilization Review at Catherine Gratz Griffin... ...to 6p or 6p to 6a. ** The Case Manager, RN (PT)reflects the mission, vision,... ...Delivers notice of Medicare discharge appeal rights within the appropriate time...Remote workHourly payTemporary workWork experience placementCasual workLocal areaRelocation packageFlexible hoursRotating shiftWeekend workWeekday work- ...seeking a Registered Nurse for a temporary Utilization Management role. You will ensure prior... ...care programs. Required are an active CA RN license and at least five years in patient... ...substitute for experience. Hybrid work and remote- interview options are offered. #J-1880...Remote workTemporary work
- Humana is seeking an experienced Utilization Management Nurse 2 to support medical necessity reviews,... ...with providers and members. The role is remote/work-from-home with weekend shifts and... ...few times annually; requires Kentucky RN license, 2+ years clinical experience,...Remote jobWork at officeWork from homeShift work
- ...CVS Health is seeking a Utilization Management (UM) Nurse Consultant for a fully remote, full-time role open to CST zone candidates. You will coordinate, document, and communicate all aspects of utilization and benefit management, ensuring appropriate care levels within...Remote workFull time
- A leading healthcare organization is seeking a Care Manager RN for a remote role primarily serving the state of Washington. This per diem position involves crucial utilization management activities, ensuring compliance with payer requirements and regulations. Candidates...Remote workHourly payDaily paidDay shift
$59.5k - $116.6k
...UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services and requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate...Remote workWeekend work- A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote workFlexible hoursWeekend workDay shift
- ...service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and... ...resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license... ...clinical practice and knowledge of Utilization Review Guidelines. The...Remote work
- ...years of experience in an acute, post-acute or payer setting Required ~3 years of utilization review or care management experience Preferred Licenses and Certifications ~ RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure...Remote workWork experience placement
- Jefferson Health Plans in Philadelphia, PA, is hiring a Registered Nurse for Utilization Management. You will apply medical necessity criteria to determine patient status and coordinate denial/appeal activities for inpatient hospital care. Work is varied hours with an...Afternoon shift
$81.1k - $116.48k
Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member complaints,... ...providers. This position is 100% Remote. We are hiring for the... ...Minimum Qualifications: RN, LPN OR Dental Hygienist... ..., claims processing, utilization review or utilization management...Remote jobContract workTemporary workWork experience placementLocal areaMonday to FridayShift work$70k - $75k
...AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections... ...a better path!! Job Description The Utilization Management Registered Nurseis responsible for...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home- ...Utilization Management Specialist Shift: Monday through Friday 8:00 AM to 4:30 PM, with every fifth weekend rotation. Contract Length: 1... ...experience necessary. ~ Must be computer literate and have remote working experience. Compliance / Notes: Must provide...Remote workContract workWork experience placementLocal areaMonday to FridayShift workWeekend work
- A healthcare management organization is seeking a Utilization Management Nurse to oversee health service utilization while... .... This role requires an active LPN/RN license, and candidates should have... ...benefits package including remote work options. #J-18808-Ljbffr Healthcare...Remote job
$58.66k - $142.45k
...Peer-to-Peer Utilization Review Nurse Mass General Brigham... ...Central Utilization Management team, specializing in identifying... ..., supports appeal and reconsideration pathways... ...) processes through RN-to-RN collaboration with... ...and Work Model ~ Remote / Work from Home. ~32...Remote workWork from homeShift work- Appworkshub is seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this role, you will conduct inpatient and outpatient utilization reviews, support transitions of care, and ensure compliance with...Remote job
- UCHealth in Colorado is seeking a Registered Nurse for a remote-capable role focused on utilization and case management. This fully remote opportunity requires residency in Colorado and adherence to payer guidelines and documentation standards. The role emphasizes medical...Remote job
$39 - $40 per hour
...the job poster from The Judge Group Lead Healthcare Recruiter at The Judge Group Utilization Management Registered Nurse (RN) Type: 6-Month Contract W2 Location: Remote - but MUST reside in one of the following states: IL, TX, NM, OK, MT, TN Schedule:...Remote workDaily paidContract workMonday to FridayShift workWeekend work
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