Remote Utilization Management Services Rep I
Excellus BCBS
Excellus BCBS is seeking an UM Services Representative to support Utilization Management workflows with administrative and customer service duties. You will handle inbound/outbound calls, process authorizations via phone, fax, and provider tools, and ensure timely, accurate responses for procedures across inpatient, outpatient, behavioral health, and durable medical equipment.
The role requires strong communication, analytical skills, and the ability to work in a collaborative, regulated
#J-18808-Ljbffr- ...This position supports the Utilization Management (UM) workflows by providing... ...administrative support and customer service. This position acts as a... ...and training to UM Services Reps. Collaborates with other key... ...may be opportunity for remote work within all jobs posted...Remote workContract workWork at officeWork from homeHome office
- ...GuideWell Mutual Holding Corporation is seeking a Medical Director to lead all utilization management reviews (Pre-service, Post-service, Concurrent Review and Appeals) and to collaborate with physician providers and Case Managers on complex cases. The ideal candidate...Remote work
$31.2k - $35.36k
...a primary point of contact for our clients, managing inbound and outbound communications with professional excellence. Utilizing a suite of web-based tools, you will efficiently... ...is ideal for individuals passionate about service delivery in a high-velocity environment....Remote workOngoing contractFull timeWork from homeShift work- ...Coordinator 2 plays a key role in supporting the administration of utilization management services for healthcare providers. This position is responsible... ...Work-From-Home Requirements To be successful in this remote role, employees must maintain: A dedicated,...Remote workWork at officeWork from home
- ...CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. You will assess and coordinate care, determine coverage... ...experience, an active RN license, and Med/Surg exposure. Remote work from home with flexible scheduling and HIPAA compliance...Remote workWork at officeWork from homeFlexible hours
- ...CVS Health is hiring an experienced Registered Nurse (RN) for Utilization Management to ensure appropriate care at the right time through evidence-based review and coordination. This role supports 24/7 operations and may require evenings, weekends, and holidays from a...Remote workWork from homeWeekend workAfternoon shift
- ...Utilization Management Nurse at Cambia Health Solutions, Inc. works from home across Oregon, Washington, Idaho or Utah, with preference for Idaho/ Utah residents. The role performs prospective, concurrent and retrospective reviews to ensure medical necessity and appropriate...Remote workWork from home
- ...Automation for end-to-end Revenue Cycle Management, providing practice and financial management services to the healthcare industry.... ...Employees are proficient in utilizing these platforms effectively.... ...agencies. Location & Hours: Remote in USA Only. We cannot consider...Remote workFull timeTemporary workFor contractorsVisa sponsorshipFlexible hours
- ...Job Description Job Description We are seeking a Field Manager for utility access road construction and data mapping to become an integral part of our team! Days consisting of exploring remote access roads, managing field operations, using GIS technology, and supporting...Remote workFull timeWork at officeWork from homeFlexible hours
- ...CVS Health in Florida is seeking a Utilization Management Nurse Consultant. This full-time remote (work from home in Florida) role requires an active Florida RN license and at least 3 years of inpatient nursing experience. You will review medical necessity, coordinate...Remote workFull timeWork from homeWeekend workAfternoon shift
$65k - $68k
...Utilization Management RN (M-F FROM YOUR HOME OFFICE) HealthCare Strategies Description Do you want to work from the comfort of your... ...members for the purpose of: * Providing patient education services. * Rendering initial determinations of medical appropriateness...Remote workFull timeWork at officeHome officeMonday to Friday- Cambia Health Solutions seeks a Clinical Specialist to support utilization management and regulatory compliance from a remote home base across Idaho, Oregon, Utah, and Washington. The role emphasizes clinical insight, documentation, and collaboration with RNs to optimize...Remote jobWork from home
- Cambia Health Solutions, Inc. is seeking an Utilization Management Nurse to perform prospective, concurrent, and retrospective reviews for member care across multiple states. The role emphasizes applying clinical criteria, ensuring medical necessity, and coordinating with...Remote jobWork from home
- Cambia Health Solutions is seeking a Clinical Specialist to support utilization management processes from a home-based model across select western states. You will review requests, gather information, and prepare cases for clinical review while coordinating with providers...Remote jobWork from home
- Arkansas Blue Cross Blue Shield is seeking an Utilization Management Nurse to perform clinical reviews of prior approvals, network exceptions, and inpatient/outpatient procedures. The role requires an active RN license and a Bachelor's degree is preferred, with at least...Remote jobWork from home
- ...is expanding its presence in distributed generation and small utility-scale markets. The Sales Executive will develop long-term customer... .... You will engage developers, IPPs, EPCs and utilities and manage opportunities in NetSuite and HubSpot. The role requires a strategic...Remote job
- A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board certification and unrestricted medical license in relevant states. The role involves performing detailed...Remote jobFull timeWork from home
$108.18k - $147.1k
...Baystate Health’s Health New England is seeking a Manager of Utilization Management to lead our Utilization Management Health Services Team and help shape the delivery of high-... ...Solving process. Location: ~ Fully remote position- candidate MUST reside in MA or CT...Remote workHourly payFull timeWork at officeMonday to FridayAfternoon shift$139.6k - $209.4k
...Category): Sales, Marketing & Product Management Job Schedule: Full time Remote: Yes Job Description: The... ...As an Account Manager supporting utility customers, you will maintain and... ...for products, systems, and services. You will help address customer challenges...Remote workFull timeWork from home$275k
...hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health... ...of inpatient, outpatient, and pharmacy services by reviewing clinical information and... ...Management. Work Location: This is a remote position, open to candidates who...Remote workFull timeLocal areaWork from homeHome officeWeekend work- ...Remote DUR Pharmacist Safe & Cost-Effective Medication Use Work... ...from home. This remote Drug Utilization Review Pharmacist role is ideal... ...license. Experience: Managed care, PBM, or health-plan preferred... ...managed-care pharmacy services nationwide. Our DUR pharmacists...Remote jobWork from home
- ...Northwest (PNW) practice, and we are looking for a Senior Utility Management Services (UMS) Consultant to help lead that growth from the ground... ...functions of this job. \n This is a hybrid position (in office/remote). We offer a telecommute option to work once a week from...Remote workFor contractorsWork at officeLocal areaWork from homeWork visa1 day per week
$45k - $70k
...mobility journey. This role is service focused, with the... ...mobility journey. Regularly utilizes digital tools to access client... ...purchase, home rental, property management, expense management, household... ...our organization. #LI-Remote Sirva Worldwide, Inc. provides...Remote workFull timePart timeLocal areaWorldwideRelocationFlexible hours$29.1 - $62.32 per hour
...schedules will be determined in collaboration with management to ensure adequate weekend coverage. Position Summary Utilize your clinical experience and skills in a... ...options to facilitate appropriate healthcare services and benefits for members. Key...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeShift workWeekend work$60.53k - $129.63k
...and one community at a time. Registered Nurse (RN) Utilization Management Nurse Consultant - Remote Make a difference in patient care from the comfort... ...leverage your clinical expertise to review healthcare services, coordinate care, and help ensure members receive the...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeAfternoon shift$54.1k - $155.54k
...one person, one family and one community at a time. Utilization Management Registered Nurse (RN) - Remote Make a meaningful impact on patient care from... ...members receive appropriate, high-quality healthcare services and benefits. What You'll Do Review and...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeAfternoon shift- ...offers industry-leading revenue cycle management services for healthcare providers. Our team has... ...streamlined manner. We are seeking a ABA Utilization Review Specialist The ABA Utilization... ...environment. This is a fully remote or office/home hybrid position. Your Responsibilities...Remote workWork at officeFlexible hours
$40k - $52.3k
...part of our caring community Full-Time, Remote Telephonic opportunity The UM... ...Coordinator 2 supports the administration of utilization management by performing a variety of moderately... ..., operational, and customer service tasks. Responsibilities may include...Remote workFull timeTemporary workApprenticeshipWork from homeHome office$104k - $143k
...Become a part of our caring community The Utilization Management Clinical Pharmacist 2 (VSP/PT) is a... .... Job Description Location: Remote – United States Schedule: This is a... ...effectively, the self-provided internet service of Home or Hybrid Home/Office employees...Remote workBi-weekly payDaily paidFull timePart timeApprenticeshipWork at officeWork from homeHome officeShift workWeekend workAfternoon shift$65.52k - $118.56k
...Utilization Management Nurse Work from home within Oregon, Washington, Idaho or Utah Preference... ...lives better. As a member of the Clinical Services team, our Utilization Management... ..., and regulatory organizations. #LI-Remote Pay ranges vary based on the candidate...Remote workFull timeWork at officeImmediate startWork from homeFlexible hours
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