Remote RN Utilization Review Specialist
Ascension
- Remote job
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 team, coordinate with care teams, oversee CMS and payer regulations, and help with precertifications, denials, and discharge planning. This role emphasizes safe transitions and data-driven reporting. #J-18808-Ljbffr Ascension
$65k - $85k
...Utilization Review Specialist (RN) – RemoteAt Concierge Home Care, we are growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team.This role is ideal for an RN with strong experience in OASIS, coding, QA, and home health...Remote workMonday to FridayWeekend work- HonorHealth is seeking a Utilization Review RN Specialist to review and monitor health care utilization, ensuring medical necessity and appropriate... ..., and driving accurate documentation for data reporting. Remote work is available after training, with a day shift in a major...Remote jobDay shift
- Ensemble is seeking Virtual Utilization Review Specialists to join our remote team. You will evaluate medical necessity, coordinate with physician advisors, and... ...utilization of resources. Must hold an unrestricted RN or LPN license and have 3+ years of acute care nursing...Remote job
- ...NeighborHealth’s SCO RN UM Reviewer role is based in East Boston within the Senior Care Options team. You will review clinical appeals and service authorization needs to ensure medical necessity aligns with CMS standards and organizational determinations. The role requires...Remote work
- ...Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The role involves performing retrospective medical... ...in a relevant medical setting, and the ability to work in a remote environment. Comprehensive benefits are provided, including medical...Remote workContract workWork from home
- ...Remote Authorization SpecialistThis role manages insurance authorization... ...-certifications, concurrent reviews, verifying benefits,... ...never disrupted by a payer issue.Utilization Review · Insurance... ...experience as a UR/authorization specialist at the PHP and IOP levels of...Remote work
- ...Coronis Health is seeking a remote Utilization Review Specialist to manage treatment authorization for behavioral health and substance abuse, interfacing with insurance and managed care entities. The role covers pre-certification, concurrent reviews, and appeals with...Remote work
- ...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
- ...Utilization Review Specialist The primary purpose of the Utilization Review Specialist is to create and manage the flow of revenue for each client... ...limits. Proficient in Microsoft Office Satisfactory CORI and background check. Satisfactory drug screen Part Time Remote Role...Remote workPart timeWork at officeFlexible hours
$50k
...the lives of patients and their families What to Expect (Job Responsibilities) Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary treatment team to gather necessary information for concurrent...Remote work- ...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
$55k - $70k
...support to behavioral health programs. We are looking for a Utilization Review (UR) Specialist in Boca Raton, FL Compensation: $55,000 - $70,000 a... ...position and must have prior UR & clinical experience. Remote hires and applicants without prior experience will not be...Remote workFull timeWork at office$80 per hour
...healthcare professionals experienced in prior authorization, utilization management, clinical review, medical necessity criteria, payer authorization... ...healthcare operations.This role supports current and upcoming remote consulting opportunities focused on AI-assisted prior...Remote workHourly payPart timeFor contractorsWork at officeFlexible hours- ...Utilization Review Specialist | Remote | Full-TimeBanyan Treatment Centers is seeking an experienced and detail-driven Utilization Review Specialist to... ...health related fieldClinical licensure (LCSW, LMHC, LPC, RN, or equivalent) — valued but not requiredExperience working...Remote workTemporary work
$30 - $45 per hour
...consulting agency is seeking an Operations Specialist III for a contract opportunity in Long... ...along with experience in Epic EHR and Utilization Review. The selected candidate will perform... ...program metrics. This position is remote and offers a pay range of $30-$45 per...Remote workHourly payContract work- ...ABA Utilization Review Specialist Spectrum Billing Solutions offers industry-leading revenue cycle management services for healthcare providers... ...in a cohesive and rewarding environment. This is a fully remote or office/home hybrid position. Your Responsibilities:...Remote workWork at officeFlexible hours
- ...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
- ...excellence.Who We're Looking ForWe are seeking an experienced specialist who is passionate about making a difference in the lives of... ...Health or related field required preferred.2-3 years of utilization review experience in behavioral health, addiction treatment, or managed...Remote workDaily paidFull time
$39.4 - $53 per hour
...Advancement This position pays: RN pay scale $39.40 - $53/hr based on experience... ...weekend We are seeking Virtual Utilization Review Specialists to join our team. Essential job... ...and Abilities Required: This is a remote role which requires access to high...Remote workTemporary workWork at officeLocal areaMonday to FridayWeekend work- ...to help improve the health of individuals and the quality of life in our community. New Horizons is seeking an Utilization Review Specialist , who will be responsible for following up on patient accounts when authorization for stay is required, initiate pre-...Remote workLocal area
$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- ...Responsible completion of assigned tasks related to preadmission reviews, continued stay reviews, medical necessity requests, and chart... ...appropriate services, in the least restrictive environment, utilizing proven clinical interventions will lead to the provision of safe...Remote workWork at office
$41.6k - $47k
...Utilization Review SpecialistAt Umpqua Health, we're more than a healthcare organization we're... ...healthier community.The Utilization Review Specialist supports Umpqua Health Alliance by... ...to stay organized and productive in a remote, independent work environmentProactive...Remote workWork at officeLocal areaImmediate startMonday to FridayShift work- ...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
- 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
- ...American Health Plans in Franklin, TN seeks an Utilization Review Nurse to assess medical necessity and quality of care for plan members. You... ...services comply with regulatory guidelines. The role requires RN licensure and UM experience; knowledge of Interqual/MCG and Medicare...
- ...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
- Diversified Treatment Alternative Centers is looking for a Utilization Review Specialist in Chadds Ford, PA. This role supports behavioral health... ...case management. This position offers flexible hybrid or remote work options and a comprehensive benefits package. #J-188...Remote jobFlexible hours
$51 per hour
...Utilization Review Specialist (BCBA Licensee) Baltimore, MD (Remote – offsite) Contract To Hire $51/hr (W2) 100% Remote Must be Licensed in one of the 3 states: MD, VA or Washington D.C. Utilizing key principles of utilization management, the Utilization Review...Remote workContract workWork at officeWork from home
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