Remote Nurse Reviewer — Utilization & QR
Health Care Service Corp.
- Remote job
Health Care Service Corporation in the United States seeks a Registered Nurse for Utilization Management and Quality Review oversight. The role requires 5+ years of nursing experience with UR/QR exposure and travel as needed. This is a remote, nationwide position with potential for professional development. The successful candidate will support clinical review activities, ensure compliance, and contribute to decisions affecting benefits and patient care across the health plan. #J-18808-Ljbffr Health Care Service Corp.
- Gainwell Technologies LLC is seeking a Senior Nurse Reviewer to perform reviews of medical records, healthcare claims, itemized medical... ...expertise and itemized bill review experience, with potential utilization review responsibilities. Home-based position within the...Remote jobWork from homeFlexible hours
$28 per hour
LPN Utilization Management Nurse Reviewer Miami, FL (Work from Home position for FL residents only) Currently seeking an LPN FL licensed Utilization Management... ...LPN clear and active for the state of FL (Required) Work Location: Remote #J-18808-Ljbffr Coastal Care Services, Inc.Remote workHourly payFull timeWork at officeLocal areaWork from homeRelocationHome officeWeekday work- Gainwell Technologies LLC is seeking a Nurse Reviewer (RN) to perform clinical reviews ensuring medical necessity based on criteria, policies... ...and support review determinations. The role is full-time with remote options for US-based employees. Expect to review records,...Remote jobFull time
- Gainwell Technologies is seeking a Nurse Reviewer to perform clinical reviews to determine if documentation supports the need for the service according to criteria and policies. This role emphasizes accuracy, compliance, and timely decisions within contract-specific review...Remote jobContract workWork from homeFlexible hours
$51k - $82k
...data analysis, investigation, and medical review to detect, prevent, deter, reduce, and... ..., and abuse. We are looking to add a Nurse Reviewer to our SGS team of talented professionals... ...sophisticated data model output, and utilize a variety of tools to detect situations...Remote workContract workShift workNight shift- ...Nurse Reviewer Contract Duration: Initial 6-months Pay: $27.50/hr on W2 Start Date: 9/8/2026 Location: Fully Remote (US Only) LPN State License must be active and in good standing... ...of quality standards by utilizing job aids, work instructions and...Remote workContract work
- ...requirements for this role, as well as associated experience, then apply with your CV below. SUMMARY: The Utilization Management Authorization Review Nurse is responsible for managing inpatient & outpatient utilization by conducting thorough reviews of clinical...
$78k - $88k
...development. Summary We are seeking a talented individual for a Nurse Reviewer who will be responsible for performing clinical reviews to... ...service based on clinical criteria, coverage policies, and utilization and practice guidelines as defined by review methodologies...Remote jobFull timeContract workWork from homeFlexible hoursWeekend work$78k - $99.2k
.... Summary We are seeking a talented individual for a Senior Nurse Reviewer to perform reviews of medical records, healthcare claims, itemized... ...in our mission Perform an in-depth review of medical claims utilizing the UB-04 and detailed itemized statement to ensure the...Remote jobFull timeWork from homeFlexible hours$40 per hour
PT (20-30 hours week) - Remote Work Environment Non-Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review... ...claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS...Remote workContract workWork at officeLocal areaImmediate start- ...Cost Projections. This includes reviewing records, preparing the... ...Associate Degree or Diploma in Nursing required ~3-5 years' experience... ..., medical bill reviews and utilization reviews in injury cases preferred... ...utilization #LI-ZP1 #LI-Remote For over 50 years, Verisk...Remote workFull time
- ...clients and the people they serve. Location: Remote with on‑site visits across Illinois Position Overview The Nurse Reviewer conducts provider compliance reviews to... ...documentation supporting compliance findings. Utilize technology and web‑based systems to convert paper...Remote workH1bWork at officeFlexible hours
$78k - $88k
...development. Summary We are seeking a Nurse Reviewer (RN) who will be responsible for performing... ...criteria, coverage policies, and utilization and practice guidelines. This role involves... .... Monday through Friday work schedule.Remote role available to employees residing...Remote jobFull timeMonday to FridayFlexible hours- ...CVS Health is seeking an experienced Registered Nurse to support utilization management from a remote home-based setting across the United States. The role involves assessing patient needs, planning and coordinating care, and collaborating with providers to render coverage...Remote workWork from homeWeekend work
- Description The Clinical Nurse Reviewer plays a crucial role in the healthcare industry by evaluating... ..., ideally in case management, utilization review, or quality assurance. Familiarity... ...the essential functions. This is a remote position. While performing the duties of...Remote workWork at office
$65k - $75k
...measurable impact. Job Description Performs utilization review of cases to determine if the request... ...requirements in collaboration with Nursing Management. Keeps current with regulation... ...Training: 10:30am CST - 7:00pm CST Location: Remote Job Type - Full-time Compensation...Remote workFull timeWork at officeLocal areaMonday to Friday- Health Care Service Corporation is hiring a Nurse Liaison I for Utilization Management & Quality Review. This remote nationwide role supports clinical review activities,... ...license, 3 years of clinical experience (2 in UM/QR), strong analytical and communication skills,...Remote job
$43 - $47 per hour
...Roles, MA, Phlebotomist, CNA|| Passionate ||… Home Health RN – Remote (CA License Required) Facility: Compassus Providence Home... ...Torrance, CA (5315 Torrance Blvd, Ste 169-B) Role Type: Remote Reviewer RN – Back Office Chart Review Start Date: 11/03/2025...Remote workContract work- ...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 workFull timeWork from home
- A healthcare organization is seeking a Nurse Reviewer to perform comprehensive medical necessity reviews for Medicaid claims. The role involves... ...review experience. This position offers a chance to work in a remote setup with competitive hours. Benefits include medical, dental...Remote job
- ...Providing timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions, treatment planning... ...licensure preferred Bachelor's degree in nursing (BSN) from an accredited institution or...Remote workFull timeWork experience placement
- Commence is seeking a Nurse Reviewer to perform expert medical record reviews of Medicare Part A/B and DMEPOS claims. You will apply clinical... ...policies, documenting clear rationales for actions. This remote role emphasizes HIPAA compliance and precise medical notation....Remote jobLocal area
- ...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
$63.1k - $94.65k
...next steps. Our partner is looking for a Utilization Review RN based in the United States.... ...hospital operations. In this part-time, remote role, you will apply your clinical expertise... ...excellent opportunity for a registered nurse who combines strong clinical judgment with...Remote workTemporary workPart timeWork at officeWork from homeFlexible hoursShift workAfternoon shift$1,949.74 per month
...Job Type Travel Offering Nursing Profession Registered Nurse Specialty Utilization Review Job ID 17979666 Job Title... ...13 Week(s) Job Description Remote Utilization Review RN responsible for concurrent...Remote workWeekly payShift work- ...Collaborating with the Medical Director, the full-time Registered Nurse Utilization Review will manage care variance reduction, ensure timely... ..., and refer members to appropriate resources while working remotely. Key responsibilities Assist in building and implementing...Remote workFull time
- ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge planning and utilization review.Responsibilities:• Reviews admissions and service requests within...Remote work
$1,813 - $1,908 per week
...Registered Nurse:Utilization Review,16:00:00-04:30:00 Location: Torrance, California Type: Travel Job 17789408 Salary: $1,813... ...Commission/ Core Measure/National Safety Goals Additional Skills remote UR work CA and Medi-Cal experience/knowledge*Remote work- ...RN Utilization Review Review patient medical records to assess the appropriateness and medical necessity of hospital admissions, continued... ...management experience (hospital-based) ~ Skilled experience with remote work Length of assignment: 13 weeks Shift / hours...Remote workShift workWeekend work
$110k - $140k
...strong negotiation/communication skills. This is a remote role. Key Responsibilities Claims Analysis & Review ~ Perform detailed audits of hospital and... ...Required Qualifications ~ Hospital/Surgical/ICU Nursing background (RN) and clinical coding background for...Remote workFull timeContract work
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