Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Remote Utilization Management RN

Humana

Humana is seeking a Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care programs (SNF, Home Health, DME). The role involves consulting with physicians, coordinating member care, and maintaining documentation while working remotely with periodic travel to Humana offices as needed.You must have a Compact RN license, 1+ year of RN experience, and familiarity with medical necessity criteria.J-18808-Ljbffr

Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Remote Utilization Management RN in Guin, AL vacancy
  •  ...Job Summary: As an on-site Hospital Utilization Management (UM) Nurse, you are the primary link between...  ...and administrative compliance. Unlike remote roles, this position relies heavily on...  ...-site UM Nurse is a Registered Nurse (RN) responsible for performing admission... 
    Remote work
    Full time
    Immediate start
    Shift work

    Wellstar Health Systems, Inc.

    Augusta, GA
    18 days ago
  •  ...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 work
    Work from home

    Cambia Health Solutions, Inc.

    Provo, UT
    5 hours ago
  •  ...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 work
    Work from home
    Weekend work
    Afternoon shift

    Native American Talent

    Arizona
    21 hours ago
  •  ...CVS Health is seeking a Utilization Management Nurse Consultant (Remote) to support Florida Medicare home-care requests. You will review cases, determine coverage...  ..., full-time setting. The position requires an active RN license, 2+ years of experience (including 1+ year in... 
    Remote work
    Full time

    CVS Health

    United States
    4 days ago
  • $52 - $56 per hour

     ...Now find a role that uses both. We're hiring a contract RN for a New York health plan (Medicare Advantage, Medicaid...  ...apply the same medical necessity judgment you built in utilization management. 100% remote (U.S.) | Contract | $52–$56/hr based on experience Business... 
    Remote job
    Contract work
    Afternoon shift

    Phaxis LLC

    New York, NY
    12 days ago
  • 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 job
    Work from home

    Arkansas Blue Cross Blue Shield

    Bismarck, ND
    5 days ago
  • $65k - $68k

     ...Utilization Management RN (M-F FROM YOUR HOME OFFICE) HealthCare Strategies Description Do you want to work from the comfort of your own HOME? Do you want to work for a progressive company that is a leader in their industry? F/T 40-hour/week Position Monday... 
    Remote work
    Full time
    Work at office
    Home office
    Monday to Friday

    HealthCare Strategies, Inc.

    Remote
    10 days ago
  • $70k - $75k

     ...Utilization Management Registered Nurse (RN) - Remote The Utilization Management Registered Nurse is responsible for performing utilization review activities in compliance with federal and state regulations, URAC standards, and Guidehealth policies. This role applies... 
    Remote work
    Bi-weekly pay
    Full time
    Temporary work
    For contractors
    Local area
    Work from home

    Guidehealth

    United States
    21 hours ago
  • $113.73k - $170.46k

     ...receive high-quality care while efficiently utilizing medical resources. Reviews patient...  ...Certifications: ~ Registered Nurse (RN) licensure in the state of practice: Required...  ...variances to the on-site care management teams when appropriate. Reviews and analyzes... 
    Remote work
    Full time
    Work experience placement

    Adventist Health

    Remote
    2 days ago
  •  ...Guidehealth, a data-powered healthcare company, seeks a Utilization Management Registered Nurse (RN) to perform utilization review remotely. The role supports compliance with federal and state regulations and URAC standards, applying medical necessity criteria to documentation... 
    Remote work

    Guide-Health

    Gary, IN
    21 hours ago
  •  ...Health is seeking a Medicare Precertification Utilization Management Nurse Consultant. You will assess and...  ...patient outcomes. The role requires 3+ years of RN experience, an active RN license, and Med/Surg exposure. Remote work from home with flexible scheduling and HIPAA... 
    Remote job
    Work at office
    Work from home
    Flexible hours

    CVS Health

    Sacramento, CA
    2 days ago
  •  ...Logan Health is seeking a Utilization Management Specialist to join our team in a fully remote role focused on inpatient admissions reviews, physician documentation assessment, and authorizations across the Logan Health system. The position emphasizes collaboration with... 
    Remote work

    Logan Health

    Montana
    21 hours ago
  •  ...CVS Health is seeking an experienced Registered Nurse for a remote Utilization Management Nurse Consultant role focused on Medicare joint procedures....  ...care and utilization. The position requires 3+ years RN experience, an active RN license, an associate degree in nursing... 
    Remote work

    CVS Health

    Guin, AL
    21 hours ago
  •  ...Arkansas Blue Cross and Blue Shield is seeking an experienced Utilization Management Nurse to perform clinical reviews for prior approvals,...  ...containment and quality of care. The position requires a RN license in good standing, a BSN preferred, and at least four... 
    Remote work

    Arkansas Blue Cross and Blue Shield

    Little Rock, AR
    21 hours ago
  • A healthcare recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an active RN license and experience with health plan operations. Responsibilities include evaluating healthcare... 
    Remote work
    Contract work

    The Judge Group

    Chicago, IL
    21 hours ago
  •  ...Integrated Home Care Services (IHCS) seeks a Utilization Management Nurse to ensure home health services are delivered with quality, cost efficiency...  ...optimize patient outcomes. State licensure as an LPN or RN and a minimum of 2 years in Utilization Management are... 
    Remote work

    Integrated HomeCare Services

    Florida
    21 hours ago
  •  ...CVS Health is seeking an Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) for a remote, full-time role. The position supports treatment planning, prior authorization decisions, and quality improvement in a Medicare context. The role... 
    Remote work
    Full time
    Work at office

    CVS Health

    Tallahassee, FL
    21 hours ago
  •  ...CVS Health is seeking a Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) to support treatment decisions remotely. You will collaborate with providers and apply clinical judgment for the right care at the right time. An active RN license... 
    Remote work
    Work at office

    CVS Health

    Crystal Bay, NV
    21 hours ago
  •  ...About the role We're looking for an RN who has personally owned grievance and...  ...hospital-based role. The best fit has a utilization management or case management foundation and has...  ...time-sensitive cases at once in a fully remote setting. Nice to haves BSN or MSN... 
    Remote job

    Phaxis LLC

    New York, NY
    12 days ago
  •  ...Logan Health is seeking a Utilization Management Specialist to review admissions across our system and determine appropriate status. The role...  ...insurance partners, and clear communication. This full-time, remote-enabled position requires Montana residence, with four 10-... 
    Remote work
    Full time
    Shift work
    Weekend work

    Logan Health

    Helena, MT
    21 hours ago
  •  ...Job Description Job Description The utilization review and management (UM) component program ensures that external healthcare services provided...  ...5 pm with one hour for lunch This is an in-office, no remote work capability position Travel ~ Some travel may be... 
    Remote work
    Work at office

    MedTrust LLC

    Oklahoma City, OK
    9 days ago
  •  ...CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant via remote work in the United States. The role requires RN licensure and 3+ years of nursing experience, with Med/Surg exposure and proficiency in Microsoft Office. You will assess... 
    Remote work
    Work at office
    Afternoon shift

    CVS Health

    Springfield, IL
    21 hours ago
  • $81.95k - $110.24k

     ...provider of technology-enabled revenue cycle management solutions for health systems,...  ...the possible in healthcare. The Lead Utilization Review RN is a key contributor to the overall financial...  ...degree Nursing required #LI-LS1 #LI-REMOTE Join an award-winning company... 
    Remote work
    Full time
    Work at office
    Local area

    Ensemble Health Partners

    Remote
    13 days ago
  •  ...CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to assess, coordinate, and determine appropriate healthcare...  ...-compliant practices. The position requires an active RN license, 3+ years of nursing experience, and comfortable use... 
    Remote work
    Work at office

    CVS Health

    Kansas City, MO
    21 hours ago
  •  ...Job Description Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY, NJ, or CT) Schedule: Monday – Friday, 9:00 AM – 5:00 PM Position Type: Full-Time Position Overview We are seeking... 
    Remote work
    Full time
    Monday to Friday

    Medix

    Mundelein, IL
    2 days ago
  •  ...timely discharges, and to refer members to other plan resources to meet their care conditions. Reports to the Health Plan Manager of Utilization Management. This position will be an integral member of the health plan’s medical management team. This position is a collaborative... 
    Remote work
    Casual work
    Work at office
    Shift work

    Peak Healthcare

    United States
    1 day ago
  • 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

    Healthcare Management Administrators

    Bellevue, WA
    5 days ago
  • Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. You will oversee inpatient case reviews, coordinate referrals, and collaborate with physicians, discharge planners, and ancillary services to ensure safe, cost-effective... 
    Remote job

    Alignment Health

    New York, NY
    2 days ago
  • CVS Health in the United States is seeking a Registered Nurse (RN) for its Utilization Management team. You will review clinical information to support coverage determinations and care recommendations, applying guidelines, policies, and professional judgment across the... 
    Remote job

    Morgantown, PA

    Phoenix, AZ
    2 days ago
  • $62.4k - $117.62k

     ...integrating, and monitoring the utilization of physical health (PH)...  ...to and work closely with Case Management to address member needs. Participates...  ...degree and active NYS RN license required. Bachelors...  ...There may be opportunity for remote work within all jobs posted by... 
    Remote work
    Full time
    Contract work
    Work at office

    Excellus BCBS

    Remote
    6 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Utilization Management RN. Be the first to apply!