Remote RN Clinical Reviewer - Utilization & Compliance
$28.37 - $36 per hourAcentra Health
Acentra Health is seeking a Clinical Reviewer - RN - PRN to join our team. This remote role involves reviewing medical records for compliance with medical appropriateness while achieving production goals. You will work with regulatory criteria and ensure accurate documentation for services. Ideal candidates have a valid RN license, as well as clinical and remote work experience. Benefits include a 401(k) plan, wellness programs, and EAP resources. The pay range for this position is between $28.37 and $36.00 per hour. #J-18808-Ljbffr
$28.37 - $36 per hour
...Acentra Health, LLC is seeking a Clinical Reviewer - RN - PRN (Remote U.S.) to join our growing team. The role involves reviewing patient records and ensuring medical necessity while adhering to HIPAA policies. Candidates should have a valid RN license in South Carolina...Remote workHourly payReliefFlexible hours$45 - $50 per hour
...looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical... ...of accredited nursing programs with an active New York RN license. #J-18808-Ljbffr...Remote workHourly pay$50 per hour
...experienced Registered Nurse Clinical Reviewer for a fully remote position with an hourly... ...role involves conducting utilization reviews and ensuring healthcare documentation compliance for a respected non-profit... ...an active New York State RN license and 1-3 years of experience...Remote jobHourly pay$70k - $120k
...Fully Remote : Clinical Documentation Specialist Job Description... ...and retrospective reviews of medical records to... ...documentation. Utilize clinical knowledge and... ...documentation improvement. Ensure compliance with regulatory... ...Registered Nurse (RN) with a current license...Remote workLocal areaMonday to Friday- ...organization is seeking a Care Manager RN for a remote role primarily serving the... ...diem position involves crucial utilization management activities, ensuring compliance with payer requirements and... ...license along with 3 years of clinical experience. The role offers competitive...Remote workHourly payDaily paidDay shift
- TEEMA Solutions Group is looking for a Clinical Quality Reviewer to support a large-scale federal healthcare... ...ideal candidate will have an active RN or LCSW license, at least 3 years of... ...skills. This role offers flexibility with remote or onsite work options, depending on...Remote job
- ...Centene Corp. is seeking a Supervisor, Utilization Management (RN) to lead and supervise our Clinical Review team. This role focuses on ensuring appropriate care for our members and promotes adherence to compliance standards through effective team management and continuous...Remote workFlexible hours
- ...Health is seeking a Supervisor of Utilization Management (UM). This remote position requires overseeing the Pre... ...Authorization team while ensuring compliance with guidelines. Your leadership... ...in Utilization Management, strong clinical knowledge, and excellent interpersonal...Remote job
- Capacity Path is seeking a Behavioral Health Utilization Manager, RN, for a remote position in Houston, TX. This role focuses on reviewing concurrent and discharge cases for patients, ensuring compliance with established criteria, and providing timely feedback to healthcare...Remote job
- ...BCBS is hiring for a Utilization Management... ...health and ensuring compliance with standards. The... ...candidate will have clinical experience, strong... ...and an active NYS RN license. The position... ...-service clinical reviews and collaborating... ...and potential for remote work based on...Remote work
- ...NY. The position demands extensive clinical experience and knowledge of utilization management, with responsibilities including performing clinical reviews and collaborating with providers. Applicants... ...an Associate degree and active NYS RN license, with a preference for a...Remote work
- ...A healthcare organization is seeking a Clinical Services Specialist RN to perform reviews of patient records for medical necessity compliance. This full-time role involves analyzing records according to policies and facilitating communication with various stakeholders...Remote workFull timeWork from home
$50 per hour
...Overview RN Clinical Reviewer / IDR - Remote (#25310C) Location: Remote Employment Type: Full-time Hourly Rate: $50/hr Position Overview Greenlife... ...setting. Must have 1-3 years of experience in acute care utilization review/ appeals background. Technical Skills:...Remote workHourly payFull timeWork at officeFlexible hours- .... The role requires a NYS RN license and 3+ years of clinical experience. Responsibilities include clinical reviews and collaboration with providers... ...candidates will have utilization management experience and... ...experience, and potential for remote work. #J-18808-Ljbffr...Remote work
- ...Health is seeking a Travel Nurse RN Case Manager specializing in Utilization Review for a role in Somerville,... ...coordinators, ensuring best clinical practices and compliance. The ideal candidate holds a... ...travel position offers a flexible remote working schedule from Monday...Remote workMonday to FridayFlexible hours
$68k - $71.03k
...Claims Clinical Documentation Reviewer Job No: 541748 Work Type: Full-time Location: REMOTE OPTIONS, VARIOUS-STATEWIDE, PHOENIX... ...Nursing/Investigations/Compliance AHCCCS Arizona... ...over and under service utilization, conduct prepayment claims...Remote workFull timePart timeInternshipWork at officeWork from homeLong distanceFlexible hours- ...program to identify a Clinical Quality Reviewer. This role focuses on... ...in clinical review, utilization management, or healthcare... ...efforts Ensure compliance with regulatory requirements... ...a Registered Nurse (RN) or Licensed Clinical... ...Other Information Remote or onsite depending...Remote workWork at officeHome office
- A healthcare provider is seeking a Utilization Review Nurse to coordinate resources and ensure efficient delivery of home health care. This role involves monitoring patient admissions and ongoing care while ensuring adherence to guidelines. The ideal candidate will have...Remote workContract work
- ...the first 25 applicants Job Title:Clinical Review Nurse (RN) – Utilization Management Location:Oregon or bordering... ...and meetings for updates and compliance Crosstrain to support broader team... ...) Clinical Program Coordinator RN *Remote* Clinical Program Coordinator RN *Remote...Remote workContract work
- ...healthcare services. Interns will conduct clinical reviews, communicate with healthcare providers, and ensure compliance with regulations. Candidates must hold an active RN license and have at least two... ...experience. The position is remote with a weekday schedule. #J-18808...Remote workInternshipWeekday work
- ...Omaha seeks a full-time Utilization Review Nurse to oversee... ...treatment requests and ensure compliance with guidelines.... ...Candidates should have a BSN or RN degree and at least 5 years of clinical experience in critical... ...offers options for remote work, health insurance,...Remote workFull time
- ..., DC is seeking a DME Medical Reviewer to ensure compliance with nursing standards and provide... ...candidate must hold an active RN license and have at least two years of clinical experience. Responsibilities... ...audits. The role emphasizes remote work capabilities and adherence...Remote work
$90.87 - $154.33 per hour
...healthcare organization seeks a Physician Clinical Reviewer in Gastroenterology to provide medical review for service requests remotely. Candidates should have 5+ years of... ...patient care and work collaboratively in a utilization management team while enjoying a competitive...Remote work$28.37 - $36 per hour
...Acentra Health is looking for a Clinical Reviewer - RN - PRN (Remote U.S.) to join our growing team.... ...benchmarks, ensuring precision and compliance in medical record reviews. Review... ...and adhering to HIPAA policies. Utilize proper telephone etiquette and judicious...Remote workContract workWork experience placementReliefWork at officeLocal areaMonday to FridayFlexible hours- Optum is seeking a Clinical Claim Review Nurse to perform claim reviews and ensure compliance in a telecommute role. You will verify coding accuracy and support health outcomes... ...role requires an Associate's degree, active RN license, and clinical experience. You’ll enjoy...Remote jobFlexible hours
- ...Degree Manage Others No The Utilization Management (UM) Clinical Reviewer is responsible for... ...outcomes, ensure regulatory compliance, and support optimal care... ...Tuesday - Saturday (fully remote) Key Responsibilities: Review... ...nursing program (RN, LPN, or LVN), or Graduate...Remote jobFull timeWork at officeLocal areaWeekend work
$35.29 - $47.37 per hour
...their work-life balance ~ Remote work options and Flexible scheduling... ...All duties are performed in compliance with organization’s policies... ...hiring a Part-time REMOTE Utilization Review Nurse . If you are a... ...Utilization Review Nurse The Clinical Review Nurse is responsible...Remote workHourly payPart timeCurrently hiringWork at officeLocal areaWork from homeMonday to FridayFlexible hours$85k - $105.34k
UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG,... ...Management Nurse evaluates clinical service requests to ensure... ...care settings, ensuring compliance with Oregon Health Plan (OHP... ...Active, unrestricted RN license (BSN or MSN) in Oregon...Remote workFull timeWork at officeLocal areaImmediate startMonday to Friday- Blue Cross Blue Shield of Arizona needs a clinical expert for managing member and provider appeals. This remote position requires strong accuracy, knowledge of compliance timelines, and a focus on customer service. Applicants should possess a healthcare-related degree...Remote job
- A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and collaborating with teams to meet...Remote jobContract work
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