Remote RN Utilization Management Nurse — Quality, Cost & Care
Arkansas Blue Cross and Blue Shield
Arkansas Blue Cross and Blue Shield is seeking an Utilization Management Nurse to perform clinical reviews for prior approvals, network exceptions, and benefit inquiries from a home office in Arkansas or other eligible states. The role focuses on medical necessity and evidence-based criteria to guide cost-effective care.
Candidates should have an RN license in good standing, a Bachelor's degree in Nursing preferred, and at least four years of clinical nursing experience with utilization
#J-18808-LjbffrVacancy posted 15 hours ago
Similar jobs that could be interesting for youBased on the Remote RN Utilization Management Nurse — Quality, Cost & Care in Arkansas vacancy
$101.72k - $198.36k
...California - Ability to work remote, but selected... ...requires California RN Licensure.... ...following functions: utilization management, care management, behavioral... ...strategy to provide quality and cost-effective member care... ...behavioral health, nurse advice line, and/or...Remote workQualityContract workWork experience placementWork at officeLocal areaMolina Healthcare Careers
Bakersfield, CA28 days ago$63.1k - $94.65k
...revenue cycle management solutions for... ...compact RN license, or be... ...Information: Our Utilization Review team... ...(diagnoses, cost criteria, and... ...of health care resources and... ...readmissions Quality/Revenue... ...physicians, nurses, multidisciplinary... ...This is a remote role which requires...Remote workQualityTemporary workPart timeWork at officeLocal areaFlexible hoursShift work$100k - $130k
...providing high-quality, affordable, and... ...preventive care while leveraging... ...care at a lower cost—delivering the... ...it most. The Utilization Management (UM) team plays... ...As the Lead RN, Utilization Management... ...Management nurses and clinical reviewers... ..., we embrace a remote-first culture...Remote workQualityFull timeWork experience placementWork at officeFlexible hours$39.4 - $53 per hour
...revenue cycle management solutions for... .... The Lead Utilization Review RN is a key contributor... ...financial, quality, and clinical... ..., patient care delivery system... ...with physicians, nurses, other patient... ...to ensure costs are medically... ...#LI-LS1 #LI-REMOTE Join an award...Remote workQualityWork at officeLocal area- ...Join our team as a remote (Oklahoma City)... ...every other weekend RN Case Manager -Utilization Review at... ...appropriate levels of care as indicated by clinical... ...to reduce cost of managing patient... ...impacting quality or outcomes. Participates... ...RN (Registered Nurse) Current...Remote workQualityFull timeWork at officeWeekend work
- ...here . Job Summary Utilization Management Nurse performs clinical review... ...and promotes appropriate care and quality toward cost effective and cost containment... ...~ Registered Nurse (RN) with active, current, unrestricted... ...in an office setting or remotely, periodically has lifting...Remote workQualityFull timeWork at officeWork from home
- Ensemble Health Partners is seeking an RN Utilization Review quality professional to lead QA efforts within... ...license, at least three years of acute care nursing experience, and knowledge of medical necessity review criteria. Remote work with travel to client sites is expected...Remote jobQuality
- ...experienced Registered Nurse for the Medicare Utilisation Management Nurse Consultant role (Remote, Full-Time). You will... ...receive the right care at the right time within... ...to improve care quality while supporting care integration and utilization management. #J-18808...Remote jobQualityFull time
- Guidehealth, a fully remote healthcare company, is seeking a Utilization Management Registered Nurse to perform reviews, apply medical necessity criteria, and document... ...role emphasizes AI integration into daily workflows and high-quality care. #J-18808-Ljbffr GuidehealthRemote jobQuality
$72.8k - $130k
...organization that delivers care, aided by technology... ...opportunity for remote work based on business... ...needs. As a Sr Utilization Management Nurse in the Springfield MA... ..., and promoting quality patient care. Responsibilities... ...a Registered Nurse (RN) with a current,...Remote workQualityMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal areaOptum
Amherst, MA4 days ago$77.08k - $119.47k
...Department/Unit: Care Management/Social Work Work... ...0 Responsible for Utilization Management, Quality Screening and Delay... ...Characteristics # Registered nurse with a New York... ...regarding costs, supplies and department... ...cannot be done from a remote location. Other Requirements...Remote workQualityFull timeShift workAlbany Medical Center
Albany, NY4 days ago- ...United States seeks an RN Utilisation Management Nurse Consultant to support Medicare... ...joint procedures in a remote, full-time role. Remote... ...criteria, coordinate care with providers, and help optimise utilization while upholding safety and quality. #J-18808-Ljbffr CVS HealthRemote jobQualityFull timeAfternoon shift
$70k - $75k
...Guidehealth leverages remotely-embedded... ...™ and a centralized Managed Service Organization... ...partners to deliver high-quality healthcare focused on... ...Description The Utilization Management Registered Nurse is responsible for performing... ...Quality of care concerns Interfacing...Remote workQualityBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from homeGuidehealth
Kenosha, WI15 hours ago$47.03 - $63.48 per hour
...enabled revenue cycle management solutions for health... ...in healthcare. RN, Senior Utilization Review Quality will play an essential... ...experience; Specialty/Major: Nursing or related field... ...in an acute care environment required... ...experiences This is a remote position; however, candidates...Remote workQualityTemporary workWork at officeLocal area$26.01 - $56.14 per hour
...colleagues who care deeply,... ...prioritize safety and quality in everything... ...: 100% Remote (U.S. only) About... ...accredited medical management organization... ...provide flexible, cost-effective care... .... As a Utilization Management (UM) Nurse Consultant specializing... ...unrestricted RN license in...Remote workQualityHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hoursShift workCVS Health
United States4 days ago$29.1 - $62.32 per hour
...passionate colleagues who care deeply, innovate with purpose... ...and prioritize safety and quality in everything we do. Join... ...one community at a time. Utilization Management Nurse Consultant Clinical Precertification RN (Medicare Home Care) Remote | Full-Time | Weekday...Remote workQualityHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work$26.01 - $62.32 per hour
...by passionate colleagues who care deeply, innovate with purpose... ...accountable and prioritize safety and quality in everything we do. Join us... ...one community at a time. RN Utilization Management Nurse Consultant (Medicare – Joint Procedures) Remote | Full-Time | Monday–Friday (...Remote workQualityHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work$29.1 - $62.32 per hour
...by passionate colleagues who care deeply, innovate with... ...accountable and prioritize safety and quality in everything we do. Join us... ...one community at a time. Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) Remote | Full-Time | Weekday...Remote workQualityHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work$71.1k - $97.8k
...Become a part of our caring community The Utilization Management Registered Nurse uses clinical nursing skills... ...Registered Nurse (RN) license in your state... ...Experience working in a fully remote, metrics-focused role... ...leading to a better quality of life for people with...Remote workQualityBi-weekly payFull timeTemporary workApprenticeshipWork at officeHome office$77.91k - $116.86k
...conventional health care, committed to serving... ...an inpatient review nurse to join the remote utilization management team. As an... ...the most appropriate, cost effective level of care... ...maintaining safety and quality. Schedule: Monday... ...unrestricted LVN or RN license in California...Remote workQualityFull timeImmediate startMonday to Friday$60k
...LVN experienced in the managed care payor environment to... ...service and post-service utilization reviews and appeals... ...SKILLS/ABILITIES The UM Nurse’s responsibilities... ...development opportunities Remote Opportunities We... ...is to improve the quality of life for the...Remote workQualityFull timeTemporary workLocal area$69.8k - $125.9k
...ensuring compliance with Utilization Management (UM) and Quality Review (QR)... ...of experience as a Nurse Reviewer or Clinical... ...~ Registered Nurse (RN) with an unrestricted... ...knowledge of managed care principles. ~ Analytical... ...This is a remote role #LI-KW1 #LI-...Remote workQualityFull timeNight shift- ...comprehensive case management services to members, ensuring quality, cost-effective care delivery, and... ...preventing improper utilization of member benefits... ...principles. Bachelors in Nursing. Current State RN licensure OR... ...~ Office-Based or Remote Position...Remote workQualityContract workFor contractorsWork at officeLocal area
$60.53k - $129.63k
...passionate colleagues who care deeply, innovate with purpose... ...and prioritize safety and quality in everything we do. Join us... ...one community at a time. Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) Remote | Full-Time | Monday-Friday...Remote workQualityHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shift- ...practice of primary care. We are putting... ...improved quality, better patient... ...and lower total cost of care. Job Summary... ...: The Nurse Care Manager is responsible... ...goals. Utilize Motivational Interviewing... ...in a remote setting. Education... ...(BSN) or RN with bachelor’s...Remote workQualityFull timeWork experience placementWork at office
- ...the direction of the Care Management Manager, the Health Coach... ...as the primary nurse to provide both health... ...plan, ensuring high quality, cost-effective services are... ...issues to manager and utilizes the occurrence screening... .... Fully Remote: This role is designated...Remote workQualityWork at officeFlexible hours
Independence Blue Cross
United States3 days ago - ...in personalized managed health care, focused on... ...excellence and cost containment that... ...while ensuring quality care through effective... ...-life balance.Remote settingRole... ...individual will utilize clinical... ...and acceptable nursing practice guidelines... ...not limited to RN, LMSW, LMHC.Must...Remote workQualityTemporary workWork at officeMonday to FridayFlexible hours
Hines
Rockford, IL3 days ago $26.41 - $59.21 per hour
...Molina Healthcare is hiring a remote RN Care Manager. Preference for candidates... ...strategy to provide quality and cost-effective member care. •... ...experience. • Registered Nurse (RN). License must be active... ...Resource Linkage / Utilization, Transportation & Follow-up...Remote workQualityHourly payWork experience placementWork at officeLocal areaNight shiftWeekend workMolina Healthcare Careers
Renton, WA14 days ago- SUMMARY OF POSITION:The Utilization Management (UM) Nurse is a licensed nursing... ...coordinating patient care to ensure patients... ...data for utilization, quality improvement,... ...make decisions within RN's clinical scope of practice... ...may be in understaffed/remote areas, in the...Remote workQualityWork at office
- ...accomplished Registered Nurse (Utilization Management) . Candidate must be... ...Location: 100% Remote for California Residents... ...appropriate level of care. Also, you will be reviewing... ...identify potential quality of care issues,... ...a current California RN License. Requires at...Remote jobQualityContract workWork at officeLocal area
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN Utilization Management Nurse — Quality, Cost & Care. Be the first to apply!
