Remote Utilization Management RN - Care Coordination
Humana Inc
- Remote job
Humana Inc. is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. You will report to the Manager of Utilization Management and support post-acute care services across SNF, home health, and DME to ensure members receive appropriate care in the right setting. The role requires an active compact RN license, over one year of RN experience in hospital/SNF/home health/acute care, and a #J-18808-Ljbffr Humana Inc
- Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care such as SNF, Home Health, and DME. The role reports to the Manager of Utilization...Remote job
- Humana is seeking an Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. You will report to the Manager of Utilization Management and serve on the One Home/Home Solutions...Remote job
- Humana Inc. is seeking a remote Utilization Management Registered Nurse to interpret clinical data and coordinate medical service determinations for home solutions and post‑acute care. You will review, document, and communicate with providers to ensure appropriate care...Remote job
- Highmark Health is seeking a remote Care Manager RN to support utilization management and care coordination. The role requires weekend availability (Saturday and Sunday) plus three weekdays, focusing on reviewing services, applying criteria, and improving member outcomes...Remote jobWeekend workWeekday work
- ...recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an... ...include evaluating healthcare services and coordinating care for members. Join a dynamic team and make a meaningful...Remote workContract work
$101.72k - $198.36k
...California - Ability to work remote, but selected candidate... ...position requires California RN Licensure. Candidates must... ...of the following functions: utilization management, care management, behavioral health... ...facilitating, planning and coordinating integrated delivery of care...Remote workContract workWork experience placementWork at officeLocal area- ...experienced Registered Nurse to join the Utilization Management team in a remote, full-time role focused on Medicare... ...information, apply criteria, and coordinate care plans to ensure members receive... ...Ideal candidates have an active RN license in their state, 3+ years of...Remote workFull timeWork at office
- Elevance Health is seeking a Wound Care Utilization Management RN to perform pre-certification and authorization... ...needs. You will review records, coordinate with physicians and home health... ...for continuity of care. This largely remote role requires in-person training...Remote jobMonday to FridayShift work
- CVS Health is seeking an Utilization Management Nurse Consultant to assess, plan, implement, coordinate, monitor, and evaluate healthcare... ...role requires a skilled RN with experience in acute/critical care and utilization management, offering remote work in California and a...Remote jobFull timeAfternoon shift
- ...Partners is seeking a Virtual Utilization Review Specialist to join our remote team. You will perform medical necessity reviews, manage denials, and coordinate with FCC and care management to optimize... ...Qualified candidates hold a current RN license, have at least 1 year...Remote job
$63.1k - $94.65k
...enabled revenue cycle management solutions for... ...have current compact RN license, or be... ...Information: Our Utilization Review team provides... ...of health care resources and assists... ...Denial Management Coordinates the P2P process with... ...: This is a remote role which requires...Remote workTemporary workPart timeWork at officeLocal areaFlexible hoursShift work$70k - $75k
...Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to... ...Description The Utilization Management Registered... ...services Quality of care concerns Interfacing... ...user‑friendly. Care Coordination & Quality Support Initiating...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home$39.4 - $53 per hour
...enabled revenue cycle management solutions for health... ...healthcare. The Lead Utilization Review RN is a key contributor... ...-oriented, patient care delivery system, which... ...MANAGEMENT: Coordinates the appeal process with... ...required #LI-LS1 #LI-REMOTE Join an award-winning...Remote workWork at officeLocal area- ...in the United States seeks an RN Utilisation Management Nurse Consultant to support... ...Medicare joint procedures in a remote, full-time role. Remote work... ...apply evidence-based criteria, coordinate care with providers, and help optimise utilization while upholding safety and...Remote jobFull timeAfternoon shift
- Highmark Inc. is seeking a full-time REMOTE Care Management professional with weekend availability to coordinate utilization management and health coaching. You will review services... ...3 years of progressive clinical experience; RN licensure in PA or multi-state licensure,...Remote jobFull timeWeekend work
- ...Description: Home Care & Hospice Virtual Care Center Coordinator Registered Nurse (RN) Hiring for the following... ...critical moments. Utilizing virtual platforms,... ...Leadership - Accessible managers who understand the... ...patients' conditions remotely. Develop and...Remote workFull timeTemporary workPart timeReliefLocal areaImmediate startMonday to FridayShift workWeekend work
$47.03 - $63.48 per hour
...enabled revenue cycle management solutions for health... ...possible in healthcare. RN, Senior Utilization Review Quality will... ...management denials. Coordinate with service line... ...experience in an acute care environment required... ...experiences This is a remote position; however,...Remote workTemporary workWork at officeLocal area$29.1 - $62.32 per hour
...passionate colleagues who care deeply, innovate with... ...one community at a time. Utilization Management Nurse Consultant Clinical Precertification RN (Medicare Home Care) Remote | Full-Time | Weekday Schedule... ...MDs and care teams to coordinate a smooth transition of care...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work- Humana Inc. is seeking an Utilization Management Administration Coordinator to support non-clinical processes ensuring appropriate care for members. This fully remote role reports to the UM Manager within the Home Solutions organization, aligning with SNF services and...Remote job
$26.01 - $62.32 per hour
...by passionate colleagues who care deeply, innovate with... ...and one community at a time. RN Utilization Management Nurse Consultant (Medicare – Joint Procedures) Remote | Full-Time | Monday–Friday... ...providers and care teams to coordinate appropriate treatment plans...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work$29.1 - $62.32 per hour
...passionate colleagues who care deeply, innovate with purpose... ...one community at a time. Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) Remote | Full-Time | Weekday Schedule... ...and care teams to coordinate appropriate treatment Apply...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work- Description Join our team as a remote (Oklahoma City) full time days and every other weekend RN Case Manager -Utilization Review at INTEGRIS Health,... ...available resources. Recommends and coordinates timely transfers to appropriate levels of care as indicated by clinical needs...Remote workFull timeWork at officeWeekend work
- ...highest quality patient care to residents... ...Transition of Care Coordinator to join our team.... ...TOC) Coordinator, RN supports high-risk... ...reducing avoidable utilization (reducing total... ...hybrid model with remote opportunities and... ...plans and symptom management strategies. Serve...Remote workContract workLocal areaFlexible hours
- ...seeking a Registered Nurse Case Manager to handle an individual... ...communication with the health care team. The role emphasizes case... ...management, documentation, and payer coordination to ensure quality patient care. Required are an active RN license and a bachelor’s degree...Remote workWork from home
$42 - $45 per hour
...Care Management Coordinator/RN Location: 100% Remote Duration: 3+ Months (FT conversion) This is a Utilization Management RN part time position - working every other weekend (2 days a week in a 2 week cycle). Must be available M-F 8:30-4:30pm for 2-3 weeks of training...Remote jobHourly payFull timeTemporary workPart timeFlexible hoursWeekend work2 days per week$71.1k - $97.8k
...Become a part of our caring community The Utilization Management Registered Nurse uses clinical... ...and support the coordination, documentation and communication... ...Compact Registered Nurse (RN) license in your state of... ...Experience working in a fully remote, metrics-focused role...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeHome office- Centene is seeking a registered nurse care manager to develop, assess, and facilitate complex... ...care plans, educate families, and coordinate with providers to address unmet needs.... ...Macomb counties, with the option to work remotely from home the remaining time. Mon-Fri,...Remote jobLocal areaWork from home
$60.53k - $129.63k
...passionate colleagues who care deeply, innovate with purpose... ...one community at a time. Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) Remote | Full-Time | Monday-... ...healthcare quality, and care coordination to improve member outcomes...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shift- ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge... ...and claim denials/appeals.• Assesses and coordinates discharge planning needs with healthcare...Remote work
- ...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
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