Remote RN Reviewer - Utilization & Care Policy
Gainwell Technologies LLC
Gainwell Technologies is seeking a Nurse Reviewer (RN) to perform clinical reviews determining medical necessity and documenting findings. You will access proprietary systems, apply criteria, and support review determinations with policy and regulatory knowledge.
The role is full-time, with day-one benefits, and offers a remote option for US-based employees. Travel is minimal, and opportunities for training and career development are provided.
#J-18808-Ljbffr- ...Power of Every One. Job Title Utilization Management RN Reviewer Location Cleveland Facility Remote Location Department Utilization... ...Knowledge and experience with Care Guidelines, Medical Necessity Criteria... ...procedures in accordance with policies and procedures Knowledge of and...Remote workPolicyFull timeWork at officeShift workWeekend work
- ...Massachusetts Licensed RN Reviewer will determine medical necessity... ...decisions while working remotely. Key responsibilities: Perform utilization management and medical... ...and addressing policy interpretation issues Required... ...Experience in a managed care setting is preferred...Remote workPolicyFull time
- ...Sentara Health Plans is hiring a Clinical Claims Reviewer/RN for a remote role. This full-time position involves utilization management and post-payment review across various care settings, with RN licensure and coding credentials under consideration. The role offers...Remote workFull time
- ...Working remotely in a full-time capacity, the Florida RN Utilization Reviewer will conduct admission, concurrent, and retrospective reviews of medical records to ensure... ...data and identify issues affecting patient care and reimbursement Document findings accurately...Remote workFull time
- ...Sentara Health Plans is seeking a Clinical Claims Reviewer/RN for a remote, full-time position. Responsibilities include utilization management, pre/post payment claim reviews,... ...license, and at least three years of acute care experience, plus experience in health plans...Remote workFull time
- ...Sentara Health Plans is seeking an RN Clinician for remote utilization management and claims review. You will perform pre/post payment reviews, authorizations, and... ...guidelines. Requires a BSN and 3 years of acute care clinical experience; CPC preferred. Remote options...Remote work
- ...Cook Children's Health Care System is seeking a Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer to coordinate the efficient utilization of health care resources for CCHP members and ensure timely, quality care throughout the continuum...Remote work
- ...In this remote contract role, the physician reviews clinical service requests from members and... ...clinical judgment and managed care criteria to determine... ...to physician review policies, procedures, and continuous... ...Preferred Experience in utilization review, case review, or related...Remote workPolicyFull timeContract workWeekend workWeekday work
- ...Humana is seeking a remote Utilization Management Behavioral Health Professional... ...The role requires an active RN license in Indiana, an ASN (... ...year of clinical and managed care experience. You will... ...ensure optimal care, interpret policies, and follow established guidelines...Remote workPolicy
- Utilization Reviewer (RN)- Full Time, Days, 8 AM - 4 PM, Morristown Morristown, NJ, United States Trending... ...denials or reduction in level of care. 2.Performs daily surveillance of... ...assigned cases in accordance with department policy and procedure. 9.Complies with the...PolicyHourly payFull timeTemporary workPart timeFor contractorsFor subcontractorFlexible hoursShift work
- ...the full-time South Carolina Licensed RN Reviewer will complete evaluations and assessments... ..., and maintain continuity of patient care in a remote environment. Key responsibilities Complete... ..., and treatments in accordance with policy and individualized care plans Ensure all...Remote workPolicyFull time
- ...Corporation is seeking a Utilization Management Nurse Consultant (RN) for remote work supporting prior... ...utilization management. You will review requests, evaluate... ..., and collaborate with care teams to ensure timely,... ...ensuring compliance with policies and standards while #J-1...Remote workPolicy
- ...Plans is seeking a Clinical Claims Reviewer/RN for remote work. The role involves evaluating utilization management, reviewing pre/post... ..., and ensuring adherence to policy across multiple states. A BSN and... ..., with 3 years of acute care experience. Remote opportunities...Remote workPolicy
- ...CVS Health is seeking a Remote Utilization Management Nurse Consultant (RN) to review and determine appropriate coverage, applying policies and clinical guidelines. The role collaborates with care teams to coordinate treatment and improve member outcomes in a 4-day weekend...Remote workPolicyWeekend work
$52 - $56 per hour
...We're hiring a contract RN for a New York health plan... ...necessity judgment you built in utilization management. 100% remote (U.S.) | Contract | $52–$5... ..., investigation, clinical review, decision and notification... ...‑based or long‑term care background (not inpatient...Remote workContract workAfternoon shift- ...Responsibilities As our Utilization Review RN, you will meticulously review... ...review principles, hospital policies, and external regulatory agencies... ...—physicians, payers, and Care Coordinators—regarding... ...This position is open to remote/out of state candidates residing...Remote workPolicy
$35 - $40 per hour
...Sagility LLC, a leader in healthcare transformation, seeks an RN Utilization Management Reviewer for a fully remote role. You will perform timely clinical decision reviews for services requiring prior authorization across various clinical areas, applying criteria like...Remote workHourly pay$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis... ...performing utilization review activities in compliance... ..., and Guidehealth policies. This role applies established... ...services Quality of care concerns...Remote workPolicyBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home$75k - $88k
...process. Clinical Reviewer RN - Alabama Alabama,... ...has engaged in health care quality consulting and... ...outcomes. Our talented remote workforce spans the... ...are seeking Clinical Utilization Review Nurses (RN) based... ..., organizational policies, and contract requirements...Remote workPolicyFull timeContract work- ...Position Description Position Title: Utilization Review Nurse Position Code: RN-6027 Department: Case Management... ...for determining level of care. Assures medical documentation accurately... ...required timeframes as per KHI policies and procedures. Responsible for...Remote workPolicyWork at officeFlexible hours
$89.07k - $162.8k
...and retrospective case reviews to ensure appropriate... ...admit status and level of care by utilizing the nationally... ...way. This position is remote but must be willing to... ...adheres to organizational policies procedures and quality... ...Certifications: RN - Registered Nurse - State...Remote workPolicy- ...Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations from a remote location. The role requires... ...judgment, collaboration with care teams, and a weekend-... ...management and adherence to policies while offering a stable full...Remote jobPolicyFull timeWeekend work
- ...of integrated health care plans and related... ...the LTSS department. RN will be responsible... ...authorization and concurrent review. Provides monthly... ...setting by utilizing the applicable medical policy and industry standards... ...Additional Info: *possible remote opportunity after...Remote workPolicyContract workMonday to FridayFlexible hours
- ...is seeking a Registered Nurse (RN) ICD-10 and Oasis Reviewer for home health services. This REMOTE role requires you to reside in... ...evaluate, document, and coordinate care under the Oasis process,... ...home settings while aligning with policy and care plans. Join a leading...Remote jobPolicy
$47.03 - $63.48 per hour
...possible in healthcare. The RN, Senior Utilization Review Quality will play an... ...and management VUR policies/procedures for entry level... ...nursing experience in an acute care environment required Utilization... ...experiences This is a remote position; however, candidates...Remote workPolicyTemporary workWork at officeLocal area$63.1k - $94.65k
...have current compact RN license, or be willing... ...Schedule Information: Our Utilization Review team provides coverage... ...utilization of health care resources and assists... ...in departmental policies and procedures Communication... ...: This is a remote role which requires...Remote workPolicyTemporary workPart timeWork at officeLocal areaFlexible hoursShift work$60.2k - $107.4k
...Utilization Management NurseOptum is a global organization that delivers care, aided by technology to help millions of people live healthier... ...accurately and efficiently review and extract pertinent case... ...adhering to both Optum and OPAS policies and procedures, which include...Remote workPolicyMinimum wageFull timeWork experience placementLocal areaMonday to FridayFlexible hoursWeekend workAfternoon shift- ...Registered Nurse Rn Icd 10 and Oasis Reviewer REGISTERED NURSE (RN) - EPISODE ASSESSMENT... ...- HOME HEALTH SERVICES - REMOTE Must live in South Carolina... ..., where we deliver quality care where the patients choose... ...in accordance with policy and the individualized care...Remote workPolicyLive inFlexible hours
$78.88k
...and critical-thinking Utilization Review (UR) Nurse Specialist... ...our team. In this fully remote position, you will... ...resource management, care appropriateness, and revenue... ...are an experienced RN with acute care background... ...adherence to hospital policies, HIPAA,...Remote workPolicyTemporary workWork at office10 hours per weekShift workWeekend workAfternoon shift$39 - $40 per hour
...The Judge Group Utilization Management Registered Nurse (RN) Type: 6-Month Contract... ...W2 Location: Remote - but MUST reside... ...operations and utilization review. You will be... ...services, coordinating care, and ensuring... ...with Judge's Privacy Policy, information obtained...Remote workPolicyDaily paidContract workMonday to FridayShift workWeekend work
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