Remote RN: Utilization Management & Clinical Validation
$60.2k - $107.4kConstruction Association of Michigan
- Remote job
Optum is seeking an Utilization Management & Clinical Validation RN who will review and extract case details from patient records and craft defensible appeal letters in line with process guidance. You will use encoders, ICD-9/10, CM/PCS, CPT, HCPCS and supporting literature to justify coding changes as needed. The role offers telecommuting from anywhere in the U.S. with a schedule-driven environment, collaboration across teams, adherence to HIPAA, and a pay range of $60,200 to $107,400 per year. #J-18808-Ljbffr Construction Association of Michigan
- UnitedHealth Group's Optum is seeking an experienced RN for Utilization Management & Clinical Validation. You will review patient records, extract pertinent... ...evidence-based literature and coding guidelines. This remote role supports telecommuting from anywhere in the U.S...Remote jobFlexible hours
- Optum, a UnitedHealth Group company, is seeking an Utilization Management and Clinical Validation RN to review medical records and craft defensible appeal letters. You will work with evidence-based medical literature and coding guidelines, while supporting telecommuting...Remote job
- ...to help millions of people live healthier lives. The Utilization Management and Clinical Validation RN will review patient medical records, extract pertinent... ...process instructions and guidelines. This role is remote from anywhere in the U.S. with an unrestricted RN license...Remote job
$60.2k - $107.4k
...Utilization Management & Clinical Validation Rn Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the...Remote jobMinimum wageFull timeWork experience placementLocal area- Optum is seeking a Utilization Management & Clinical Validation RN to review medical records, extract pertinent details, and craft defensible appeal letters. The role involves coding knowledge, literature references, and HIPAA compliance, with a telecommute option from...Remote job
- UnitedHealth Group is seeking an Utilization Management & Clinical Validation RN to accurately review medical records and extract case details, crafting defensible appeal letters using evidence-based literature and coding knowledge. You will work from anywhere in the U....Remote jobFlexible hours
- ...is seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this role, you will conduct... .... The ideal candidate will have strong clinical judgment, a valid RN license, and 3+ years of experience in utilization...Remote job
- Comagine Health is seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess medical necessity... ...retrospective reviews. This full-time remote role supports compliant, cost-... ...a Physician Advisor when needed. A valid Alabama RN license and 3+ years of clinical...Remote jobFull timeContract work
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays... ...critical role in supporting utilization management operations by conducting... ...This is a 100% remote role, and requires robust... ...Suite, anchored by Cohere Validate™, an AI-driven clinical...Remote workFull timeFlexible hoursShift work- 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... ...Candidates should possess a nursing degree and a valid California RN license, along with 4+ years of...Remote jobFlexible hours
- ...Brigham Health Plan is seeking a Registered Nurse to provide clinical review and escalation support for Utilization Management, triaging inquiries and ensuring medical necessity and regulatory compliance. This remote role supports our national network while collaborating...Remote job
- ...RN Clinical Consultant The RN Clinical Consultant is a key member... ...Healthcare's Enhanced Care Management (ECM) program, providing clinical... ..., reducing avoidable utilization, and supporting members through... ...using eClinical Works (eCW) Valid BLS certification from the...Remote workTemporary workWork at officeFlexible hours
$92.3k - $120k
Registered Nurse (RN), Home Health Utilization Management Remote - USA At Clover Health, we are committed to providing... ...their care journey, combining clinical expertise with data-driven insights... ...Hold a current and valid Compact Registered Nurse (RN) license...Remote workWork at officeLocal areaFlexible hours$34 - $35 per hour
Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical Nurse - Work from... ...reliability reviews Qualifications RN license in an eNLC (Enhanced Nurse Licensure... ...Review Nurse- Prior Authorization Remote Registered Nurse (Remote Patient...Remote workFull timeWork at officeWork from homeNight shift$72.8k - $130k
...Sr Utilization Management Nurse Optum is a global organization... ...occasional opportunity for remote work based on business... ...details, reviewing clinical information for appropriateness... ...~ Registered Nurse (RN) with a current,... ...to provide proof of a valid, unrestricted Driver's...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- ...The purpose of Dignity Health Management Services Organization (... ...managed care administrative and clinical services to medical groups,... ...Responsibilities As our UM RN (Utilization Management Registered Nurse)... ...resources. As a remote employee, we will provide you...Remote workLocal areaWork from homeShift workWeekend work
- Humana is seeking an experienced Utilization Management Nurse 2 to support medical... ...members. You will use clinical judgment to decide on level... ...providers and members. The role is remote/work-from-home with weekend... ...annually; requires Kentucky RN license, 2+ years clinical...Remote jobWork at officeWork from homeShift work
$29 - $52 per hour
...RN Clinical Care Coordinator At UnitedHealthcare, we... ...will be the primary care manager for a panel of members... ...promote appropriate utilization of services and improved... ...flexibility to work remotely as you take on some tough... ...transportation and valid US driver's license with...Remote workHourly payMinimum wageFull timeTemporary workWork experience placementLocal area$35 - $62.5 per hour
...Clinical DRG RN Auditor $10,000 SIGN ON BONUS FOR EXTERNAL... ...proprietary tools, you will validate ICD-10 diagnosis and... ...overpayments. Utilizing excellent communications... ...requirements Maintain and manage daily case review... ...work independently in a remote environment and...Remote jobHourly payDaily paidMinimum wageFull timeTemporary workPart timeWork experience placementWork at officeLocal areaRelocation package- ...Description Job Description: Manager of Clinical Utilization Management - Denial... ...CAPosition Type: Hybrid (85% remote, 15% onsite in Northridge,... ...Registered Nursing Program; RN preferred.2. Minimum of five... ...computerized environment.7. Valid CA driver's license and car...Remote workPermanent employmentFull timeTemporary workFlexible hours
- ...Utilization Manager Registered Nurse (UMRN) Spectrum Healthcare Resources has a need for a Utilization... ...Nurse (UMRN). These will be completely remote positions, working entirely from the... ..., the HCWs must have pertinent clinical experience within the past two (2) years...Remote workFull timeContract workWork at officeWork from homeMonday to Friday
$100k
...1-3 years Salary $100,000 Remote Job Job Description This is a remote position. The Utilization Management (UM) Nurse is responsible for conducting clinical reviews and assessing the medical... ...unrestricted Registered Nurse (RN) license in the applicable state...Remote workContract workWork experience placement- ...Nurse for a full-time remote position, who will review... ...expertise is needed Utilize CMS guidelines and... ...nursing experience in a clinical setting At least 1 year... ...UM experience in a managed care environment Active, valid, and unrestricted LVN or RN license in California...Remote workFull time
$81.1k - $116.48k
...Grievances (A&G) unit manages Healthfirst member... ...of or delivery of clinical and non-clinical... ...position is 100% Remote. We are hiring for... ...Qualifications: RN, LPN OR Dental Hygienist... ...processing, utilization review or utilization... ...transacted with a valid "@healthfirst.org"...Remote jobContract workTemporary workWork experience placementLocal areaMonday to FridayShift work- Netsmart is seeking a Registered Nurse with solid utilization management experience to perform ED utilization reviews and admissions screening... ...criteria. The role requires adept EMR review, strong clinical judgment, and collaboration with ED physicians to ensure appropriate...Remote job
- A healthcare management organization is seeking a Utilization Management Nurse to oversee health service... ...requires an active LPN/RN license, and candidates should have clinical experience and proficiency... ...benefits package including remote work options. #J-18808-Ljbffr...Remote job
- Molina Healthcare seeks an experienced RN to support Arizona Plan clinical member services review processes.... ...AZ RN license and experience with utilization management, prior authorization, and both inpatient and outpatient settings. Remote position, must reside in Arizona,...Remote job
$59.5k - $116.6k
UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services... ...an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate will work...Remote jobWeekend work- A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote jobFlexible hoursWeekend workDay shift
- SSM Health is seeking a Manager of RN Utilization Management to oversee system-wide UM activities and... ...high-performing team. The role blends clinical nursing expertise with strategic leadership... ...of care. The position is fully remote with a preference for candidates in MO...Remote jobWeekend work
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