Remote Senior Clinical Quality RN - Audit & Utilization Lead
$72.8k - $130kUnitedHealth Group
- Remote job
UnitedHealth Group is seeking a Registered Nurse for Utilization Review with remote work flexibility. Responsibilities include representing care coordination services during audits, analyzing UR functions, and collaborating with internal partners. Candidates must have at least 1 year of experience and be proficient in Microsoft applications. The role offers a salary range from $72,800 to $130,000 annually, alongside a competitive benefits package. Join us to impact the health care system positively! #J-18808-Ljbffr UnitedHealth Group
$86.3k - $118.7k
Humana Inc in Nashville is seeking a Senior Quality Assurance, Clinical Professional to lead quality audits and ensure high standards are met. This full-time position... ...to enhance quality assurance policies while utilizing nursing licensure and healthcare management experience...Remote jobQualitySeniorFull timeMonday to Friday$125k - $145k
...Description Sr Director Clinical Operations... ...Registered Nurse Senior Director of Clinical... ...ID: 2026-80776 Remote/Virtual Position... ...Reimbursement MI RN License Required... ...of personnel and utilize mentoring and motivational... ...in or leads quality improvement activities...Remote workQualitySeniorLocal areaFlexible hours$68.97k - $113.31k
...The Senior RN Clinical Consultant will work in partnership with Clinical... ...activities, customer inquiries, and quality. You are A highly... ...Oversee external vendor utilization within team Leverage knowledge... ...Location This is a remote position with occasional...Remote workQualitySeniorFull timeVisa sponsorshipWork visaFlexible hours$115k - $130k
...Role We're hiring a Clinical Operations Senior Manager, RN to help build, lead, and improve the systems... ...help deliver high-quality, patient-centered care... ...women's healthcare Remote corporate role with meaningful... ..., queue performance, utilization, quality, and...Remote jobQualitySenior$72.8k - $130k
...removing barriers to quality care. The work you... ...to work remotely* as you take on some... ...Responsibilities: Perform clinical documentation... ...work against an audit tool or information... ...independently while utilizing good critical... ...Active, unrestricted RN license in the state...Remote jobQualitySeniorMinimum wageFull timeFor contractorsWork experience placementWork at officeLocal area$30.58 - $55.09 per hour
...8 million members as a clinical professional on our Medical... ...team to promote quality and cost effectiveness... ...healthcare providers, utilization management team, and care... ...state plan and requires NY RN Licensure. Pay Range $... ...approach to work with remote, hybrid, field or office...Remote jobQualitySeniorHourly payFull timePart timeWork at officeFlexible hours$54.1k - $155.54k
...Resources, LLC is seeking a Clinical Team Lead to provide leadership and clinical... ...for a team responsible for Utilization Management Outpatient Appeals. This full-time remote position requires strong... ...candidate will mentor staff, ensure quality metrics, and foster a...Remote jobQualityFull time- ...Health, Inc. is seeking a Utilization Management Nurse to join their remote team. In this role, you... ...providers, monitor quality outcomes, and assist in... ...A minimum of 2 years of clinical nursing experience and an... ...impact on healthcare for seniors across the United States...Remote jobQualitySenior
- Humana Inc in Sacramento is seeking a Senior Quality Assurance, Clinical Professional who will oversee Quality audits of patient interactions. This position requires a current Registered Nurse licensure and experience in Quality Assurance. The ideal candidate will collaborate...Remote jobQualitySenior
- Humana Inc. is seeking a Senior Clinical Policy Research Professional to... ...policies crucial for ensuring quality healthcare services. This... ...analyzing clinical information, utilizing your expertise in policy... ...proficiency in Microsoft Office. Remote work will be standard, with...Remote jobQualitySeniorWork at office
- ...Senior Clinical Nurse II - Virtual Heart Failure Transitional... ...readmissions. The RN will work... ...resources to improve quality outcomes and... ...monitoring through remote patient monitoring... ...treatment plans Utilize evidence-based practice... ...and experience in leading initiatives....Remote workQualitySenior
- ...- I/DD to join our Medical Management team in North Carolina. This fully remote position requires extensive clinical and health plan experience in the I/DD field, focusing primarily on utilization management activities. Responsibilities include providing peer reviews, evaluating...Remote workSenior
$60.2k - $107.4k
...removing barriers to quality care. The work you do... ...Growing together. The Senior Clinical Administrative Nurse is... ...the flexibility to work remotely * from anywhere within... ...emergency department utilization and alternative levels... ...Current and unrestricted RN compact license...Remote workQualitySeniorMinimum wageFull timeWork experience placementLocal areaWeekday work- ...Registered Nurse with active licensure and minimum 3 years of clinical experience for a remote position. Candidates must have strong clinical... ...This role involves reviewing medical records, identifying quality issues, and supporting quality improvement initiatives while...Remote jobQuality
- Harris Health System, Inc. is seeking a Utilization Management Review Nurse (UMRN) in... ...service necessity and efficiency, ensuring quality care based on clinical guidelines. The UMRN will work... ...Bachelor’s in Nursing and being a licensed RN in Texas, alongside significant...Remote jobQualityFlexible hours
- ...Duties and Responsibilities The Utilization Nurse utilizes clinical expertise, discretion, and independent... ...Required: ~ Registered Nurse (RN) in the State of California... ...continues its mission to provide the highest quality health care services through the core...Remote workQualityLocal area
$20.38 - $36.44 per hour
...Utilization Review Specialist (LVN) Explore opportunities... ...Kelsey-Seybold Clinic, part of the Optum... ...of the nation's leading health care... ...help drive higher quality, higher patient satisfaction... ..., including mock audits, to ensure... ...flexibility to work remotely as you take on...Remote jobQualityHourly payMinimum wageFull timeWork experience placementLocal areaFlexible hours- A clinical-stage biotechnology firm is seeking a Senior Clinical Quality Associate to lead quality assurance activities in clinical research. This remote role requires strong knowledge of FDA regulations and GCP standards, with opportunities for growth in the innovative...Remote jobQualitySenior
- ...Clinical Supervisor, UM Denial Compliance Location:... ...Position Type: Hybrid (85% remote, 15% onsite in Burbank,... ...in ensuring a high-quality, efficient, and compliant... ...departmental reports, audits, and surveys. Monitor... ...Nursing Program; RN preferred. Minimum of...Remote workQuality
$77k - $128.3k
The clinical insights and performance lead will support the measurement and evaluation of provider performance... ...finance, and analytic teams, the Senior Advisor will support provider... .... Analyze trends related to quality, utilization, affordability, and provider performance...Remote workQualitySeniorFull timeLocal areaWork from home$100.7k - $200.9k
A leading clinical research organization is seeking a Clinical Trial Manager/Senior Clinical Trial Manager to oversee clinical studies from... ...key study documents. This remote position requires at least 7... ...experience, strong leadership qualities and excellent organizational...Remote jobQualitySenior- Alimentiv is seeking a Clinical Operations Lead to oversee the Clinical Monitoring unit in Chicago. In... ..., you will lead a team to ensure high-quality clinical trial execution and manage... ...leadership skills. This position supports remote work and offers the opportunity to...Remote jobQualitySenior
- 6AM City, LLC is seeking a Senior Specialist Programmer for a remote position with an emphasis on delivering quality programming for clinical studies. Candidates should have extensive programming... ...vaccine domain. The role involves leading programming deliveries, ensuring...Remote jobQualitySenior
$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi,... ...and will include 80% travel. Remote role. Will require a driver’... ...complaints and appeals. Licensed Clinical Social Worker/Registered... ...be an infectious agent of quality care wherever they go....Remote workQualityHourly payFull timeContract workImmediate startShift work3 days per week- ...Job Title- Clinical Data Governance Lead Location: Basking Ridge, NJ 07920 Duration... ...; however qualified remote based candidates would be considered... ...rates will comparable to a senior level/experienced Clinical... ...data management, data quality, data policies, data controls...Remote workQualitySeniorContract workLocal areaImmediate start
- Everest Clinical Research Services Inc. is seeking a Senior Clinical Data Manager for their Bridgewater, New Jersey location, with remote work options available. The role includes developing and maintaining project plans, overseeing data management deliverables, and providing...Remote jobQualitySenior
- ...Description: Manager of Clinical Utilization Management -... ...Type: Hybrid (85% remote, 15% onsite in Northridge... ...work-plans and audits. 5. Monitor and enhance the quality of the denial... ...necessary changes. 8. Lead the department... ...Nursing Program; RN preferred. 2. Minimum...Remote workQualityPermanent employmentFull timeTemporary workFlexible hours
- ...Description At Vetter Senior Living, our... ...a Director of Clinical Informatics who... ...opportunity for an RN who thrives at... ...You will: Lead and support ICD-... ...EHR) systems Audit clinical documentation... ..., and system utilization to ensure compliance and quality Provide targeted...QualitySenior
$36.95 - $46.19 per hour
...Senior RN (Administrator on Site) FT / PT Status -... ...$46.19 Hourly Wage Remote Work / In-Office - In... ...and evaluate patient's clinical problems and health care... ...Aid and/or CPR. Utilized information and techniques... ..., and propose quality solutions. Maintain...Remote workQualitySeniorHourly payFull timeWork at officeShift workNight shift- Ensemble Health Partners is seeking Senior Virtual Utilization Review Specialists to join their remote team in the United States. This... ...experience, possess current LPN or RN compact licensure, and have strong communication and clinical assessment skills. The position offers...Remote jobSenior
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