Remote Utilization Review Specialist - RN/LPN
Ensemble Health Partners
- Remote job
Ensemble Health Partners is seeking a Remote Utilization Review Specialist to join our team, focusing on medical necessity reviews and collaboration with care management and billing teams. This role is remote with potential onsite travel as business needs require. Qualified candidates must hold an active LPN or RN license, have a Bachelor's degree or equivalent, and bring at least three years of nursing experience, including utilization review knowledge. #J-18808-Ljbffr Ensemble Health Partners
$65k - $85k
...Utilization Review Specialist (RN) – RemoteAt Concierge Home Care, we are growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team.This role is ideal for an RN with strong experience in OASIS, coding, QA, and home health...Remote workMonday to FridayWeekend work- HonorHealth is seeking a Utilization Review RN Specialist to review and monitor health care utilization, ensuring medical necessity and appropriate... ..., and driving accurate documentation for data reporting. Remote work is available after training, with a day shift in a major...Remote jobDay shift
- TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews, assisting...Remote job
- ...NeighborHealth’s SCO RN UM Reviewer role is based in East Boston within the Senior Care Options team. You will review clinical appeals and service authorization needs to ensure medical necessity aligns with CMS standards and organizational determinations. The role requires...Remote work
- ...seeking experienced nursing professionals to review medical records and ensure appropriate... .... Candidates must have a valid California RN license and at least two years of clinical... ...degree in a related field. The position offers remote work with emphasis on critical thinking...Remote work
- ...Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The role involves performing retrospective medical... ...experience in a relevant medical setting, and the ability to work in a remote environment. Comprehensive benefits are provided, including...Remote workContract workWork from home
- ...an Appeals and Grievances Clinical Specialist to manage member complaints and... ...case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities... ...practice and knowledge of Utilization Review Guidelines. The position offers a...Remote work
- ...Utilization Review Specialist | Remote | Full-TimeBanyan Treatment Centers is seeking an experienced and detail-driven Utilization Review Specialist to... ...health related fieldClinical licensure (LCSW, LMHC, LPC, RN, or equivalent) — valued but not requiredExperience working...Remote workTemporary work
- ...Utilization Review Specialist The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients... ...skills. Preferred Qualifications: Registered Nurse (RN) license or equivalent clinical certification....Remote work
- ...patients-we invest in our people. About the Role: The Utilization Review Specialist plays a critical role in ensuring that healthcare services... .... Preferred Qualifications: Registered Nurse (RN) license or equivalent clinical certification. Experience...Remote workPart time
$39.4 - $53 per hour
...This position pays: RN pay scale $39.40 - $53/hr based on experience LPN pay scale $32.65 - $46.90/hr... ...We are seeking Virtual Utilization Review Specialists to join our team. Essential... ...Abilities Required: This is a remote role which requires access...Remote workTemporary workWork at officeLocal areaMonday to FridayWeekend work- Spectrum Healthcare Resources seeks a Utilization Manager Registered Nurse (UMRN) to work entirely from home in a fully remote role. The nurse will review cases, educate patients on... ...schedule of 8 hours per day, requiring an RN with a Bachelor's degree, state licensure...Remote jobWork from homeMonday to Friday
- ...providing telephonic and e-Referral case review and authorization of services utilizing established mental health and... ...This position is full-time, fully remote (work from home) and requires some... ...State of Michigan clinical license (RN, LMSW, LP, LPC, or LLP) required.Remote workFull timeWork from homeShift workWeekend workAfternoon shift
- ...integrating, and monitoring the utilization of behavioral health (BH) or... ...cases to the Medical Director for review. Refer to and work closely... ...Associates degree and active NYS RN license required. Bachelors... ...There may be opportunity for remote work within all jobs posted by...Remote workContract workWork at office
- ...General Hospital is seeking an Utilization Management Nurse (UMN) to ensure... ...concurrent, and retrospective reviews, collaborate with physicians and... .... Role requires Florida RN licensure and at least 3 years of nursing experience. Remote or hybrid work options may apply...Remote job
- ...American Health Plans in Franklin, TN seeks an Utilization Review Nurse to assess medical necessity and quality of care for plan members. You... ...services comply with regulatory guidelines. The role requires RN licensure and UM experience; knowledge of Interqual/MCG and Medicare...
- ...Coronis Health is seeking a remote Utilization Review Specialist to manage treatment authorization for behavioral health and substance abuse, interfacing with insurance and managed care entities. The role covers pre-certification, concurrent reviews, and appeals with...Remote work
$29.62 - $45.31 per hour
...Department Coordinate and execute the review and research functions required to support... ...Critically assess and prepare all cases for RN/MD review of coverage (medical necessity,... ...inquiries, provider resolutions, etc.) Remote Work This position offers 100% remote work...Remote workMinimum wageFull timeWork experience placementLocal areaShift work- ...ABA Utilization Review SpecialistSpectrum Billing Solutions offers industry-leading revenue cycle... ...to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR... ...rewarding environment. This is a fully remote or office/home hybrid position.Your Responsibilities...Remote workWork at officeFlexible hours
- ...Remote Authorization SpecialistThis role manages insurance authorization... ...-certifications, concurrent reviews, verifying benefits,... ...never disrupted by a payer issue.Utilization Review · Insurance... ...experience as a UR/authorization specialist at the PHP and IOP levels of...Remote work
- ...Seeking an experienced and detail-driven Utilization Review Specialist, the full-time remote position will manage a caseload of 50-75 patients, conducting admission and continuing-stay reviews, coordinating authorizations, and serving as a liaison between clinical operations...Remote workFull time
- ...Alliance Health is seeking a UM Clinical Specialist-LTSS for full-time remote work, NC-based. You will perform utilization reviews and authorizations for I/DD and TBI waivers, ensuring services meet clinical guidelines and are provided in the least restrictive setting....Remote workFull time
$30 - $45 per hour
...consulting agency is seeking an Operations Specialist III for a contract opportunity in Long... ...along with experience in Epic EHR and Utilization Review. The selected candidate will perform... ...program metrics. This position is remote and offers a pay range of $30-$45 per...Remote workHourly payContract work$55k - $70k
...support to behavioral health programs. We are looking for a Utilization Review (UR) Specialist in Boca Raton, FL Compensation: $55,000 - $70,000 a... ...position and must have prior UR & clinical experience. Remote hires and applicants without prior experience will not be...Remote workFull timeWork at office$80 per hour
...healthcare professionals experienced in prior authorization, utilization management, clinical review, medical necessity criteria, payer authorization... ...healthcare operations.This role supports current and upcoming remote consulting opportunities focused on AI-assisted prior...Remote workHourly payPart timeFor contractorsWork at officeFlexible hours- ...Utilization Review Specialist The primary purpose of the Utilization Review Specialist is to create and manage the flow of revenue for each client... ...limits. Proficient in Microsoft Office Satisfactory CORI and background check. Satisfactory drug screen Part Time Remote Role...Remote workPart timeWork at officeFlexible hours
$50k
...the lives of patients and their families What to Expect (Job Responsibilities) Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary treatment team to gather necessary information for concurrent...Remote work$70k - $100k
...of the Surgery Partners network, is seeking an experienced Utilization Review Specialist to join its team in Addison, Texas. This position is ideal... ...is a hybrid opportunity offering the flexibility of three remote workdays per week while maintaining an onsite presence two...Remote workContract work2 days per week- ...Responsible completion of assigned tasks related to preadmission reviews, continued stay reviews, medical necessity requests, and chart... ...appropriate services, in the least restrictive environment, utilizing proven clinical interventions will lead to the provision of safe...Remote workWork at office
- Mass Digital Health is seeking a Utilization Review Nurse in Quincy, Massachusetts. This role involves evaluating patients for appropriate admission... ...coordination. This position requires at least two years of RN experience in care management or utilization management. The...
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Review Specialist - RN/LPN. Be the first to apply!
- senior safety specialist Brooklyn, NY
- health specialist Brooklyn, NY
- outreach specialist Brooklyn, NY
- invoice specialist Brooklyn, NY
- information technology specialist Brooklyn, NY
- rehabilitation specialist Brooklyn, NY
- asset protection specialist Brooklyn, NY
- change management specialist Brooklyn, NY
- housing program specialist Brooklyn, NY
- equal employment specialist Brooklyn, NY

