Remote RN Utilization Management Reviewer
Cook Children's
Fort Worth, TX
- Remote job
Cook Children's Health Plan in Fort Worth, TX seeks an experienced RN Reviewer for Utilization Management to coordinate care and ensure timely, quality services for plan members. The role focuses on behavioral health and ambulatory care, with cross-training across areas as needed. The RN UM/ECM Reviewer assesses clinical information, determines medical necessity with the Medical Director, and uses MMC criteria to authorize services while maintaining regulatory timelines. #J-18808-Ljbffr Cook Children's
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote RN Utilization Management Reviewer in Fort Worth, TX vacancy
$35 - $40 per hour
...service offerings for clinical, case management, member engagement, provider... ...containment, and analytics. Job Title RN Utilization Management Reviewer Responsibilities Conduct timely clinical... ...may require weekends. Location: Fully remote work at home role. Secure, private...Remote workHourly payTemporary workMonday to FridayFlexible hoursWeekend workSagility LLC
New York, NY1 day ago- 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 job
$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 InterQual...Remote jobHourly pay- ...power of the Cleveland Clinic Health System team, and The Power of Every One. Job Title Utilization Management RN Reviewer Location Cleveland Facility Remote Location Department Utilization And Quality Assur-Weston Hospital Job Code 000446 Shift...Remote workFull timeWork at officeShift workWeekend work
$35 - $40 per hour
...service offerings for clinical, case management, member engagement, provider... ...employees across 5 countries. Job title: RN Utilization Management Reviewer Job Description: We are currently hiring... ...require weekends This is a fully remote work at home role. You must have a...Remote workHourly payTemporary workCurrently hiringMonday to FridayFlexible hoursWeekend work- Coastal Care Services, Inc. is seeking an LPN licensed Utilization Management Nurse Reviewer for a work-from-home opportunity serving the Miami, FL area. Work schedule is 10am to 7pm, with every other Sunday and a weekday off for a total of five days per week. The role...Remote jobWeekday work
- ...Role Overview Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient... ...Ability to obtain additional RN licensure across the enterprise including... ...Package Flexible work solutions include remote options, hybrid work schedules,...Remote workMonday to FridayFlexible hoursWeekend work
AmeriHealth Caritas
Newtown Square, PA3 days ago $86k - $117.3k
...For roles that are 100% remote or hybrid, you must have access... ...most. We offer integrated managed care products, pharmaceutical... ...of a supervisor, the Utilization Management Reviewer evaluates medical necessity... ...unencumbered Registered Nurse (RN) license in the District of...Remote workHourly payContract workMonday to FridayFlexible hoursWeekend work2 days per weekAmeriHealth Caritas
Washington DC1 day ago- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board certification and unrestricted medical license in relevant states. The role involves performing detailed...Remote workFull timeWork from home
ExamWorks
United States3 days ago - ...Great Place to Work" company is seeking a Physician to provide utilization review services for the Group Health Department. This role... ...business background required Experience in Utilization Management with criteria review utilizing standard practice guidelines...Remote work
Dane Street
United States5 days ago - ...Location: Remote - TX Department: Utilization Shift: First Shift (United States of America) Standard... .... Works with the Department Manager and Team Lead to assure the timely... ...Management/Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate...Remote workFull timeShift workDay shift
$219k - $286.9k
Oscar Health is hiring a Physician Reviewer to join our Utilization Management team. You will determine the medical appropriateness of inpatient, outpatient... ...and applying evidence-based guidelines. This remote role in the United States offers work from home with occasional...Remote jobWork from home$219k - $286.9k
...Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around a... ...Utilization Management. Work Location: This is a remote position, open to candidates who reside in the United...Remote workFull timeLocal areaWork from homeHome officeWeekend work- Oak Street Health is seeking a Utilization Management Physician Reviewer for a fully remote, full-time role. You will apply UM criteria and clinical judgment to determine coverage for inpatient and outpatient services, coordinating with care teams to ensure appropriate...Remote jobFull time
- Oscar Health seeks a Physician Reviewer to join the Utilization Management team in a remote US-based role. You will determine the medical appropriateness of services and document decisions using evidence-based guidelines and Oscar workflows. Responsibilities include timely...Remote job
- Oak Street Health is seeking a Full-Time Utilization Management Physician Reviewer to provide accurate coverage determinations for inpatient and outpatient services, applying UM criteria, clinical judgment, and internal policies. You will coordinate with care teams to ensure...Remote jobFull time
- A leading independent review organization is seeking a Utilization Management Physician Reviewer for a full-time remote role. Candidates must possess an active Nebraska medical license and have a minimum of 5 years clinical practice experience. Responsibilities include...Remote jobFull timeCasual workMonday to Friday
$230k
...health care one person, one family and one community at a time. Company: Oak Street Health Title: Utilization Management Physician Reviewer Location: Fully Remote Hours: Full-Time, Monday - Friday, 8am -5pm CST Salary: $230k per year Role Description...Remote workHourly payFull timeLocal areaMonday to Friday- ...Humana is seeking an Utilization Management Registered Nurse to interpret and... ...post-acute care. You will work remotely, reporting to the Manager of... ...include an active RN license in your state and 1+... ...candidates have UM/utilization review experience, knowledge of Milliman...Remote work
Humana
Florida, NY2 days ago - ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge planning and utilization review.Responsibilities:• Reviews admissions and service requests within...Remote work
First Connect Health
Austin, TX4 days ago - ...Humana is seeking a Utilization Management Nurse to leverage clinical nursing skills in coordinating, documenting, and communicating medical service... ...members to ensure appropriate care. The position expects RN licensure with no disciplinary actions, a Bachelor’s degree,...Remote work
Humana
United States4 days ago - Elevance Health is seeking a Wound Care Utilization Management RN to work primarily virtually with periodic in-person training sessions. The role... ...health care settings. The RN will coordinate care plans, review home-based services, and discuss plans of care with providers...Remote jobWork from home
- ...Guidehealth is seeking an Utilization Management Registered Nurse to perform medical-necessity reviews and document findings for determinations... ...ensuring timely decisions in a remote work environment. Ideal candidates hold an active IL RN license, have 3+ years in...Remote work
Guidehealth
Gary, IN5 days ago - ...States is seeking an Inpatient Utilization Management Clinician to evaluate inpatient... ...planning across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and... ...management to ensure timely reviews, document outcomes, and maintain...Remote workFull time
Well Sense Health Plan
United States5 days ago - ...Utilization Management RN (Part-Time, Remote) Position Overview Under the direction of a designated manager, the Utilization Management RN performs telephonic review of hospital admissions and recommends alternative levels of care when appropriate. This role...Remote workPart timeMonday to Friday
The Judge Group
Philadelphia, PA5 days ago $70k - $75k
...Utilization Management Registered Nurse (RN) - Remote The Utilization Management Registered Nurse is responsible for performing utilization review activities in compliance with federal and state regulations, URAC standards, and Guidehealth policies. This role applies...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from homeGuidehealth
United States3 days ago$2,158.8 per week
...Ref. 65547807 RN - Utilization Review $2,158.80 per week Location: Fort Myers, FL... ...for a travel assignment in Fort Myers, FL. This remote position requires expertise in utilization management, making it an excellent opportunity for experienced...Remote workWeekly payWork experience placementMonday to FridayFlexible hoursShift workWeekend workSeven Healthcare
Fort Myers, FL2 days ago- Elevance Health is seeking a Psychologist Reviewer - ABA to join our behavioral health team in a virtual, full‑time capacity. You will... ...clinical/counseling psychology, an active license, and experience in managed care. Travel is not required, training sessions are in-person...Remote jobFull time
- ...Utilization Management RN Remote I'm currently working on a Utilization Management RN opportunity with a health plan client, supporting a temporary... ...fully remote in EST hours. This position will be reviewing prior authorization requests, assessing medical necessity...Remote workContract workTemporary workMonday to FridayShift work
InterSources
United States5 days ago $39.83 - $59.74 per hour
...Utilization Management RN Robbinsdale, MN Posting Date: Sep 18 2026 Apply now ( Back to search Requisition Number: 514508 Why North Memorial... ...: Every Other Weekend Call Requirement: None Remote or On-site: Hybrid Remote- Must live in MN or WI FLSA Status...Remote workFull timeContract workPart timeFor contractorsFor subcontractorLive inWork at officeShift workWeekend workNorth Memorial Health Care
Minneapolis, MN1 day ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN Utilization Management Reviewer. Be the first to apply!
Related searches
- injection rn Fort Worth, TX
- pediatric icu rn Fort Worth, TX
- connect rn Fort Worth, TX
- pediatric oncology rn Fort Worth, TX
- davita rn Fort Worth, TX
- womens health rn Fort Worth, TX
- registered nurse ii Fort Worth, TX
- rn per diem nurse Fort Worth, TX
- rn staff development coordinator Fort Worth, TX
- hospice registered nurse Fort Worth, TX