Remote Clinical Review Nurse Utilization & Discharge Advocate
Centene Corporation
Centene Corporation is seeking a Nurse Reviewer for remote work in the United States. The role involves performing concurrent reviews to determine appropriate level of care and discharge planning, with emphasis on medical necessity and care setting.
Requires active Nursing license and acute care experience. Ideal candidates will have knowledge of Medicare/Medicaid regulations and experience with health management systems.
#J-18808-Ljbffr- Centene is seeking a Clinical Review Nurse for a remote role supporting members in Pennsylvania. The candidate will perform... ..., assess care necessity, and contribute to discharge planning, leveraging case management or utilization management experience. The position offers...Remote jobFull timeShift workDay shift
- ...the full-time Michigan Licensed Clinical Review Nurse will perform concurrent reviews... ...appropriateness of care, and contribute to discharge planning while working remotely from home. Key responsibilities... ...preferred Familiarity with utilization management processes preferred...Remote workFull timeWork from home
- ...in Olathe, KS, is seeking a dedicated Utilization Review Specialist to scrutinize patient admissions... ...orgs and external reviewers while advocating for appropriate treatment plans across... ..., and the ability to ensure compliant discharge planning #J-18808-Ljbffr Cottonwood...Suggested
- ...Work Mode: 100% Remote, Source candidates... ...Perform concurrent reviews of members for appropriate... ...of stay, and discharge planning of... ...systems according to utilization management policies... ...necessity based on clinical policies and guidelines... ...School of Nursing or Bachelor's degree...Remote workWeekend work
- ...members in Georgia, the full-time remote Georgia Licensed Clinical Review Nurse will perform concurrent reviews... ...necessity of care, and contribute to discharge planning according to established... ...systems in compliance with utilization management policies Required qualifications...Remote workFull time
$34 - $35 per hour
...Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical... ...and concurrent review of hospitalizations and extended... ...manual changes Evaluate discharge planning risks and facilitate... ...- Prior Authorization Remote Registered Nurse (Remote...Remote workFull timeWork at officeWork from homeNight shift- ...the full-time State Licensed Clinical Review Nurse will perform concurrent... ...providers, all while working remotely. Key responsibilities Conduct timely inpatient utilization reviews against medical necessity... ...with providers to support discharge planning and care coordination...Remote workFull time
- ...Accredited School of Nursing or Bachelor's degree in... ...related experience. Clinical knowledge and ability... ...preferred. Knowledge of utilization management processes... ...and clinical reviews of authorization requests... ...member's transfer or discharge plans to ensure a timely...Remote workFlexible hours
- ...Overview Clinical Review Nurse - Concurrent Review TX Location: 100% Remote - TX: RN only with TX license SHIFT: Tuesday – Saturday... ..., and contributing to discharge planning according to care policies... ...systems according to utilization management policies and guidelines...Remote workContract workShift work
$36.49 - $41.49 per hour
...Job Overview: The Clinical Medical Review Nurse handles day to day review... ...descriptive or medical information utilizing the CPT and HCPCS manuals.... ...Previous case management, discharge planning or utilization... ...skills. Remote EMR access experience is essential...Remote workWork at office$27.02 - $48.55 per hour
...Business Area: Clinical & Care Management... ...Performs concurrent reviews, including determining... ...contributing to discharge planning according... ...: This is a remote position. The required... ...systems according to utilization management... ...Accredited School of Nursing or Bachelor’s degree...Remote workHourly payFull timePart timeWork at officeMonday to FridayFlexible hours- ...Position Title Clinical Review Nurse - Concurrent Review Work Location Remote-MS CST Assignment Duration 3 Months... ...necessity, and contributing to discharge planning according to care... ...Background & Context The Utilization Management team review members...Remote workContract workFlexible hoursWeekend work
- WNS is seeking a clinically trained reviewer to perform utilization reviews and case management activities. The role requires RN or LVN/LPN licensure and at... ...and insurance terminology. The candidate will work remotely, coordinate with providers and clients, and help ensure...Remote job
$27.02 - $48.55 per hour
About This Role The Clinical Review Nurse performs concurrent reviews to assess members' overall... ...of care, and contribute to discharge planning. This remote position is ideal for those with experience in case management or utilization management. Highlights Pay: $27.02...Remote workHourly payFull timeFlexible hoursDay shift- ...Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. The nurse will collaborate with the patient’s PCP, facility case manager, discharge planner, and contracted providers to ensure appropriate, cost-effective levels of...Remote work
- ...HealthEdge Software, Inc. is seeking a highly motivated Utilization Review RN to join our team. The RN will perform prospective, concurrent... ...Responsibilities include authorizing services, coordinating discharge planning, and documenting outcomes while maintaining...Remote workContract work
$27.02 - $48.55 per hour
...medical necessity and clinical reviews of authorization... ...member’s transfer or discharge plans to ensure a timely... ...interdepartmental teams on utilization processes to promote... ...Accredited School of Nursing or Bachelor’s degree... ...to work with remote, hybrid, field or office...Remote workHourly payFull timePart timeWork at officeFlexible hours$63.1k - $94.65k
...partner is looking for a Utilization Review RN based in the United... ...operations. In this part-time, remote role, you will apply your clinical expertise to evaluate... ...for a registered nurse who combines strong clinical... ...in utilization review, discharge planning, medical necessity...Remote workTemporary workPart timeWork at officeWork from homeFlexible hoursShift workAfternoon shift- ...Cleveland Clinic is seeking an Utilization Management RN Reviewer to support remote operations from home. The role covers admission and concurrent reviews, and ensures... ...criteria are applied to hospital stays and discharges. Qualifications include RN licensure, BSN preferred...Remote work
- ...RN for a 6-month, full-time remote contract. The role focuses on initial and concurrent reviews, discharge coordination, and liaison activities... ...RN license, 3 years of clinical experience in a healthcare... ...skills. Preferred: utilization management experience with MCG...Remote workFull timeContract work
- ...HealthEdge Software, Inc. seeks an experienced Utilization Review RN to perform prospective, concurrent... ...The role includes coordinating care, discharge planning, and addressing benefits and... ...hold an RN license with 2+ years of clinical experience and may have Case...Remote work
- ..., the full-time Registered Nurse Utilization Review will manage care variance reduction, ensure timely discharges, and refer members to appropriate... ...resources while working remotely. Key responsibilities... ...Three years of healthcare clinical experience Bachelor's Degree...Remote workFull time
- ...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
- ...Freeman Health System is hiring for a remote/hybrid position in Utilization Review and Case Management. The role focuses on... ...Department patients with their social and discharge needs. Candidates must be licensed RNs with strong nursing experience. The organization offers...Remote work
$60.2k - $107.4k
...work directly with providers to review medical necessity criteria... ...enjoy the flexibility to work remotely from anywhere within the U.S.... ...valid diagnoses Obtain clinical information from providers on... ...Managed Care experience Utilization Management experience All...Remote jobMinimum wageFull timeWork experience placementWork at officeLocal areaMonday to Friday- ...Job Description: Manager of Clinical Utilization Management - Denial Compliance... ...Position Type: Hybrid (85% remote, 15% onsite in Northridge,... ...managing daily tasks, performance reviews, and any necessary... ...from an accredited Registered Nursing Program; RN preferred. 2....Remote workPermanent employmentFull timeTemporary workFlexible hours
- ...Medix™ seeks an experienced Utilization Review Nurse Specialist for a fully remote role in the United States. You will evaluate medical necessity, determine... ...candidates are RNs with ICU/ED/OR background, strong clinical judgment, and a passion for leveraging AI-enabled...Remote work
$1,766.5 per month
...Travel Offering Nursing Profession Registered... ...Nurse Specialty Utilization Review Job ID 38515471... ...Department operating fully remote - Provide exceptional... ...Admissions - Case management - Discharge planning - Utilization...Remote workWeekly payWork experience placementShift work- HonorHealth in Phoenix is seeking an Utilization Review RN Specialist to review and monitor utilization, ensuring medically necessary care and appropriate discharge planning within Medicare, AHCCCS, Self-pay, and other payer guidelines. The ideal candidate has an RN license...Remote job
$40 per hour
...Industry Registered Nurse (RN) $40/hour - Contract... ...in TX Full time remote Candidates must be... ...initial, concurrent review activities; discharge care coordination... ...divisions. Collects clinical and non-clinical data... ...regarding utilization management requirements...Remote workFull timeContract workWork at office
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