Remote Utilization Management RN - SNF & TOC Expert
Appworkshub
Appworkshub 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 inpatient and outpatient utilization reviews, support transitions of care, and ensure compliance with Medicare Advantage regulations. The ideal candidate will have strong clinical judgment, a valid RN license, and 3+ years of experience in utilization management. We offer competitive compensation, a collaborative environment, and work-life balance. #J-18808-Ljbffr
$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 and requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate...Remote workWeekend work$50 per hour
...Drips.com is looking for an Appeals RN (Temporary) to handle grievances and appeals effectively. This role requires... ...communication skills and a strong background in utilization management. The position is remote and offers a salary of $50/hr. In this position, you will...Remote workTemporary work- A healthcare staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates to reside in PA, DE, or NJ. Key duties involve applying criteria for medical necessity, collaborating...Remote work
- ...NeuroPsychiatric Hospitals is seeking a Utilization Review Nurse (RN) to coordinate patient services across multiple hospitals. The role supports... ...collaborating with teams for better outcomes. Located remotely with a preference for candidates in Indiana, Michigan, or...Remote work
- ...integrity through compliance management. Here, you’ll champion the needs... ...Registered Nurse (RN) license Strong clinical... ...medical records Experience in utilization review, case management, quality... ...vulnerable populations Remote work – enjoy the convenience...Remote jobFull timeTemporary workWork at officeWork from home
- ...Confluence Health in Wenatchee, WA is looking for a Utilization Management Nurse. This role focuses on performing utilization reviews, evaluating... .... This position provides a hybrid work environment that combines both remote work and office settings. #J-18808-Ljbffr...Remote workWork at office
- ...integrity through compliance management. Here, you'll champion the needs... ...Registered Nurse (RN) license Strong clinical background... ...records Experience in utilization review, case management, quality... ...for vulnerable populations Remote work - enjoy the convenience...Remote workFull timeTemporary workWork at office
- ...dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our growing... ...clinical judgment , inpatient/SNF experience , and... ...policies) . This is a fully remote opportunity requiring discipline... ...support Transitions of Care (TOC) and discharge planning....Remote work
- ...integrity through compliance management. Here, you'll champion the needs... ...Registered Nurse (RN) license Strong clinical background... ...records Experience in utilization review, case management, quality... ...for vulnerable populations Remote work enjoy the convenience...Remote jobWork from home
$65k - $75k
Gainwell Technologies LLC is seeking a Nurse Reviewer (RN) to perform clinical reviews remotely in the United States. Responsibilities include... ...license, 5+ years of clinical experience, and 2+ years in utilization review or claims auditing. This full-time position offers...Remote workFull time- ...L.A. Care Health Plan in Los Angeles is hiring a Utilization Management Claims Review Nurse RN II responsible for conducting clinical reviews of medical claims. The position requires a minimum of 5 years in clinical nursing, with experience in Medi-Cal and Medicare managed...
- ...Health Care Service Corp. is seeking a Registered Nurse (RN) for a Remote position responsible for Utilization Management and Case Management functions. This role involves coordinating care, assessing members for wellness education, and providing support to healthcare...Remote work
- ...UofL Health in Louisville, KY, is seeking a Utilization Review RN to support utilization management functions. The RN will be responsible for clinical recommendations regarding medical necessity, working collaboratively with healthcare professionals. Ideal candidates must...
- ...ServiceNow, we implement integrated asset management, field service management, planning &... ...seeking an SAP Mobility & Scheduling Expert - Utilities to lead the delivery and execution of... .... A collaborative, people-first remote culture with annual company gatherings...Remote workWork at officeShift work
$239k - $350k
A management consulting firm is seeking a Vice President, Utility Return on Equity & Cost of Capital Expert Witness. This role involves leading complex engagements, advising on regulatory... ...Marlborough, MA office and two days remote, with a competitive salary between $239...Remote workWork at office$87k - $101k
...Job Description RN Case Manager – Los Angeles, CA Region Work from home + local field travel Salary: $87,000 – $101,000 annually Quarterly... ...injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical...Remote workWork at officeLocal area- ...Santa Barbara Cottage Hospital is seeking a Case Manager - Utilization Review Specialist to work remotely. This role involves analyzing patient records, ensuring... ...managing appeals. Candidates should possess a current RN license and significant healthcare experience,...Remote work
$71k - $90.5k
...Description: Cityblock's Transition of Care (TOC) program helps members safely navigate... ...community. The TOC Registered Nurse Care Manager (RNCM) coordinates with hospital case... ...coding as evidence of gap closure. Utilize care facilitation, electronic health records...Remote workWork experience placement- 4004 Aetna Medicaid Administrators is seeking a Utilization Management Nurse Consultant for a crucial role in a 24/7 operation based in Florida.... ...The ideal candidate will have clinical experience, an active RN license, and a commitment to high-quality healthcare service....Remote workWork from home
- ...seeks an experienced Registered Nurse to manage patient discharges and ensure optimal healthcare... ...healthcare teams and mandates a valid RN license in Nevada. Applicants should have... ...settings, with preferred experience in utilization review. Benefits include competitive...
- ...Industrial Asset Management Council, Inc is looking for a Remote RN to join their team. The role requires 2 years of RN experience and Utilization Review expertise, supporting various units in a clinical review capacity. This work-from-home position offers flexible scheduling...Remote workWork from homeFlexible hours
- ...Network Health Administrative Services, LLC in Menasha, WI is seeking an RN Coordinator for Utilization Management. This role involves reviewing authorization requests and ensuring compliance with payment guidelines while coordinating with providers to optimize patient...Remote workFull timeWork from home
- PACS Group, Inc. is seeking a detail-oriented Remote Biller to manage billing processes for Skilled Nursing Facilities. This full-time position requires experience with SNF billing and a strong understanding of Medicare, Medi-Cal/Medicaid, and private payers. The ideal...Remote workFull time
$55 per hour
...Amerit Consulting is seeking a remote Utilization Management Nurse to support Medicare utilization review activities. Candidates must be California-based RNs with a minimum of 5 years of direct patient care in a hospital setting and strong clinical skills. This contract...Remote workHourly payContract work- ...A regional healthcare provider in Houston is seeking a Utilization Management Review Nurse. This role involves evaluating the appropriateness of medical services based on necessity and promoting quality care outcomes. The candidate must have a Bachelor's in Nursing and...Remote workFlexible hours
- ...A healthcare management organization is seeking a Utilization Management Nurse to oversee health service utilization while... .... This role requires an active LPN/RN license, and candidates should have... ...benefits package including remote work options. #J-18808-Ljbffr...Remote work
- ...Brigham is seeking a Peer-to-Peer Utilization Review Nurse to join the Central Utilization Management team. This role involves... ...Bachelor's of Science in Nursing, an RN license, and extensive experience... ...utilization review. The position offers a remote work model with a flexible...Remote workFlexible hours
$77.91k - $116.86k
...E2E Alignment Healthcare USA, LLC is seeking a remote Utilization Management Nurse to review prior authorization requests for medical necessity. The role requires a valid LVN or RN license in California, along with experience in nursing and utilization management. Successful...Remote work$71.1k - $97.8k
...A healthcare organization seeks a Utilization Management Registered Nurse to utilize clinical skills in coordinating medical services. This remote position requires a Compact RN license and over a year of clinical experience. Responsibilities include making benefit determinations...Remote work- A leading healthcare organization is seeking a Care Manager RN for a remote role primarily serving the state of Washington. This per diem position involves crucial utilization management activities, ensuring compliance with payer requirements and regulations. Candidates...Remote workHourly payDaily paidDay shift
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