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
- ...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
- ...A major healthcare organization is seeking a registered nurse for a remote position focused on utilization review. Candidates should have 2 years of experience in a hospital setting and expertise in evaluating medical necessity. Responsibilities include assessing care...Remote work
$49.34 - $76.59 per hour
...A leading healthcare organization is seeking a Utilization Review RN for a fully remote role in Oregon. Candidates must hold an Oregon Registered Nurse... ...particularly in collaboration with physicians. This position manages medical management programs to optimize patient care....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
- ...Concierge Home Care is seeking a Utilization Review Specialist (RN) for a remote opportunity. This position requires a Florida RN License, OASIS Certification, and Home Health Coding Certification. You will be responsible for reviewing home health clinical documentation...Remote workFlexible hoursWeekend workWeekday 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 workFull timeTemporary workWork at officeWork from home
- ...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
$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- ...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
- ...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
- ...Utilization Management, Registered Nurse (RN) Remote - USA At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare... ...review across acute inpatient, post-acute (SNF, IRF, LTACH) and outpatient services Apply CMS Medicare...Remote workWork at officeFlexible hours
- ...Actalent is hiring a Clinical Review Pharmacist for a 100% remote position, focusing on reviewing Utilization Management requests. Ideal candidates should have a PharmD, experience in a retail environment, and be able to communicate effectively. Responsibilities include...Remote workFull timeContract 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- 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...
- ...Department: Managed Services Please make sure you read the following details carefully... ...6 open positions for this role. The Utilization Management (UM) RN performs utilization review... ...manner. This position is hybrid with remote and in-office assignment. SPECIFIC SKILLS...Remote workWork at officeWork from homeRelocation package
- ...Job Description Spectrum Healthcare Resources has a potential need for Registered Nurse Utilization Managers (RNUM) . These will be completely remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases, educating patients on appropriate...Remote workFull timeContract workWork at officeWork from homeMonday to Friday
- ...A leading staffing agency is looking for a Utilization Review Registered Nurse to work remotely with a major health insurance client. This role involves evaluating patient care cases and ensuring requested services align with medical necessity while adhering to confidentiality...Remote work
- ...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
$35 - $45.94 per hour
...Oscar Health is looking for a Utilization Review Nurse to join their team. The role involves... ...patient care. Candidates must hold an active RN license and have at least one year of... ...utilization review or acute care settings. This remote position offers a competitive pay range...Remote workHourly pay- ...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
- ...Communities Together. This is a remote position in which we are... ...: ~ ~ Health plan utilization management ~ Medicare and Medicaid rules... ...Collaborates with SHS system experts to ensure focus, alignment,... ...Current unencumbered Oregon RN License required within 90 days...Remote work
- ...A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote workFlexible hoursWeekend workDay shift
- ...A healthcare recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an active RN license and experience with health plan operations. Responsibilities include evaluating healthcare...Remote workContract work
- ...Registered Nurse to coordinate and facilitate patient care while utilizing resources effectively. Candidates must have a Bachelor's... ...experience. Preferred qualifications include experience in case management and ANCC certification. The position requires strong communication...
- ...Santa Barbara Cottage Hospital seeks a Utilization Management RN – Pediatrics to ensure quality and cost-efficient healthcare services for pediatric patients. This fully remote role requires an active New York RN license and a minimum of 2 years of pediatric nursing experience...Remote work
- ...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...
- ...involves reviewing complex claims and documenting decisions based on established clinical guidelines. Applicants must hold an active RN license and have at least two years of clinical experience. The position is full-time and includes a six-week training, partially onsite...Remote workFull time
- ...in Chicago is hiring a Clinical Care Manager to oversee high-quality, patient-centered care through Utilization Review. The role requires an active RN license in Illinois and significant experience... ...position offers the flexibility of remote work while supporting professional...Remote work
$67.7k
...consulting firm is seeking a Medical Claims Reviewer to conduct medical reviews and provide guidance on claims. This remote role requires an active RN license, a bachelor's degree in nursing, and at least five years of clinical experience. Ideal candidates will work full...Remote workFull timeMonday to Friday$71.1k - $97.8k
...a part of our caring community The Utilization Management RN will collaborate with other health care... ...nursing experience in Hospital, SNF, LTAC, DME or Home Health. Bilingual... ...information. Travel: While this is a remote position, occasional travel to Humana'...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeWeekend work
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