Remote LVN — Medical Management & Utilization Specialist
SCAN
- Remote job
SCAN is seeking a Medical Management Specialist-LVN to support care quality and cost-effectiveness for members. The role requires managing utilization processes and working closely with the Clinical Supervisor. This position allows for remote work, ensuring timely and effective healthcare delivery. The ideal candidate will have 3+ years in medical-surgical nursing and a current California LVN license. Join us at SCAN and contribute to improving care for older adults while enjoying a range of benefits. #J-18808-Ljbffr SCAN
$46.76 - $51.76 per hour
...concurrent, and retrospective) to determine medical necessity, clinical appropriateness, and... ...NCQA Standards and departmental SOPS to manage member assignments. Conducts research... ...Nice to Have: Prior experience in utilization management, care management, or payer-...Remote jobWork at office- SHPCA SCAN Health Plan is seeking a Medical Management Specialist‑LVN to promote the quality and effectiveness... ...regulatory guidelines. This role is remote and requires a California Licensed... ...in medical/surgical nursing and utilization management, with proficiency in maintaining...Remote job
$29.62 - $45.31 per hour
...multiple resources to support the review (Medical Policies, KMS, Benefit Grids, Handbooks,... ..., provider resolutions, etc.) Remote Work This position offers 100% remote... ...metrics ~1 year experience in database management and spreadsheets ~6 months experience...Remote workMinimum wageFull timeWork experience placementLocal areaShift work$20 - $31 per hour
...the nation’s leading specialty risk manager for self-insured organizations,... ...The primary responsibility of the utilization review nurse is to review medical records to determine the medical necessity... ...applicants with arrest or conviction records. #LI-AJ1 #LI-Remote...Remote workHourly payTemporary workWork experience placementLocal areaMonday to Friday$55k - $70k
...Utilization Review Specialist – Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary: $55K - $70K About the Role As a Utilization... ...reports or insights to management to identify areas for... ...Healthcare Administration, Medical Records, Behavioral...Remote workFlexible hours$26.35 - $39.53 per hour
...Utilization Management Nurse, LVN/LPN California, United States NeueHealth is a value-driven healthcare... ...– Centrum Health and Premier Medical – as well as unique partnerships with... ...Corporate office preferred / remote may be considered Collaborative environment...Remote workHourly payWork at office$50k
Employer Industry: Behavioral Healthcare Management Why consider this job opportunity... ...authorizations, concurrent reviews, and internal utilization review assessments Consult with the... ...appeals Staff individual cases with medical doctors as required Maintain...Remote job$58.47k
...73.00 Annually Location: Primarily Remote (Michigan-based) Schedule: Full-Time... ...skilled Behavioral Health Utilization Management (UM) Specialist to join our team. This role is responsible... ...behavioral health services to ensure medical necessity, regulatory compliance, and...Remote workFull timeFlexible hours$41.6k - $47k
...Utilization Review Specialist HYBRID, must be able to travel to 3031 NE STEPHENS ST. ROSEBURG,... ...prior authorization requests within Medical Management. This role is responsible for ensuring... ...stay organized and productive in a remote, independent work environment...Remote workFull timeWork at officeLocal areaImmediate startMonday to FridayFlexible hoursShift work- ...from-home position. The role involves performing retrospective medical reviews based on patient eligibility and contract requirements,... ...experience in a relevant medical setting, and the ability to work in a remote environment. Comprehensive benefits are provided, including...Remote jobContract workWork from home
- ...MTSL Group, a local Medical Billing and Practice Management company, is currently seeking... ...time provider enrollment specialist. The position is to start... ...!! The position is fully remote and work from home. However... ...software usage and utilization of company software. Technical...Remote workFull timePart timeLocal areaWork from homeMonday to Thursday
- ...Working remotely in a full-time capacity, the Behavioral Health Utilization Review Specialist will manage the authorization of treatment through insurance and managed care companies... ...Knowledge of ASAM guidelines and medical terminology Familiarity with State and Federal...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... ...Medicaid program metrics. This position is remote and offers a pay range of $30-$45 per hour...Remote workHourly payContract work- ...To ensure the delivery of medically necessary and efficient healthcare... ...services, the full-time Utilization Review Specialist will evaluate patient... ...standards while working remotely. Key responsibilities: Review... ...utilization review, case management, or clinical healthcare...Remote workFull time
$13 - $14 per hour
...hour Job Type: Contract Location: Remote Schedule and Shift: Monday-Thursday... ...health plans requirements related to Utilization Management and authorizations Acts as a... ...requirements Reviews benefit language and medical records to assist in completion of...Remote workHourly payContract workWork at officeShift work- ...prior authorization requests in the medical care management program. Adheres to policies and procedures... ...healthcare delivery. Work Mode: Remote Responsibilities Prioritizes... ...healthcare databases. Experience with Health Plan Utilization and Customer Service....Remote workWork at office
- ...Utilization Review Specialist The Utilization Review Specialist plays a critical role in ensuring... ...healthcare services provided to patients are medically necessary, efficient, and compliant... ..., insurance companies, and case managers to facilitate timely approvals and...Remote work
- ...industry-leading revenue cycle management services for healthcare... ...are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The... ...environment. This is a fully remote or office/home hybrid... ...clinical information to ensure medical necessity and compliance...Remote workWork at officeFlexible hours
- ...Prior Authorization Specialist Responsible for screening and... ...authorization requests in the medical care management program, including a broad... ...with Health Plan Utilization and Customer Service. Required... ...Work is performed fully remotely. No or very limited physical...Remote workWork at office
- ...Utilization Management Specialist Under general supervision by management, and in collaboration with Medical Directors and other members of the clinical team, gathers and synthesizes clinical information in order to authorize services. Reviews health care services to...Remote workContract workLocal area
$51 per hour
...Utilization Management Specialist (UM / Utilization Review Nurse) — Remote In this role, you'll use your clinical background and utilization management experience to review requests for care and determine medical necessity, appropriateness, and benefit coverage. You...Remote workContract workWork at officeLocal areaFlexible hours- ...2 days ago Requisition ID: 9252 UR Specialist – Join Camber and Make an Impact At... ...difference every day. Job Summary The Utilization Review department manages all aspects of a patient’s stay... ...schedule of 2 days in office and 3 days remote after successfully completing their...Remote workFull timeWork at officeMonday to Friday
- ...IHMS USA, Inc. provides medical services to some of... ...accredited and compliant management systems that help... ...Electronic Medical Record Specialist is responsible for the... ...: Utilize and support an Office... ...Record system provides remote access, required accounts...Remote workMinimum wageFull timeContract workWork at officeLocal area
$51.46k - $60k
...Monday through Friday from 9:00AM-5:30PM (2-days remote, 3-days in office) Utilization Management Specialists are responsible for: Obtaining initial and subsequent... ...at Gateway Foundation: Health and Wellness: Medical, dental, and vision insurance for employees and dependents...Remote workFull timeTemporary workWork at officeMonday to FridayFlexible hoursShift work$55k - $70k
...Utilization Review Specialist – Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary: $55K - $70K Who We Are Exact Billing Solutions... ...team of revenue cycle management professionals... ...documentation, treatment plans, and medical records to optimize...Remote workWork at officeFlexible hours- ...Harbor Health is seeking a dedicated Utilization Management (UM) LVN. The UM LVN supports prior authorization... ...clinical information, support medical necessity determinations, and maintain... ...Business Hours This position is fully remote Monday-Friday 8am - 5pm with the...Remote workLocal areaMonday to FridayShift work
- ...Metered Utilities Specialist Are you someone who enjoys research and has... ...those trends? Do you enjoy managing projects and building relationships... ...~ Life insurance ~ Paid medical leave/disability insurance... ...available; 50% in the office, 50% remote About LCS London...Remote workLive inWork at officeRelocationWork visa
- ...Database Sustainment Specialists to support the DMLSS-FM... ...government personnel Facility Management Team meetings, as... ...prepared to travel to remote locations that are... ...cycle management (FLCM) utilizing the DMLSS-FM Facility... ...personnel who support the medical facility, i.e.,...Remote workContract workFor contractorsWork at officeLocal area
- Spectrum Billing Solutions is seeking an ABA Utilization Review (UR) Specialist to join their team. This fully remote or hybrid position involves reviewing clinical information and obtaining authorizations for ABA services. Candidates should have 3-5 years of relevant...Remote job
- An established industry player in health care is seeking a Utilization Review Nurse to join their dedicated team. In this vital role, you will evaluate medical records and apply clinical expertise to ensure the delivery of necessary health services. Your contributions...
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