Senior Utilization Review RN Remote Quality Lead
Ensemble Health Partners
Ensemble Health Partners is seeking a Senior Utilization Review Quality RN to review the quality of VUR work across cases, partner with leadership, and identify opportunities for process improvements. The role includes onboarding support and mentoring UR staff to enhance the quality review process.
Travel to client sites or corporate offices as needed is required. Candidates should bring strong nursing experience, UR knowledge, and a commitment to compliance and customer service.
#J-18808-Ljbffr- Ensemble Health Partners is seeking an RN Utilization Review quality professional to lead QA efforts within the VUR team. You will mentor staff, evaluate QA... ...and knowledge of medical necessity review criteria. Remote work with travel to client sites is expected, and opportunities...Remote jobQualitySenior
- ...Ensemble Health Partners seeks an RN for Senior Utilization Review Quality to oversee quality reviews and mentor UR staff. You will partner with Leadership... ...adherence, and support training and onboarding. Remote role with travel to client sites as needed; requires RN...Remote workQualitySenior
- Telligen is seeking a Senior Review Coordinator RN for a home-based, part-time weekend position. The role focuses on utilization review/medical management across services, including training and mentoring of team members and providing technical and clinical support to...Remote jobSeniorPart timeWork from homeWeekend work
$39.4 - $53 per hour
...career at Ensemble! Ensemble is a leading provider of technology-... .... Position Overview The Lead Utilization Review RN is a key contributor to the overall financial, quality, and clinical performance of... ...24 Monster Top Workplace for Remote Work 2024 Great Place to Work...Remote workQualityWork at officeLocal area$81.95k - $110.24k
...career at Ensemble! Ensemble is a leading provider of technology-... ...possible in healthcare. The Lead Utilization Review RN is a key contributor to the overall financial, quality, and clinical performance of... ...required #LI-LS1 #LI-REMOTE Join an award-winning company...Remote workQualityFull timeWork at officeLocal area$47.03 - $63.48 per hour
...a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue... ...the possible in healthcare. The RN, Senior Utilization Review Quality will play an essential role in reviewing... ...and client experiences This is a remote position; however, candidates must be...Remote workQualitySeniorTemporary workWork at officeLocal area- ...Gainwell Technologies LLC is seeking a Senior Nurse Reviewer to perform reviews of medical records,... ...review experience, with potential utilization review responsibilities. Home-based position... ...US, supporting a flexible, quality-driven team environment.J-18808-Ljbffr...Remote workQualitySeniorWork from homeFlexible hours
- ...is seeking an experienced Supervisor of Utilization Management to lead the Prior Authorization, Concurrent Review, and Retrospective Review teams. This remote role supports members across the health plan with a focus on quality and compliance. You will supervise day...Remote workQuality
- ...Ensemble Health Partners is seeking an experienced RN to join our Senior Utilization Review Quality team. You will review and ensure quality of VUR work across multiple clients and host systems, identifying opportunities for improvement and coaching junior members....QualitySenior
- ...KeyCorp is seeking a Senior Credit Risk Reviewer to lead a team evaluating private credit risk, underwriting quality, and portfolio performance. You will assess complex transactions... ...timely, high-quality risk assessments in a largely remote-capable #J-18808-LjbffrRemote workQualitySenior
- ...clinically strong, detail-oriented Registered Nurse to join our Utilization Review team in a fully remote role. You will conduct medical necessity reviews,... ...and collaborate with physicians and payors to support quality patient care and appropriate resource utilization. The...Remote workQuality
- ...Sedgwick is seeking an Utilization Review Nurse (RN) to provide timely, evidence-based utilization review services in a remote role across the United States. You will assess injured... ...claims teams, and promote cost-effective, quality care in a nontraditional setting. Ideal...Remote workQuality
- ...CoxHealth is seeking a Utilization Review Nurse (RN) to collaborate with physicians and a multidisciplinary team to ensure high-quality, cost-effective patient care. The role focuses on concurrent medical record reviews to assess medical necessity and level of care, determining...Remote workQuality
- ...Ensemble is seeking a Lead Utilization Review Registered Nurse to support outcomes-oriented patient care delivery and drive documentation quality. This role interfaces with physicians, nurses, coding professionals, and hospital staff to verify that care meets medically...Quality
- ...EK Health Services Inc. is hiring for a Utilization Review (UR) Health Care Professional in a remote-capable role. The position emphasizes clinical knowledge in... ..., evaluation, planning, and communication of decisions, with a focus on compliant, quality #J-18808-LjbffrRemote workQuality
$89.07k - $162.8k
...Utilization Review Supervisor Candidate must have acute care Utilization Review experience. Candidate... ...' continuing health needs in a high-quality cost-effective manner by identifying... ...preferred Licenses and Certifications: RN - Registered Nurse - State Licensure and...QualityLive in- ...OU Health is seeking a Case Manager, RN - Utilization Review (PRN) to evaluate medical necessity and appropriate care, securing authorizations... ...records, apply evidence-based criteria, and participate in quality improvement initiatives while maintaining regulatory alignment...Remote workQualityRelief
- ...Asante is seeking a Utilization Review Nurse to monitor utilization from preadmission... ..., ensuring cost-effective, quality patient care and regulatory compliance in a remote, full-time role. The position includes... ...for appropriate status. Oregon RN licensure and 2 years of acute...Remote workQualityFull timeShift workWeekend work
$65k - $85k
...Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning... ...and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team... ...Managers, and field clinicians Support quality assurance and regulatory compliance...Remote workQualityMonday to FridayWeekend workWeekday work- ...Facility: Remote Missouri: 1423 North Jefferson Avenue... ...5802 Department: 1665 Utilization Review Scheduled Weekly Hours... ...) CoxHealth is a leading healthcare system serving... ...Review Nurse RN collaborates with the... ...patient focused, high quality, evidence based, appropriate...Remote workQualityLocal areaShift workDay shift
- ...Description Job Description The utilization review and management (UM)... ...recognizing our commitment to quality, safety, and excellence in... ...records. Serves as the medical lead during joint commission... ...This is an in-office, no remote work capability position...Remote workQualityWork at office
- ...delivers a number of leading health benefit... ...LTSS department. RN will be responsible... ...members to promote quality member outcomes, to... ...and concurrent review. Provides monthly... ...treatment setting by utilizing the applicable medical... ...: *possible remote opportunity after...Remote workQualityContract workMonday to FridayFlexible hours
$78k - $99.2k
...Review medical records and itemized bills to ensure... .... Requirements: Active RN license and 5+ years inpatient... ...education assistance, remote work. Partner Company... ...medical claims and utilization reviews to ensure accurate... ...offer a collaborative, quality-focused remote...Remote workQualitySeniorFlexible hours$75k - $88k
...application process. Clinical Reviewer RN - Alabama Alabama, US 30+... ...has engaged in health care quality consulting and quality improvement... ...outcomes. Our talented remote workforce spans the country... ...Overview We are seeking Clinical Utilization Review Nurses (RN) based in...Remote workQualityFull timeContract work$38.46 - $43.27 per hour
IPRO in Jericho, NY is seeking a Clinical Reviewer (RN) to perform utilization and quality reviews, support Medical Review Analysts and Physicians, and ensure accurate processes. Duties include chart reviews, data collection, and guiding staff through procedures. Required...QualityHourly payWork at office- ...KHI) Staff Position Description Position Title: Utilization Review Nurse Position Code: RN-6027 Department: Case Management Safety Sensitive:... ...supports KHI’s vision to be among the kindest, highest quality health systems in the country. Key Responsibilities...Remote workQualityWork at officeFlexible hours
$89.07k - $162.8k
...and retrospective case reviews to ensure appropriate admit... ...and level of care by utilizing the nationally approved... ...to ensure high-quality patient care in the most... ...way. This position is remote but must be willing to... ...and Certifications RN - Registered Nurse - State...Remote workQuality- ...sciences, clinical research solutions, quality & compliance, pharmacovigilance,... ...: Position will act as the overall lead for the retrospective product review workstream. Responsible for... ...not. Whilst ProPharma supports remote working, we also recognise the value...Remote workQualitySeniorInterim roleWork at office
- ...Facility: Remote Missouri: 1423 North Jefferson Avenue... ...5802 Department: 1665 Utilization Review Scheduled Weekly Hours... ...) CoxHealth is a leading healthcare system serving... ...Review Nurse RN collaborates with the... ...patient focused, high quality, evidence based, appropriate...Remote workQualityLocal areaShift workDay shift
- Curana Health, Inc. is seeking a Utilization Management Nurse for a primarily remote telephonic role focused on review and prior authorizations, concurrent and retrospective... ...opportunities to improve outcomes, cost savings, and care quality. #J-18808-Ljbffr Curana Health, Inc.Remote jobQualitySenior
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