Remote Utilization Review RN | InterQual/UM Expert
Community Health Network, Inc.
- Remote job
Community Health Network is seeking an experienced RN Case Manager with Utilization Review/UR expertise for a remote-based position. The role requires active MA RN licensure with UR/UM and InterQual experience in a managed care setting, focusing on inpatient utilization and discharge planning. The position offers 40 hours per week, Monday–Friday, with some after-hours as needed, a contract arrangement, and a full benefits package including health, dental, vision, life insurance and 401K. #J-18808-Ljbffr Community Health Network, Inc.
- ...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... ...proficiency in Microsoft's applications and InterQual criteria. #J-18808-Ljbffr The Judge...Remote job
- Concierge Home Care is seeking an experienced Utilization Review Specialist (RN) for a fully remote role. You will review home health documentation, audit OASIS and care plans, and ensure coding accuracy to protect reimbursement integrity. Qualified candidates hold an RN...Remote job
$65k - $85k
Concierge Home Care is seeking an experienced Utilization Review Specialist (RN) to join our remote home health team. This role focuses on reviewing OASIS data, coding accuracy, QA, and documentation compliance, with certifications in Oasis and Coding highly preferred....Remote jobMonday to Friday- Medix Staffing Solutions, Inc. is seeking an experienced California RN or LVN with strong Utilization Management and inpatient review experience for a 100% remote role focused on inpatient clinical review, UM, and discharge planning. You will apply MCG criteria and...Remote job
- ...Ventures LLC team is seeking a skilled Medical Reviewer to evaluate a variety of medical claims,... ...services. Candidates must hold an active RN license in the United States and an... ...candidates have BSN and additional clinical and utilization review experience, plus proficiency in MS...Remote jobWork from home
- Jobgether, on behalf of a partner company, is seeking a Case Manager - Utilization Review Specialist for a remote US role. You will oversee admission and concurrent utilization reviews, assess medical necessity, and draft evidence-based appeals while coordinating with...Remote job
- ...A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information... ...of Medical/Surgical experience and proficiency with InterQual criteria. This position offers a day shift workload with...Remote workFlexible hoursWeekend workDay shift
- 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
- ...partner of ours with a need for an experienced RN Case Manager with Utilization Review/UM experience. This position is remote based and requires an activeMA RN license. (... .... Candidates MUST have current UM/UR and InterQual experience, managed care, and discharge planning...Remote workContract workMonday to FridayFlexible hours
- Gainwell Technologies LLC is seeking a Nurse Reviewer (RN) to perform clinical reviews ensuring medical necessity based on criteria, policies... ...and support review determinations.The role is full-time with remote options for US-based employees. Expect to review records,...Remote jobFull time
$35 - $40 per hour
...and analytics. Job Title RN Utilization Management Reviewer Responsibilities Conduct timely... ...criteria (e.g., InterQual) and employ clinical expertise... ...clinical decisions and work with UM Manager to ensure... ...weekends. Location: Fully remote work at home role. Secure,...Remote workHourly payTemporary workMonday to FridayFlexible hoursWeekend work- ...seeking an experienced Registered Nurse in Michigan to provide utilization review for healthcare services. Candidates should possess a valid RN license and experience in both utilization review and Interqual. This opportunity offers a competitive salary, supportive work...
$52 - $56 per hour
...Contract RN For New York Health Plan You've done UM. You've worked appeals. Now find... ...judgment you built in utilization management. 100% remote (U.S.) | Contract | $... ...investigation, clinical review, decision and... ...necessity criteria (InterQual/MCG) to outpatient, home...Remote jobContract workAfternoon shift- Jobgether is seeking a Case Manager - Utilization Review Specialist to oversee admissions and concurrent reviews, evaluate medical necessity... ...clinical and administrative appeals. You will work remotely from the United States alongside physicians, case managers,...Remote job
$41.2 - $62.17 per hour
Job Description:The RN Utilization Review Care Management I leverages clinical... ...evidence-based guidelines (e.g. InterQual/MCG) and medical policies... ....Mentors and guides the UM LPN & non-clinical on process... ...working successfully working in a remote environment or using...Remote workHourly payReliefWork at officeFlexible hoursShift workWeekend work2 days per week- ...Cincinnati Children e s Hospital Medical Center is seeking a Remote Utilization Review professional to perform admission and continued stay reviews using InterQual, ensuring medical necessity and appropriate level of care.The role collaborates with Admitting, Financial...Remote work
$1,949.74 per month
...Nurse Specialty Utilization Review Job ID 17979666... ...Title Utilization Review RN Weekly Pay $1949.... ...Job Description Remote Utilization Review RN responsible... ...utilization management using InterQual criteria while ensuring compliance...Remote workWeekly payShift work- ..., a health solutions company, seeks an Utilization Management RN to evaluate medical necessity and service... ...with potential growth into CM roles. Remote work is available in Colorado and other... ...opportunities to expand into combined UM/CM responsibilities over time. #J-1880...Remote job
- ...grievances and appeals for members and providers in a remote US-based role. The candidate will review medical necessity across inpatient, outpatient, and... ...requires a USRN license, at least 2 years in utilization management, strong communication, and the ability to...Remote jobContract work
- ...Licensed Occupational Therapist to perform clinical reviews of therapy services and durable medical... ...practice standards and policies are met. This remote role supports TX and OK markets and collaborates with Utilization and Care Management teams to optimize care delivery...Remote job
$35 - $40 per hour
...experienced Registered Nurse (RN) with health plan or payer-side Utilization Management (UM) experience to support clinical quality review and AI model development... ...criteria, such as InterQual and MCG, reviewing medical... ...- Fri, 40 hrs/weekFully Remote PositionPay Range: $35 -...Remote workLocal areaShift work- TriWest Healthcare Alliance is seeking a Utilization Management Clinical Review nurse to assess medical necessity... .../Surgical requests. You will apply InterQual criteria, document in the management... ...review. The role requires an active RN license, US citizenship, and the...Remote job
- Intermountain Health is seeking an RN Utilization Review Care Management I for remote, part-time coverage across enterprise regions. The role focuses on utilization... ...strong clinical judgment, knowledge of guidelines (InterQual/MCG), and regulatory compliance, with scheduled...Remote jobPart time
$38 - $40 per hour
...Title: RN -- Review Analyst Location: Remote Duration: 12 months with possible extension Pay Range: $... ...prospective, concurrent, and retrospective utilization reviews for inpatient, outpatient,... ...includes Utilization Management (UM) , Case Management , discharge...Remote workHourly payWork at officeMonday to FridayShift work$119.14k - $184.95k
...Utilization Review RN - REMOTE position. This position is Per Diem and will work 8- hour, Day shifts. Provide prospective, retrospective, and... ...Master's Degree in Nursing. Experience working with Interqual guidelines. Experience in a multi-hospital and/or integrated...Remote workDaily paidMinimum wageLocal areaShift workDay shift- ...Utilization Review NurseThis position has a remote option for those living close and will be able to come into the hospital... ..., concurrent, and retrospective UM related reviews and functions.... ...utilize approved screening criteria (InterQual/MCG/Centers for Medicare and...Remote workFull time
- WPS Health Solutions seeks an Utilization Management RN to evaluate medical... ...uses clinical knowledge to review requests, authorize care when... ...hospital stays. We support remote work in multiple states and... ...opportunities to grow into a combined UM/CM role. #J-18808-Ljbffr...Remote job
- ...seeking a registered nurse to perform concurrent inpatient utilization review using InterQual criteria, supporting medical necessity decisions across... ...documentation skills, and the ability to operate independently in a remote, US-based #J-18808-Ljbffr WNS Global ServicesRemote job
- ...licensed registered nurse to perform concurrent inpatient utilization reviews from a remote setting. You will collaborate with attending physicians... ...hands-on experience in acute care and familiarity with InterQual criteria, with responsibilities spanning admission, continued...Remote job
- ...seeking a Registered Nurse - Review Analyst for a remote contract role. The position... ...experience and an active RN license. Responsibilities include... ...review, applying utilization management criteria, and supporting... ...employer. Experience with InterQual or MCG utilization review...Remote jobContract workImmediate start
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