Remote Clinical Review Nurse - Utilization Management
Spectraforce Technologies, Inc.
Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse for remote concurrent review responsibilities. The role assesses member health status, medical necessity, and appropriate care levels, contributing to discharge planning within care policies and guidelines.
Ideal candidates have 2–4 years of related experience (2+ years acute care UM or managed care preferred), nursing licensure, and a nursing degree. Remote work with EST preferred; CST considered.
#J-18808-Ljbffr- ...Description Job Description: Manager of Clinical Utilization Management - Denial... ...Position Type: Hybrid (85% remote, 15% onsite in Northridge,... ...daily tasks, performance reviews, and any necessary disciplinary... ...an accredited Registered Nursing Program; RN preferred....Remote workPermanent employmentFull timeTemporary workFlexible hours
- ...Spectrumforce Technologies, Inc. is seeking a Clinical Review Nurse - Concurrent Review for a 3-month contract to hire. The role is remote with work location listed as Remote-MS CST, schedule 8 am-5 pm Central time, with occasional weekend rotation. You will perform...Remote workContract work
$34 - $35 per hour
...Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical Nurse - Work from Home... ...Conducts telephonic and concurrent review of hospitalizations and extended... ...Clinical Review Nurse- Prior Authorization Remote Registered Nurse (Remote Patient...Remote workFull timeWork at officeWork from homeNight shift$2,300 per month
...The Clinical Review Nurse (RN) supports the organization’s care management function by conducting clinical reviews, ensuring appropriate utilization of medical services, and maintaining compliance with... ...outcomes for members. This is a remote role open to candidates...Remote workWork at office- ...Centene Corporation is seeking a remote Utilization Review Nurse to perform concurrent reviews and validation of appropriate care levels. You will... ...acute care experience, and familiarity with utilization management processes. Remote, with time-zone flexibility for...Remote work
$27.02 - $48.55 per hour
...Performs concurrent reviews, including... ...records in health management systems according to utilization management policies... ...necessity based on clinical policies and guidelines... ...Details This is a remote position. The required... ...Accredited School of Nursing or Bachelor’s degree...Remote workHourly payFull timePart timeWork at officeMonday to FridayFlexible hours$27.02 - $48.55 per hour
...Centene is seeking a Clinical Review Nurse to perform concurrent reviews to assess members' health, determine medical... ...nurses with acute care experience and strong utilization management knowledge. You will work remotely in North Carolina, with a full-time day shift and...Remote workHourly payFull timeDay shift- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board... ...with management and providing guidance on clinical questions. This is a unique opportunity to work...Remote workFull timeWork from home
- ...Friend Back Remote Work from Home... ...MD 21076 Category: Nursing Schedule: Day Shift... ...Plans (JHHP) is the managed care and health services... ...- 5:00 PM As a Utilization Review Registered Nurse for... ...opportunity to use your clinical, managed care, utilization...Remote workFull timeLocal areaWork from homeMonday to FridayDay shift
- ...-Authorization Registered Nurse for a remote, full-time role based in Virginia. The RN will review prior authorization requests... ...and educate providers on utilization and management processes. Requirements... ...least two years of varied clinical nursing experience in...Remote workFull time
- ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge planning and utilization review.Responsibilities:• Reviews admissions and service requests within...Remote work
- ...TriWest Healthcare Alliance seeks a Utilization Management Clinical Review nurse to evaluate and authorize beneficiary care, focusing on cost-effective, appropriate utilization of Behavioral Health and Medical/Surgical services. Responsibilities include preauthorization...Remote work
- ...States is seeking an Inpatient Utilization Management Clinician to evaluate... ...across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and experience with InterQual... ...management to ensure timely reviews, document outcomes, and...Remote workFull time
$1,600 - $1,800 per week
...Now Hiring: Registered Nurse – Utilization Management Location: Buckley AFB & Peterson AFB, Colorado... ...weekends, no holidays, no telehealth/remote work Minimum Qualifications... ...Utilization Management, Utilization Review, or Case Management Preferred Certifications...Remote workContract workImmediate startMonday to Friday- A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing utilization management, reviewing medical records, and coordinating discharge planning. Candidates must have an active RN license...Remote workContract work
- ...Centene Management Company LLC is seeking a qualified nurse reviewer to conduct concurrent inpatient and pediatric/adult case reviews to validate medical necessity... ...Responsibilities include educating providers on utilization processes, sharing feedback with leadership for...Remote work
- ...Guidehealth is seeking a Utilization Management Registered Nurse (RN) for a fully remote, full-time position. The role involves... ...medical necessity criteria to reviews, documenting findings, and interfacing... ...license active and 3+ years clinical experience preferred....Remote workFull time
$2,158.8 per week
...Ref. 65547807 RN - Utilization Review $2,158.80 per week... ...assignment in Fort Myers, FL. This remote position requires expertise in utilization management, making it an excellent opportunity for experienced nurses to work in a flexible virtual environment...Remote workWeekly payWork experience placementMonday to FridayFlexible hoursShift workWeekend work- ...Currently seeking a Utilization Management RN . Please see details... ...below: Position is remote - candidate must reside... ...active PA license or a Nurse Licensure Compact to include... ...will evaluate members’ clinical conditions through medical record review to determine medical...Remote workImmediate startDay shift
$77.08k - $119.47k
...Department/Unit: Care Management/Social Work... ...Responsible for Utilization Management, Quality... ...1. Registered nurse with a New York State... ...Minimum of three years clinical experience in an... ...to utilization review process. 8. Excellent... ...be done from a remote location. Other...Remote workShift work$1,759.5 per week
...Travel RN - Case Management/Utilization Review American Traveler Austin, Texas, United States Position ID: P-756324 Position status: On... ...weekly pay) Description American Traveler is hiring a remote Utilization Management RN with a TX or compact license and...Remote workWeekly payWork experience placementLocal areaShift work- ...Description Job Description The utilization review and management (UM) component program... ...are medically necessary, clinically appropriate, evidence-... ...~ Registered nurse with active, unincumbered... ...This is an in-office, no remote work capability position...Remote workWork at office
$2,147 per week
...Travel RN - Case Management/Utilization Review American Traveler Somerville, Massachusetts, United States Position ID: P-762577 Position... ...pay) Description American Traveler is hiring a remote RN for Utilization Management requiring an active MA RN license...Remote workWeekly payLocal areaMonday to FridayShift work$45 - $51 per hour
...Position Details Position: RN Utilization Management / Utilization Review Setting: 100% Remote Schedule: 5x8-hour days Hours: 8:00... ...necessity using InterQual criteria . Evaluate clinical documentation to determine appropriate level of...Remote workHourly payWeekend work$219k - $286.9k
...Physician Reviewer - Utilization Management Remote Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team.... ...inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines....Remote workFull timeLocal areaWork from homeHome officeWeekend work$63.1k - $94.65k
...enabled revenue cycle management solutions for health... ...NICU and/or Pediatric nursing experience is... ...populations. Candidates with clinical backgrounds in NICU,... ...Schedule Information: Our Utilization Review team provides... ...Required: This is a remote role which requires access...Remote workTemporary workWork at officeLocal areaFlexible hoursShift work- ...Health in Oregon is seeking a Supervisor, Clinical CM to provide operational supervision of clinical staff performing utilization reviews and specialty reviews using InterQual... ...stakeholders. This role supports a flexible remote work model with occasional on-site collaboration...Remote workFlexible hours
- ...Centene is hiring a Utilization Review Clinician - Behavioral Health for a fully remote position, serving members nationwide... ...abuse utilization management. The role emphasizes clinical reviews, prior authorizations... .... Requirements include a nursing or related degree, a...Remote work
- ...Centene Corporation is seeking a Nurse Reviewer for remote work in the United States. The role involves performing concurrent reviews to determine... ...will have knowledge of Medicare/Medicaid regulations and experience with health management systems. #J-18808-LjbffrRemote work
$64.5k - $92.2k
Gainwell Technologies LLC is seeking a Clinical Quality Nurse Reviewer, Sr. Specialist for a remote role. You will conduct quality assurance audits of clinical staff's work and ensure compliance with medical records and guidelines. The position requires an active RN license...Remote work
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