Remote RN: Utilization Management & Clinical Validation
Construction Association of Michigan
- Remote job
Optum is seeking an Utilization Management & Clinical Validation RN to review medical records and extract key details for strong appeal letters. You will use ICD coding and evidence-based references to support decisions while adhering to HIPAA and policy guidelines. The role offers telecommuting flexibility within the U.S. and requires an RN license with 3+ years in ED/Telemetry/Critical Care, including 2+ years in clinical validation appeals. #J-18808-Ljbffr Construction Association of Michigan
$60.2k - $107.4k
Optum is a global organization that delivers care, aided by technology to help millions live healthier lives. The Utilization Management & Clinical Validation RN role involves reviewing medical records, extracting pertinent details, and crafting evidence-based appeal...Remote jobFull time$60.2k - $107.4k
...help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Utilization Management & Clinical Validation RN Will Accurately And Efficiently Review And Extract Pertinent Case Details From Patient Medical Records; And...Remote workMinimum wageFull timeWork experience placementLocal area- Optum is a global health services company seeking an RN in Utilization Management & Clinical Validation. This role supports evidence-based appeal letters,... ...encoders and coding guidelines is required. You will work remotely from anywhere in the United States with a flexible...Remote jobFlexible hours
- ...Description Job Description: Manager of Clinical Utilization Management - Denial... ...CAPosition Type: Hybrid (85% remote, 15% onsite in Northridge,... ...Registered Nursing Program; RN preferred.2. Minimum of five... ...computerized environment.7. Valid CA driver's license and car...Remote workPermanent employmentFull timeTemporary workFlexible hours
- ...seeking an experienced: UTILIZATION MANAGEMENT RN JOB SUMMARY: Day... ...care for members and within clinical guidelines Monitor... ...independently. ~ Must have a valid driver's license. ~ Proven... ...instructions to remote users. Visit for...Remote workWork at office
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays... ...critical role in supporting utilization management operations by conducting... ...: This is a 100% remote role, and requires... ...Suite, anchored by Cohere Validate™, an AI-driven clinical...Remote workFull timeFlexible hoursShift work$34 - $35 per hour
Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical Nurse - Work from... ...reliability reviews Qualifications RN license in an eNLC (Enhanced Nurse Licensure... ...Review Nurse- Prior Authorization Remote Registered Nurse (Remote Patient...Remote workFull timeWork at officeWork from homeNight shift- ...RN - Utilization Management ID 2026-25367 Category Registered Nurse specialties... ...Nurse (UMRN) . These will be completely remote positions, working entirely from the... ..., the HCWs must have pertinent clinical experience within the past two (2) years...Remote workFull timeContract workWork at officeWork from homeMonday to Friday
- ...healthcare organization is seeking a Care Manager RN for a remote role primarily serving the state of... ...per diem position involves crucial utilization management activities, ensuring... ...Washington RN license along with 3 years of clinical experience. The role offers...Remote workHourly payDaily paidDay shift
$59.5k - $116.6k
...UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services... ...an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate will work...Remote workWeekend 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
$29 - $52 per hour
...Growing together. The RN Field Clinical Care Coordinator, you will... ...state supportive services Manage the care plan throughout the... ...to reliable transportation & valid US driver's license... ...Managed Care ~ Ability to utilize an Electronic Medical Record...Remote workHourly payMinimum wageFull timeTemporary workWork experience placementLocal areaFlexible hours$71.1k - $97.8k
...their communities? As a Utilization Management (UM) Nurse, you will... ...You'll combine your clinical expertise, critical thinking... ...Registered Nurse (RN) in Illinois with no disciplinary... ...Workstyle: This is a remote position supporting... ...decisions only on valid job requirements. This...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday- ...Description Job Description The utilization review and management (UM) component program ensures that... ...facilities are medically necessary, clinically appropriate, evidence-based, and delivered... ...lunch This is an in-office, no remote work capability position Travel...Remote workWork at office
$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote The Utilization Management Registered Nurse is responsible for performing utilization review activities... ...to obtain, analyze, and accurately document clinical information from medical records in support of utilization...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home$39 - $40 per hour
...Healthcare Recruiter at The Judge Group Utilization Management Registered Nurse (RN) Type: 6-Month Contract W2 Location: Remote - but MUST reside in one of the... ...and evaluate healthcare services Use clinical expertise to assess, coordinate, and monitor...Remote workDaily paidContract workMonday to FridayShift workWeekend work$71.1k - $97.8k
...caring community The Utilization Management Nurse 2 utilizes clinical nursing skills to support... ...Licensed Registered Nurse (RN) in the state of... ...Information Workstyle: Remote work at home Location:... ...employment decisions only on valid job requirements. This policy...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to FridayWeekend work- A healthcare management organization is seeking a Utilization Management Nurse to oversee health service... ...requires an active LPN/RN license, and candidates should have clinical experience and proficiency... ...benefits package including remote work options. #J-18808-Ljbffr...Remote job
- ...Utilization Management RN (Part-Time, Remote) Position Overview Under the direction of a designated manager, the Utilization Management RN... ...stay requirements, and length of stay using established clinical criteria Direct care to the most appropriate setting...Remote workPart timeMonday to Friday
- ...Utilization Management Team Member Responsible for clinical review of utilization requests and assessment and implementation of potential coordination of care opportunities for overall membership, institutionalized populations, high risk members, and other members...Remote work
- UnitedHealth Group is seeking a Utilization Management Nurse to ensure efficient and effective... ..., and guide care decisions in a remote setting. Baseline requirements include Compact RN license and 3+ years in managed care or clinical settings, with prior utilization management...Remote job
$45.31 - $67.01 per hour
...Description: The Nurse Clinical Leader provides... ...department. They manage unit resources and... ...scheduled bedside RN shift with the responsibility... ...patients. The RN utilizes the nursing process... ...state of practice. Valid compact licenses... ...If applying for a remote or hybrid role,...Remote workHourly payFull timeShift work- ...Detroit, Michigan Registered Nurse (RN) Contract We are seeing a Michigan RN Utilization Manager. This is a 100% remote position in Michigan. Job... .../current Michigan RN license ~2 + yr clinical experience - acute care ~ Utilization...Remote workContract workLocal areaFlexible hours
- ...is seeking an Inpatient Care Management Nurse to ensure proper utilization of health services by assessing... ...Based in Phoenix, AZ with a fully remote work style, the role requires 3+ years of clinical nursing in acute settings and an active RN license. You will perform...Remote job
- ...Job: Utilization Management RN Location: 100% remote - candidate must reside in PA, DE, or NJ Schedule: part time position, working every other... ...Coordinator primary responsibility is to evaluate a member's clinical condition through the review of medical records (...Remote workContract workPart timeFlexible hoursWeekend work2 days per week
- Devoted Health is seeking a Clinical Guide Part A to support inpatient, behavioral health, and post-acute utilization review in alignment with CMS guidelines. This remote, full-time role requires a licensed RN with several years of UR experience and familiarity with Medicare...Remote jobFull time
$115k - $135k
Overview: Director Clinical Operations Location: St. Louis, MO Position: Hospice... ...Director of Clinical Operations, RN Job ID: 2026-91418 Remote/Virtual Position: No Coverage... ...standards. Ensures protocols are utilized to guide operations and promote adherence...Remote workWork experience placementLocal areaFlexible hours- NeueHealth seeks a full-time Utilization Management (UM) Prior Authorization (PA) Nurse in California... ...collaborate with Medical Directors and clinical teams to promote quality and cost-effective... .... Requirements include California RN license, 2-3 years of clinical nursing...Remote jobFull timeContract work
$40 - $45 per hour
...If you're a clinically driven RN or LPN with utilization management experience and a passion for making meaningful coverage decisions, this remote opportunity offers the chance to directly impact member... ...experience • Current and valid NC or Compact Multistate Nursing...Remote workHourly payTemporary workMonday to Friday$112.7k - $193.2k
...Utilization Management Director Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one... ...Management, including the review, validation, reconciliation, sign-off,... ...Texas Registered Nurse (RN) license or valid multistate...Minimum wageFull timeContract workWork experience placementLocal area
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