Remote Medicaid Utilization Review Nurse (RN)
Sentara Healthcare Inc
- Remote job
Sentara Health Plans is seeking a Utilization Review Nurse/ RN for Medicaid to work remotely. The role includes pre-certification, inpatient and concurrent reviews, and care coordination across the patient care continuum, with weekend and holiday coverage requirements. Requirements include a Registered Nurse license (Virginia or Compact), a Bachelor's in Nursing preferred, and at least 3 years of acute care experience. NCQA knowledge and InterQual/Milliman experience are highly valued. #J-18808-Ljbffr Sentara Healthcare Inc
$66.83k - $111.38k
...City/State Norfolk, VA Work Shift First (Days) Overview: Sentara Health Plans is hiring an Utilization Review Nurse/ RN for Medicaid - Remote! Status: Full-time, permanent position (40 hours) Standard working hours: 8am to 5pm EST, M-F. Weekend and holiday...Remote workPermanent employmentFull timeTemporary workShift workDay shift- ...Job Description Job Description Remote Utilization Review Registered Nurse (UR RN) Location: Remote (Texas RN License or Compact License Required) Company: Nexus Health Systems Employment Type: Full-Time Make an Impact from Anywhere Nexus Health Systems...Remote workFull timeWork at office
- ...seeking an experienced Utilization Management Nurse 2 to support medical necessity reviews, care coordination,... ...planning for Kentucky Medicaid members. You will use... ...members. The role is remote/work-from-home with weekend... ...; requires Kentucky RN license, 2+ years clinical...Remote jobWork at officeWork from homeShift work
- CVS Health is seeking an RN Case Manager for an Integrated Care Management role. This work-from-home position covers travel within... ...coordinate care for dual eligible members enrolled in Medicare and Medicaid, addressing medical and social determinants of health. The role...Remote jobWork from home
- Sentara Health Plans is hiring an Integrated Care Manager/Registered Nurse (RN) LTSS Waiver Members/Medicaid with remote work in Northern Virginia (Fairfax, Springfield and Alexandria, VA) and surrounding areas. The role requires in-person assessments and remote/home-office...Remote jobWork at officeWork from homeHome office
$30 - $38 per hour
A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Remote jobHourly payPart time$35 - $45 per hour
Position: RN / Utilization Review Nurse Location: Sacramento, CA (ON-SITE) Employment Type: Potential contract to hire Pay Range: $35.00 - $45.00/... ...paced environment. Comfortable working independently in a remote or office-based setting. Working Conditions May be exposed...Remote workWeekly payContract workWork at officeMonday to Friday- TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews, assisting...Remote job
- ...Plansis hiring an Integrated Care Manager/ Registered Nurse (RN) LTSS Waiver Members/Medicaid - Remote in NOVA (Fairfax, Springfield and Alexandria, VA)... ...disabilities ensuring cost effective and efficient utilization of health benefits; conducts gap in care management...Remote jobPermanent employmentFull timeTemporary workHome officeShift work
- ...Utilization Management Registered NurseDuration:... ...Management (UM) Registered Nurse to support outpatient utilization review and prior... ...Registered Nurse (RN) license.Associate... ...Health Plan, Medicare, Medicaid, or Commercial Insurance... ...independently in a remote environment....Remote workContract work
- Vaya Health is seeking an RN to perform needs-based assessments for Medicaid Personal Care Services in home and community settings. This role involves scheduling, telephonic and in-person evaluations, and collaboration with healthcare professionals to determine PCS eligibility...Remote job
- ...Utilization Review NurseWe are seeking a detail-oriented and experienced... ...Utilization Review Nurse to evaluate the... ...licensed Registered Nurse (RN) with experience in... ...with CMS, Medicare, Medicaid, Joint Commission, and... ...management department. Remote, hybrid, or on-site opportunities...Remote workWork at office
- ...to lead a multidisciplinary team serving Medicaid members in Illinois. The role focuses on... ...appropriate resources to improve wellness. Remote position with travel 50-75% and... ...meetings in Illinois locations. Requires RN or SW license, 5+ years of experience, and...Remote job
- Molina Healthcare is seeking an RN with a US license in good standing to join the Medicaid Team as a Clinical Auditor. The role may offer remote work flexibility, but the candidate must reside in Michigan and operate within Michigan-based guidelines. The incumbent will...Remote job
- ...LLC is seeking a Healthcare Investigator to safeguard Medicaid recipients across Ohio. This fully remote role investigates incidents, analyzes records, interviews... ...with HCBS regulations. Ohio‑licensed professionals (RN/LISW/LPC) with HCBS experience, strong analytical...Remote job
- Overview Title: Clinical Review Nurse - Prior Authorization... ...Location: Fully Remote (PST Time Zone - WA/OR... ...Authorization Review to join our Utilization Management team. In... ...Qualifications Active RN license (WA; must be... ...with Medicare and Medicaid Job Details Seniority...Remote workContract work
- ...with lines of business in Medicaid, Medicare, commercial, military... ...8:00 AM - 5:00 PM As a Utilization Review Registered Nurse for Johns Hopkins Health... ...life balance - This is a remote role! Candidates in the... ...Unencumbered Registered Nurse (RN) license in Maryland (or...Remote workFull timeMonday to Friday
$33 - $37 per hour
...rewarding career! Job Description Are you an experienced RN Utilization Review Nurse looking for a new opportunity with a prestigious healthcare... .../Day to Day Duties: Providing utilization review for the Medicaid and Medicare line of business. Primarily inpatient,...Private practiceWork at office- ...Umpqua Health. Position Title Utilization Review Nurse Department Umpqua Health... ...Pacific Standard Time) Location Remote position Salary Wage Band 2... ...Registered Nurse (RN), BSN (Bachelor of Science in... ...or debarment from Medicare/Medicaid. Preferred Qualifications...Remote workFull timeWork at officeLocal areaMonday to FridayFlexible hours
- ...Health is seeking an experienced Integrated Care Management (ICM) Care Manager to assess and coordinate care for members with Medicare/Medicaid needs. You will develop proactive plans, collaborate with healthcare teams, and leverage data to address health and social...Remote jobFull timeWork from home
$42 - $65 per hour
...Job Description Job Description Utilization Review Nurse Location: Las Vegas, NV Job Type... ...accredited School of Nursing. ~ Current RN license in the applicable state. ~5+... .... ~ Knowledge of Medicare, Medicaid, and commercial payer requirements....Full timeRelocation package- ...Johns Hopkins Health Plans is seeking a Utilization Review Registered Nurse to apply clinical, managed care and... ...to improve member outcomes. This remote role supports the organization with standard... ...discharge planning. Maryland RN license (or compact) and 3+ years acute...Remote work
$40.12 - $62.19 per hour
...Utilization Review Nurse RN ~Baltimore, MD ~SINAI HOSPITAL ~UTILIZATION REVIEW ~Full-time w/Weekend Commitment - Day shift - 8:00am-4:30pm ~RN OTHER ~96812 ~$40.12-$62.19 Experience based ~Posted: July 2, 2026 Apply Now Save Job...Full timeShift workWeekend workDay shift- ...Utilization Review NurseAmerican Health Plans, a division of Franklin, Tennessee-based American Health... ...care facilities. In partnership with nursing home operators, these Medicare Advantage... ...active and unrestricted Registered Nurse (RN) licenseEqual Opportunity EmployerThis...Remote workFull timeTemporary workLocal area
$68.4k
...This job implements effective utilization management strategies including: review of appropriateness of health care... ...Preferred ~ Bachelor’s Degree in Nursing EXPERIENCE Required ~3... ...in UM/CM/QA/Managed Care Medicaid RN (Registered Nurse) Care Management...Remote workFull timeFor contractorsWork at officeLocal areaFlexible hours$40.12 - $62.19 per hour
...Work Schedule: This is an EVERY Saturday and Sunday role Summary: The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to...Weekend work$50 per hour
...Sinai Hospital's Utilization Review operates as a distinct specialty service line of physician advisors, nurses, and support staff who ensure hospital stays are clinically appropriate... ...Role/Unit: The PRN Utilization Review RN at Sinai Hospital works with stakeholders in...ReliefLive in$33 - $37 per hour
A national healthcare staffing firm seeks an experienced RN Utilization Review Nurse in Troy, MI. Responsibilities include utilization review for Medicaid and Medicare, managing authorization processes, and collaborating with healthcare teams to ensure quality care. Ideal...Hourly payMonday to Friday$2,855 per week
...Registered Nurse (RN) | Cardiovascular Operating Room Location: Oak Lawn, IL Agency... ...those recognitions are fueled by real reviews by real travel nurses and allied healthcare... ...a lot of our team has been working remote since the pandemic), but you are part of...Remote workHourly payFull timeContract workWork at officeShift workWeekend work$85.99k - $105.34k
...focused healthcare organization in Oregon is seeking a Utilization Review Nurse for a full-time remote position. The role involves evaluating clinical... ...interdisciplinary teams. Applicants should have an active RN license and at least five years of direct patient care...Remote jobFull time
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