Remote Utilization Review Nurse
$78k - $88kGainwell Technologies
- Remote job
Gainwell Technologies is seeking a skilled Utilization Review Nurse to perform prior authorization across prospective, concurrent, and retrospective reviews for medical necessity, documenting findings and ensuring policy compliance. This home-based role supports providers, uses InterQual/MCG criteria, requires 3+ years inpatient experience and an active RN license in the U.S. Core hours 8:00 AM–6:00 PM ET; occasional travel up to 10%; salary range $78,000–$88,000 with benefits. #J-18808-Ljbffr Gainwell Technologies
$85.99k - $105.34k
...A community-focused healthcare organization in Oregon is seeking a Utilization Review Nurse for a full-time remote position. The role involves evaluating clinical service requests, conducting prior authorization reviews, and collaborating with interdisciplinary teams....Remote workFull time- ...Brighton Health Plan Solutions, LLC is seeking an Utilization Management Nurse to perform medical necessity reviews remotely. Licensed LPN with strong MS Office skills will review clinical criteria, coordinate with care partners, and document determinations in compliance...Remote work
$30 - $34 per hour
...Overview Utilization Review Nurse - Remote at Astrana Health Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Compensation: $30.00 - $34.00 / hour Department: HS - UM This is a fully remote position. Description Astrana Health is looking...Remote workHourly payMonday to Friday- ...Utilization Review Nurse American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home...Remote workFull timeTemporary workLocal area
$78k - $88k
Summary We are seeking a skilled Utilization Review Nurse to conduct prior authorization, prospective, concurrent, and retrospective reviews for medical necessity and appropriateness of services, following clinical criteria, coverage policies, and contract guidelines....Remote jobFull timeContract workWork at officeWork from homeFlexible hours- ...Overview Title: Clinical Review Nurse – Prior Authorization Review Location: Fully Remote (PST Time Zone - WA/OR Resident) Duration: 12-Month (Potential... ...for Prior Authorization Review to join our Utilization Management team. In this role, you will conduct...Remote workContract work
- ...Currently seeking a Utilization Management RN . Please see details... ...qualifications below: Position is remote - candidate must reside in... ...an active PA license or a Nurse Licensure Compact to include... ...conditions through medical record review to determine medical...Remote workImmediate startDay shift
$35 - $45 per hour
...Base pay range $35.00/hr - $45.00/hr Direct message the job poster from IntePros IntePros is seeking a Remote Utilization Review Nurse serves as a key clinical liaison, coordinating resources and services to meet patients’ needs while ensuring compliance with federal,...Remote workContract workWeekend work$55 - $60 per hour
...Position Overview We are seeking an experienced Utilization Management (UM) Registered Nurse to support outpatient utilization review and prior authorization activities for a... .... Ability to work independently in a remote environment. Comfortable using multiple systems...Remote workHourly payContract work- ...A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and collaborating with teams to meet...Remote workContract work
- ...leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the... ...insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and...Remote workFull time
- ...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 jobFull timeWork at office
- ...Utilization Review Nurse Location: [City, State / Remote] Employment Type: Full-Time Experience: 2-5+ Years Job Summary We are seeking a detail-oriented and experienced Utilization Review Nurse to evaluate the medical necessity, appropriateness, and...Remote workFull timeSecond jobWork at office
- ...Integra Partners is seeking a licensed Practical Nurse (LPN/LVN) experienced in managed care UM to perform pre-service and post-service utilization reviews and appeals for DMEPOS, working with our Medical Director in a NCQA-compliant UM program. You will review benefit...Remote work
- ...Essential Functions Applies approved utilization criteria to monitor appropriateness of... ...levels of care and continued stay review. Communication to third-party payers... ...clinical review with payer as determined by nursing judgment and/or collaboration with the payer...Remote workWork at officeShift workNight shiftRotating shift
- ...CVS Health is hiring a Utilization Management Nurse Consultant focused on Medical Review. This fully remote role supports timely, medically necessary care through expert clinical review and provider collaboration. The position requires an active RN license, 3+ years...Remote workFull time
- ...Management Location: 100% Remote Schedule: M-F 9:00am to 5... ...Summary Works with the Utilization Management team primarily responsible... ...necessity/utilization review and other utilization management... ...IL State Registered Nursing (RN) license in good standing...Remote workContract work
$27.02 - $48.55 per hour
...About This Role The Utilization Review Clinician - ABA at Centene is responsible for reviewing... ...$27.02 - $48.55 per hour Location: Remote, FL Schedule: Full Time What You'... ...Graduate of an Accredited School of Nursing or Bachelor's degree required Master...Remote workHourly payFull timeFlexible hours- ...POSITION SUMMARY: The Utilization Review Registered Nurse (UR RN) is a key contributor to the delivery of appropriate, efficient, and cost-effective... ...preferred. • Basic Life Support (BLS) certification as required for facility based staff; optional for remote staff.Remote workWork at office
- ...to meet QM objectives Responsibilities: • Reviews documentation and evaluates Potential Quality of... ...inpatient hospital experience • Registered Nurse in state of residence • Must have prior authorization utilization experience • Able to work in multiple IT platforms...Remote work
$30.64 - $45.8 per hour
...Utilization Review Nurse The Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective... ...of the Case Management department and of CorVel. This is a remote position. Essential Functions & Responsibilities:...Remote workHourly payFull timeWork at officeLocal areaFlexible hours$30.64 - $45.8 per hour
...The Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and... ...the Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES:...Remote workHourly payMinimum wageFull timeWork at officeLocal areaFlexible hours$30 - $38 per hour
...personifyhealth.com. Responsibilities Job Summary We are seeking Utilization Review Nurse RN to join our team on a part‑time basis, working a minimum... ...communication skills to successfully perform in a remote healthcare environment. Ability to perform the essential job...Remote workHourly payFull timePart timeWork at officeMonday to FridayWeekend work- ...Utilization Review Nurse Responsible for utilization review work for emergency admissions and continued stay reviews. Responsibilities include... ...(CMGT-BC) Expectations: Comfortable with remote work arrangements and virtual collaboration tools Physical...Remote workFor contractorsWork at office
$55 per hour
...from Akkodis Akkodis is hiring a Concurrent Review Nurse to support our client in the Healthcare space. Location: Remote (must be based in California) Employment type... ...setting. Preferred: Experience in case management, utilization management, or discharge planning. Experience...Remote workFull timeContract workTemporary workLocal area$1,600 - $1,800 per week
...NOW HIRING: Registered Nurse - Utilization Management Location: Buckley AFB & Peterson AFB,... ...No weekends, no holidays, no telehealth/remote work Minimum Qualifications... ...in Utilization Management, Utilization Review, or Case Management ~• Preferred Certifications...Remote workContract workImmediate startMonday to Friday- ...Prior Authorization Analyst Location: St. Louis, Missouri (Partial Remote) Role Overview We are seeking two detail-oriented Prior... ...Shield cases. The successful candidates will be responsible for reviewing clinical notes and documents to ensure accurate and timely processing...Remote work
- ...Apply Refer a Friend Back Remote Work from Home Share This Page... ..., Hanover, MD 21076 Category: Nursing Schedule: Day Shift Employment Type... ...hours are 8:00 AM - 5:00 PM As a Utilization Review Registered Nurse for Johns Hopkins Health...Remote workFull timeLocal areaWork from homeMonday to FridayDay shift
- ...leading healthcare solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services.... ...accredited nursing degree and experience in utilization review. Competitive pay and remote flexibility offered. #J-18808-Ljbffr...Remote work
$85k - $105.34k
...UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At Umpqua Health, we’re more than a healthcare organization...Remote workFull timeWork at officeLocal areaImmediate startMonday to Friday
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