Remote RN Utilization Review Specialist
AFMC
AFMC is seeking a Clinical Services Specialist RN to analyze patient records for medical service legitimacy and ensure compliance with reimbursement policies. The role requires a nursing diploma or associate's degree, along with three years of clinical experience and an understanding of quality improvement processes. This position is work from home, based in Fort Smith, AR, and involves effective communication with clients while maintaining strict data confidentiality. #J-18808-Ljbffr
$75k
...Hospital is seeking a dedicated Registered Nurse for inpatient utilization review responsibilities. This role requires performing medical... ...teams to make informed decisions. Candidates must hold an active RN license and have experience in acute care settings. The starting...Remote work- Comagine Health is seeking a Clinical Utilization Review Nurse (RN) to assess medical necessity and quality of healthcare services. This full-time, remote position will be responsible for conducting utilization management reviews and ensuring compliance with clinical criteria...Remote jobFull time
$34 - $52.7 per hour
Froedtert Health is seeking a qualified nursing professional in Menomonee Falls, WI. The role involves assessing patient clinical statuses and collaborating with multidisciplinary teams to ensure effective care. Candidates should have a minimum of 3 years in acute care...Remote workHourly pay$30 - $45 per hour
...consulting agency is seeking an Operations Specialist III for a contract opportunity in Long... ...along with experience in Epic EHR and Utilization Review. The selected candidate will perform... ...program metrics. This position is remote and offers a pay range of $30-$45 per...Remote workHourly payContract work- ...Working remotely in a full-time capacity, the Behavioral Health Utilization Review Specialist will manage the authorization of treatment through insurance and managed care companies, performing pre-certification, concurrent, and appeal reviews while ensuring compliance...Remote workFull time
- ...efficient and streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will utilize... ...in a cohesive and rewarding environment. This is a fully remote or office/home hybrid position. Responsibilities Review...Remote workWork at officeFlexible hours
- ...Utilization Review Specialist The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient, and compliant with regulatory standards. This position involves thorough evaluation of...Remote work
- Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The role involves performing retrospective medical... ...in a relevant medical setting, and the ability to work in a remote environment. Comprehensive benefits are provided, including medical...Remote jobContract workWork from home
- ...Health Plan is seeking an Inpatient Utilization Management Clinician to evaluate... ...health outcomes. This fully remote role involves supporting care transitions... ...Candidates must have an active RN license and at least 2 years of utilization review experience. Competitive salaries...Remote job
- ...Medix™ is seeking an experienced RN for a Utilization Review role, allowing you to work from the comfort of home. In this contract-to-hire position, you'll review inpatient treatment plans and communicate with medical teams to ensure appropriate care levels. Ideal candidates...Remote workContract workWork from home
- ...US 2 days ago Requisition ID: 9252 UR Specialist – Join Camber and Make an Impact At Camber... ...difference every day. Job Summary The Utilization Review department manages all aspects of a... ...of 2 days in office and 3 days remote after successfully completing their first...Remote workFull timeWork at officeMonday to Friday
$55k - $70k
...Utilization Review Specialist – Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary: $55K - $70K About the Role As a Utilization Review Specialist, you will play a pivotal role in ensuring the efficient and effective utilization of healthcare...Remote workFlexible hours$55k - $70k
...Utilization Review Specialist – Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary: $55K - $70K Who We Are Exact Billing Solutions is a unique team of revenue... ...(e.g., BCBA, LSW, LMHC, PT, OT, SLP, RN). Proven experience in utilization review...Remote workWork at officeFlexible hours- Spectrum Billing Solutions is seeking an ABA Utilization Review (UR) Specialist to join their team. This fully remote or hybrid position involves reviewing clinical information and obtaining authorizations for ABA services. Candidates should have 3-5 years of relevant...Remote job
- ...HUMBLE VASCULAR SURGICAL CENTER INC in Addison, Texas, is seeking a dedicated RN Case Manager to oversee utilization reviews and discharge planning. The role involves ensuring compliance with medical necessity guidelines while collaborating with physicians and interdisciplinary...
- ...Methodist Hospital for Surgery in Addison, Texas is seeking a qualified RN Case Manager for Utilization Review. The role involves conducting medical record reviews, ensuring compliance with regulations, and supporting discharge planning activities. The ideal candidate...
- ...A healthcare organization in Texas is seeking an RN Utilization Review Coordinator to perform utilization reviews and ensure medical necessity compliance. The role involves collaborating with healthcare teams, managing denial appeals, and supporting discharge planning....Full time
- ...Mass Digital Health is seeking a Utilization Review Nurse in Quincy, Massachusetts. This role involves evaluating patients for appropriate admission... ...coordination. This position requires at least two years of RN experience in care management or utilization management. The...
$69.38k - $92.28k
...MVP Health Care seeks a Professional Concurrent Review RN to ensure members receive appropriate care while navigating the healthcare... ...Ideal candidates are experienced RNs looking to transition into utilization management, requiring strong clinical judgment and excellent communication...Remote work- ...Utilization Review Specialist The primary purpose of the Utilization Review Specialist is to create and manage the flow of revenue for each client... ...Satisfactory CORI and background check. Satisfactory drug screen Part Time Remote Role Charles River RecoveryRemote workPart timeWork at officeFlexible hours
$50k
...lives of patients and their families What to Expect (Job Responsibilities) Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary treatment team to gather necessary information for concurrent reviews...Remote job- ...Concierge Home Care in Jacksonville, FL is seeking an experienced Utilization Review Specialist (RN) to join its remote home health team. The ideal candidate should have strong expertise in OASIS, coding, QA, and home health documentation review. This role offers flexibility...Remote work
- ...A healthcare staffing firm is seeking a skilled Utilization Review RN to join their team. This fully remote position requires a valid PA RN license and prior experience in insurance utilization review. Responsibilities include conducting clinical reviews, applying evidence...Remote work
$23.76 - $51.49 per hour
...Molina Healthcare is seeking a Registered Nurse (RN) to support clinical member services review and assessment processes. This role involves analyzing... ...hourly pay range between $23.76 and $51.49 and requires adherence to utilization management policies. #J-18808-LjbffrRemote workHourly pay- COMAGINE HEALTH is seeking a Clinical Utilization Review Nurse (RN) for a full-time remote position, focused on medical necessity assessments in healthcare. Applicants must have a BA/BS in Nursing and at least 3 years of clinical experience. The role requires strong communication...Remote jobFull timeContract workWork from home
- ...oversee high-quality, patient-centered care through Utilization Review. The role requires an active RN license in Illinois and significant experience in healthcare... ...providers. This position offers the flexibility of remote work while supporting professional growth and a...Remote work
- ...providing telephonic and e-referral case review and authorization of services utilizing established mental health and... ...This position is full-time, fully remote (work from home) and requires some... ...State of Michigan clinical license (RN, LMSW, LP, LPC, or LLP) required....Remote workFull timeWork from homeShift workWeekend workAfternoon shift
- ...RN Utilization Review Review patient medical records to assess the appropriateness and medical necessity of hospital admissions, continued... ...management experience (hospital-based) ~ Skilled experience with remote work Length of Assignment: 13 weeks Shift / Hours...Remote workShift workWeekend work
- ...Department: Utilization Management Schedule: M-F 8am-5pm Work Location: Remote Benefits for eligible positions generous paid time off paid parental leave... ...management, discharge planning and utilization review. Review admissions and service requests...Remote work
$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 workHourly payPart time
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