Remote RN Utilization Review Specialist
Santa Barbara Cottage Hospital
A healthcare facility in California is seeking experienced nursing professionals to review medical records and ensure appropriate admission status. The role involves collaboration with various stakeholders, including physicians and Care Coordination staff, to support patient admissions. Candidates must have a valid California RN license and at least two years of clinical experience or a Master's degree in a related field. The position offers remote work with emphasis on critical thinking and problem-solving skills. #J-18808-Ljbffr
- Centene Corporation seeks a Registered Nurse to perform concurrent reviews, determine member health status, evaluate medical necessity, and contribute to discharge planning according to policies. This remote role supports inpatient services assessment and collaboration...Remote job
$55k - $70k
...support to behavioral health programs. We are looking for a Utilization Review (UR) Specialist in Boca Raton, FL Compensation: $55,000 - $70,000 a... ...position and must have prior UR & clinical experience. Remote hires and applicants without prior experience will not be...Remote workFull timeWork at officeLocal area- ...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 workContract workWork from home
$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...Remote work- ...leadership programs... and more! Description The Utilization Review (UR) Specialist is a Registered Nurse responsible for conducting thorough... ...time may be required. Work Type: This position is a remote position outside traditional office, often from home or another...Remote workWork at office
- A leading medical review organization is seeking Board-Certified physicians in Gastroenterology for a flexible remote opportunity. This role requires conducting independent Utilization Reviews for just 1-2 hours per week, with no minimum commitment. Candidates must have...Remote workFlexible hours
- ...Utilization Review Specialist Ethos Risk Services is a leading insurance claims investigation and medical management company committed to providing... ...is seeking a full-time Utilization Review Specialist (REMOTE) to play a key role in ensuring the efficient, accurate, and...Remote workFull timeWork at office
- ...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. Your Responsibilities...Remote workWork at officeFlexible hours
$62k - $70k
...of this position is to ensure that the utilization process is thorough, organized and streamlined... ...timely manner Completes peer to peer reviews with insurance MDs to advocate for... ...Charlie Health-sponsored benefits. #LI-REMOTE Please note that this role is not available...Remote workFull timeLocal area$35 - $40 per hour
...Job Title: Utilization Review Specialist Location: Remote Schedule: Monday-Friday 8am-5pm MST Compensation: $35-40/hour Northpoint Recovery Holdings, LLC began 2009 as Ashwood Outpatient and officially launched the Northpoint platform in 2015. Now celebrating...Remote workFull timeTemporary workWork at officeMonday to Friday- ...Responsible completion of assigned tasks related to preadmission reviews, continued stay reviews, medical necessity requests, and chart... ...appropriate services, in the least restrictive environment, utilizing proven clinical interventions will lead to the provision of safe...Remote workWork at office
- Spectrum Billing Solutions is seeking an ABA Utilization Review Specialist to review clinical information and obtain authorizations for ABA and related services. This role supports remote or office/home hybrid work and emphasizes attention to medical necessity and HIPAA...Remote jobWork at officeWork from home
$68 per hour
...Job Title: Utilization Management Specialist (RN) Location: Baltimore, MD Type: Contract To Hire Compensation... ...(MRP) $100,500/yr Work Model: Remote – offsite Responsibilities... ...prospective, concurrent, and retrospective reviews for authorization, appropriateness...Remote workContract workTemporary workLocal area- ...American Health Plans in Franklin, TN seeks an Utilization Review Nurse to assess medical necessity and quality of care for plan members. You... ...services comply with regulatory guidelines. The role requires RN licensure and UM experience; knowledge of Interqual/MCG and...
- ...Health Business Solutions LLC seeks an experienced Utilization Review Nurse in New York to provide clinical guidance, drive appropriate level... ...criteria, and collaborate with insurers on denials. Requires RN license (US multi-state/compact), BSN preferred, 2+ years UR experience...
$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 jobHourly payContract work$16.74 - $26.92 per hour
...Job Description Job Description The Utilization Review (UR) Intake Specialist provides staff support services including typing reports and correspondence... ...an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote...Remote workHourly payMinimum wageFull timeWork at officeLocal areaFlexible hours- ...Job Description Job Description Utilization Review Specialist Job Description Unique opportunity to join Maryhaven, Central Ohio’s largest and... ...Health Records. Must have LPCC, LSW, LCDC III or RN. Utilization Review Specialist Requirements ~ Salary...
- ...through improvement huddles, employee surveys, and town hall meetings Job Description A Day In The Life The Utilization Review Specialist (RN) is responsible for ensuring appropriate utilization of healthcare services across the continuum of care. This role...Work at officeWeekend work
- ...Job Description Job Description Position Summary The PACE Utilization Review Specialist – RN oversees clinical utilization management for participants enrolled in the Program for All-Inclusive Care for the Elderly. The position ensures that services are medically...Work at office
$2,000 per week
...RadHealth+ is seeking a travel nurse RN Remote Case Manager, Utilization Review for a travel nursing job in Torrance, California. Job Description & Requirements ~ Specialty: Utilization Review ~ Discipline: RN ~ Duration: 13 weeks ~40 hours per week ~ Shift...Remote workWeekly payFor contractorsLocal areaShift workNight shift$110k
...outcomes in the expected time frame and with the most efficient utilization of resources. Carries out activities related to utilization... ...physician regarding appropriate documentation for justification. Reviews the patient’s plan of care in conjunction with the clinical...Daily paidFull timePart timeFlexible hoursShift work- Excellus BCBS in New York seeks a Utilization Management professional to coordinate behavioral... ...services for members. You will perform clinical reviews, ensure medical necessity, and... ...Requirements include an associates degree with NYS RN license and at least three years of UM...Work at office
- .... Ready to join our quest for better? Job Description The RN Utilization Specialist reflects the mission, vision, and values of NM, adheres to... ...expertise in hospital utilization. The RNUS through regular reviews and audits and collaboration with the clinical team, facilitates...For contractorsCasual workWork at officeLocal areaRelocation package
- Torrance Memorial Medical Center is seeking a Utilization Review Case Manager to review patient charts and validate appropriate levels of care... ...utilization review standards are met. The UR CM engages with RN Case Managers, physicians, patients, and families to optimize...
- Molina Healthcare is seeking a qualified RN to support clinical member services review and assessment processes. You will verify medical necessity, align... ...care across the continuum. The role emphasizes utilization management, adherence to timelines, and collaboration...
- Gateway Regional Medical Center, Inc. is seeking a full-time Utilization Review Specialist RN responsible for conducting admission and concurrent reviews to avoid payment denials, while managing appeals. This role requires collaboration with interdisciplinary teams to...Full time
- 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
- A leading healthcare staffing firm is seeking a Utilization Review RN in Syracuse, NY. The role involves conducting utilization management activities, certification reviews, and collaborating with healthcare providers. Candidates must have an RN License in NY and at least...Monday to Friday
- Orison-Solutions-LLC is seeking an experienced Registered Nurse (RN) - Utilization Review to assess medical necessity, appropriateness, and level of care for patients. The RN will review clinical documentation, apply established guidelines, and collaborate with physicians...
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