Remote Utilization Management RN — Clinical Review Leader
Guidehealth
Guidehealth is seeking a Utilization Management Registered Nurse (RN) for a fully remote, full-time position. The role involves applying medical necessity criteria to reviews, documenting findings, and interfacing with providers and members to ensure timely, compliant determinations.
Illinois license active and 3+ years clinical experience preferred. Responsibilities include collaboration with Medical Director, AI workflow integration, and participation in quality initiatives.
#J-18808-LjbffrVacancy posted 2 hours ago
Similar jobs that could be interesting for youBased on the Remote Utilization Management RN — Clinical Review Leader in Chicago, IL vacancy
$64.5k - $92.2k
Gainwell Technologies LLC is seeking a Clinical Quality Nurse Reviewer, Sr. Specialist for a remote role. You will conduct quality assurance audits of clinical staff... ...and guidelines. The position requires an active RN license, with 5+ years clinical experience preferred...Remote workGainwell Technologies LLC
Tetonia, ID2 hours ago- ...Authorization Registered Nurse for a remote, full-time role based in Virginia. The RN will review prior authorization requests... ..., and educate providers on utilization and management processes. Requirements... ...least two years of varied clinical nursing experience in acute,...Remote workFull time
Humana
Virginia, MN3 days ago - ...Description Job Description: Manager of Clinical Utilization Management - Denial... ...Position Type: Hybrid (85% remote, 15% onsite in Northridge,... ...managing daily tasks, performance reviews, and any necessary... ...Registered Nursing Program; RN preferred. 2. Minimum of...Remote workPermanent employmentFull timeTemporary workFlexible hours
Vivo HealthStaff
Burbank, CAa month ago - ...seeking a Registered Nurse for a remote role with Arizona hours (1st shift). You will review medical records for quality, safety, and utilization issues, identify PQIs, and... .... Must hold an active RN license, have 3+ years of clinical experience in med/surg or behavioral...Remote workDay shift
TEEMA
United States4 days ago $45.31 - $67.01 per hour
...Description: The Nurse Clinical Leader provides... ...department. They manage unit resources and... ...employee performance reviews. The Nurse Clinical... ...scheduled bedside RN shift with the... ...patients. The RN utilizes the nursing process... ...If applying for a remote or hybrid role, this...Remote workHourly payShift work$66.58k - $142.58k
...community at a time. Position Summary The Clinical Team Lead in the Utilization Management team utilizes clinical experience and... ...staff on cases. May be required to proctor RN/MD rounds. Assists with escalated case reviews/facility issues. Gathers clinical...Remote workHourly payFull timeTemporary workWork at officeLocal areaAfternoon shift- ...Brigham Health Plan Holding Company, Inc. is seeking an experienced nurse for utilization review in a remote-friendly setting with occasional onsite work in Somerville, MA. The role emphasizes clinical knowledge, medical necessity determinations, and collaboration with...Remote jobCasual work
- Comagine Health is seeking a Clinical Utilization Review Nurse (RN) for a 100% remote, full-time role supporting Alaska contracts. The nurse will assess medical necessity and care quality through prospective, concurrent, and retrospective reviews, applying InterQual criteria...Remote jobFull time
$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing... ...this role: This is a 100% remote role, and requires robust internet...Remote workFull timeFlexible hoursShift workCohere Health
United States3 days ago- ...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
MedTrust LLC
Oklahoma City, OK2 days ago $2,300 per month
...The Clinical Review Nurse (RN) supports the organization’s care management function by conducting clinical reviews, ensuring appropriate utilization of medical services, and maintaining compliance with... ...outcomes for members. This is a remote role open to candidates...Remote workWork at officeMotivHealth
Utah2 days ago- ...industry. Overview: The ideal Clinical Reimbursement Specialist... ...Additional Details: MDS LEADER NEEDED! MUST LOVE TO TRAVEL!... ...PER WEEK WITH ONE DAY WORKING REMOTE** How you Will make a Difference... ...and Medicare education utilizing various types of media, technology...Remote workMonday to FridayFlexible hoursNight shift
Signature HealthCARE TN, Nashville
Nashville, TN5 days ago - ...Team Leader On-site Hospital Utilization Management (UM) Nurse How would you like to work in... ...It is expected that all RN Clinical Nurses are licensed, knowledgeable... ...compliance. Unlike remote roles, this position... ...volume without medical reviews completed, management of...Remote workShift work
- ...The Charge Registered Nurse (RN) oversees the daily shift operations... ..., and efficient workflow management. The Charge RN provides clinical leadership and supervision to Remote Patient Safety Observers (... ...regards to patient:PSO ratio • Review observation routines and...Remote workFull timeImmediate startShift work
Psynergy Health
Florida, FL14 days ago - ...week ago Be among the first 25 applicants Job Title:Clinical Review Nurse (RN) - Utilization Management Location:Oregon or bordering states Duration:3+ Months... ...Opportunities) Clinical Program Coordinator RN *Remote* Clinical Program Coordinator RN *Remote* Medford, OR...Remote workContract work
$82.4k - $110k
...Clinical Review RN, Oncology AI Review Position Summary... ...Operations, Revenue Cycle Management, Product, Engineering... ..., navigation, utilization review, clinical review... ...labor considerations. Remote USA $82,400—$110,00... ...Natera™ is a global leader in cell-free DNA (...Remote workFull timeWork at officeImmediate startWorldwide$63.1k - $94.65k
...enabled revenue cycle management solutions for... ...current compact RN license, or be willing... ...: Our Utilization Review team provides coverage... ...approved clinical review criteria to... ...Required: This is a remote role which... ...Cycle 2019-2024 Leader in Everest Group'...Remote workTemporary workPart timeWork at officeLocal areaFlexible hoursShift work$112.7k - $193.2k
...opportunities with Kelsey-Seybold Clinic, part of the Optum family of... ...operational oversight for all Utilization Management functions, including inpatient utilization review, outpatient prior authorization... ...Active Texas Registered Nurse (RN) license or valid multistate compact...Remote jobMinimum wageFull timeContract workWork experience placementLocal area- ...Health in Oregon is seeking a Supervisor, Clinical CM to provide operational supervision of clinical staff performing utilization reviews and specialty reviews using InterQual... ...stakeholders. This role supports a flexible remote work model with occasional on-site collaboration...Remote workFlexible hours
Comagine Health
Brooklyn, NY3 days ago $89.07k - $162.8k
...Candidate must have acute care Utilization Review experience. Candidate must... ...Utilization Review Team. Manages daily assignment ensuring all... ...letters based on knowledge of clinical severity and intensity.... ...Licenses and Certifications RN - Registered Nurse - State Licensure...Live in- ...States is seeking an Inpatient Utilization Management Clinician to evaluate inpatient... ...planning across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and... ...management to ensure timely reviews, document outcomes, and maintain...Remote workFull time
Well Sense Health Plan
United States2 days ago $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 workkozmetickesluzby.vecnakraska.sk - Jobboard
Phoenix, AZ8 hours ago$86.96k - $113.67k
...Utilization Review Nurse Capital Health is the region's leader in providing progressive, quality patient care with significant... ..., denials, appeals and clinical audits for inpatient cases. Ensures... ...years' experience in case management field including utilization review...Full timeTemporary workPart timeFlexible hours- ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge planning and utilization review.Responsibilities:• Reviews admissions and service requests within...Remote work
First Connect Health
Austin, TX1 day ago - ...Providing timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions, treatment planning... ...treatment. Key responsibilities Perform clinical assessments and evaluate patient conditions...Remote workFull timeWork experience placement
Virtual Vocations Inc
United States1 day ago - ...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
The Judge Group, LLC
New York, NY4 days ago - ...practice and company procedures. Review and approve patient... ...to have and maintain a valid clinical license, per state requirements... ...Preferred previous experience in a management position. Preferred previous... ...for designated full-time remote positions, in-office attendance...Remote workFull timeTemporary workWork at officeLocal areaImmediate startFlexible hours
- ...Friend Back Remote Work from Home... ...(JHHP) is the managed care and health services... ...JHHP has become a leader in provider-... ...5:00 PM As a Utilization Review Registered Nurse for... ...opportunity to use your clinical, managed care,... ...Registered Nurse (RN) license in...Remote workFull timeLocal areaWork from homeMonday to FridayDay shift
Johns Hopkins Medicine
Hanover, MD4 days ago - The Nurse Clinical Leader provides leadership and clinical... ...department. They manage unit resources and... ...performance reviews. The Nurse Clinical... ...scheduled bedside RN shift with the responsibility... ...patients. The RN utilizes the nursing... ...If applying for a remote or hybrid role,...Remote workHourly payShift work
$45.31 - $67.01 per hour
...Description: The Nurse Clinical Leader provides... ...department. They manage unit resources and... ...employee performance reviews. The Nurse Clinical... ...scheduled bedside RN shift with the... ...patients. The RN utilizes the nursing process... ...If applying for a remote or hybrid role, this...Remote workHourly payShift workIntermountain Health
Golden, CO25 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Management RN — Clinical Review Leader. Be the first to apply!
