RN Utilization Management Specialist
10000 Sanford
Sanford Health, the largest rural health system in the United States, seeks a registered nurse to perform utilization management, medical necessity reviews, and prior authorization coordination. The role supports compliant, cost-conscious care across our large network. The RN will collaborate with physicians and care teams to ensure accurate documentation and appropriate resource utilization, including DRG assignments and outcome-focused reviews. #J-18808-Ljbffr 10000 Sanford
- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure... ...team-oriented environment. Requirements include active RN or LVN licensure, a minimum of two years in utilization review...SuggestedWork at officeRemote work
$83.1k - $120.36k
Learning Delivery Specialist RN General Information Req ID R022529 State New York Work Type Hybrid... ...to identify mitigation strategies. Manage learning environment to assess, evaluate... ...assigned business unit policies and procedures Utilize all systems and technology to deliver...SuggestedTemporary workWork experience placementWork at office$50k
Employer Industry: Behavioral Healthcare Management Why consider this job opportunity Starting pay up to $50,000 per year, based on... ...Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary...SuggestedRemote job- ...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...SuggestedRemote work
- ...seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case... ...This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license.... ...in clinical practice and knowledge of Utilization Review Guidelines. The position offers...SuggestedRemote work
- ...Managing insurance authorizations for mental health and substance use treatment, the full-time Behavioral Health Utilization Review Specialist will verify benefits, complete prior authorizations, and support medical necessity criteria while working remotely. Key responsibilities...Full timeRemote work
- ...addiction and mental health issues, the full-time Remote Utilization Review Specialist will manage pre-authorizations and concurrent reviews, collaborating... ...diploma or equivalent with a state license (e.g., RN, LPN, LCSW, LMHC) preferred Minimum of three years' experience...Full timeRemote work
$42 per hour
Registered Nurse (RN) - Telehealth Medicare Annual Wellness Visit Specialist - PRN Full-time WHO IS GUIDEHEALTH? Guidehealthis... ...Healthguides™ and a centralized Managed Service Organization to build... ...risk factors for chronic diseases, utilizing remote monitoring tools when...Bi-weekly payFull timeTemporary workFor contractorsReliefLocal areaRemote workWork from homeMonday to Friday$85k - $120k
...Overview We are seeking a Scheduler/ Project Controls Specialist - Utilities to join our team in Binghamton, NY. Your Role Develop... ...valuable project control databases and reports for projects. Manage and ensure the reconciliation of program controls data with...Full timeTemporary workWork at officeFlexible hours- WellSense Health Plan in the United States is seeking an Inpatient Utilization Management Clinician to evaluate inpatient medical necessity, monitor... ...teams. This fully remote, full-time role requires an active RN license, nursing degree, and experience with InterQual...Remote jobFull time
$63.1k - $94.65k
...provider of technology-enabled revenue cycle management solutions for health systems, including... .... Must have current compact RN license, or be willing to obtain* NICU and... ...encouraged to apply. Schedule Information: Our Utilization Review team provides coverage seven days...Temporary workWork at officeLocal areaRemote workFlexible hoursShift work- The Utilization Management (UM) Nurse is responsible for conducting clinical reviews and assessing the medical necessity, appropriateness, and efficiency... ...and maintain an active, unrestricted Registered Nurse (RN) license in the applicable state or possess a compact license...
$90k - $110k
...digital assets platform spans trading, investment banking, asset management, staking, self-custody, and tokenization technology. We also... ...in data centers, commercial real estate, construction, utilities, or another capital-intensive, recurring-revenue business Familiarity...Full timeFor subcontractorWork at officeLocal areaFlexible hours- ...scientific user experience to help our clients better capture, manage, integrate, and analyze complex scientific data. We help improve... ...processes that many leading companies and government agencies utilize.What would you do? Deliver exceptional, differentiated solutions...Full timeLive inWork at officeLocal area
- ...acquisition efforts through strategic proposal management. Collaborate with experts to enhance... ...environment.Job DescriptionRFP Specialist OverviewThe RFP Specialist will play a pivotal... ...environment to achieve departmental goals.Utilize professional development opportunities...
$168.5k - $198.33k
...- and we’re just getting started.Key ResponsibilitiesAccount Management: Manage a personal book of business and serve as the primary day... ...insights and actionable recommendations to merchants by utilizing internal data visualization tools.Strategic Collaboration: Coordinate...Contract workWork at office3 days per week- ...has provided trusted contingent workforce management solutions for clients ranging from... ...PrideOne is looking for a Senior Staffing Specialist or junior Program Manager to be the primary... ..., extensions, and other HR-type issues. Utilize discretion and judgment to mitigate...Full timeContract workTemporary workLocal area
$20 - $30 per hour
...A behavioral healthcare organization is seeking a Utilization Review Specialist to conduct clinical auditing and negotiate authorizations. The ideal candidate has a Bachelor's degree in Social Work or Nursing and 1-2 years of healthcare experience. Responsibilities include...$62k - $70k
...the Role The purpose of this position is to ensure that the utilization process is thorough, organized and streamlined to provide the... ...Collaborates at a high level to problem solve on complex cases with Manager Completes pre‑certs and authorizations for virtual IOP...Full timeLocal areaRemote work$50 - $55 per hour
...RN – Utilization Management New York, NY – Midtown $50–$55/hour Monday–Friday, 9:00 AM–5:00 PM Onsite for the first 6 months, then hybrid Temp-to-perm opportunity A healthcare organization in Midtown Manhattan is looking for an experienced RN Utilization...Permanent employmentTemporary workMonday to Friday- ...and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices,... ...Referral Bonus! Job Summary The Access Specialist is responsible for managing system... ...documentation, audit logs, and tracking records. Utilize ticketing systems to manage and monitor...Full timePrivate practiceWork at officeMonday to FridayShift work
$24 per hour
...Pride Health is hiring two Peer Specialists to support our client's... ...Support (IPS) principles. Utilize personal experience with the... ...including: Wellness self-management WRAP (Wellness Recovery Action... ...direct care staff (Examples: RN, LPN, Nurse Aides, Therapists...Contract workTemporary workWork at officeLocal areaFlexible hoursNight shiftAfternoon shift$60k
...Integra is looking for a LPN/LVN experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key role in collaborating with our Medical Director to perform benefit and...Temporary workLocal areaRemote work$20 per hour
...Description Concern Housing is seeking a certified Peer Specialist to work with our Crisis Incident Stress Management (CISM) team to provide support to tenants across... ...and responded to in ways that fully develop and utilize each person's talent and strengths. EOE Statement...Daily paidInternshipLive inLocal areaFlexible hoursDay shiftAfternoon shift- ...AI-enabled solutions that span practice management to electronic medical records and e-prescribing... ...care to their clients. As an RCM Specialist II, you will serve as a trusted partner... ...operational efficiency and customer outcomes. Utilize technology and available tools to...Work at office
- ...competitive compensation. JOB SUMMARY: The Coding Specialist operates as a member of the Coding Department within Revenue Cycle Management. The Coding Specialist is responsible for... ...supports level of service selection Utilizes coding software, encoder and other resources...Temporary workMonday to Friday
- ...Medicaid Eligibility Specialist The Home Care Services Program Medicaid Eligibility Unit is recruiting six (6) Medicaid... ...guidelines and procedures. Complete the required case action utilizing the Welfare Management System (WMS) and various external program applications,...Full timeWork experience placementWork at office
$61k - $74k
...enabled workflow automation and evidence management platform for streamlining the production... ...Engineering, the configuration specialist will be responsible for assisting with the... ...part of our recruitment process, we may utilize artificial intelligence tools to support...Flexible hours$118.98k - $195.47k
...motivated individual to join our team as a Lead Specialist, Tax Accounting & Reporting.This role is... ...Provide insights and recommendations to management regarding potential tax planning... ...request an alternative process that does not utilize AI Tools or would like to request a...Full timeH1bWork at officeLocal areaWork from homeVisa sponsorshipWork visaFlexible hours$86.21k - $141.64k
...motivated individual to join our team as Lead Specialist, General Audit.This role will support... ...functions as a working audit project manager, fully responsible for planning, executing... ...an alternative process that does not utilize AI Tools or would like to request a reasonable...Full timeH1bWork at officeVisa sponsorshipWork visaFlexible hours
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