Remote Clinical Review Nurse II - Utilization Expert
Elevance Health
- Remote job
The Clinical Review Nurse II role at Elevance Health is designed for experienced RNs to review and render complex medical determinations for benefits eligibility on member claims. Candidates should have an RN license, AS in nursing, and at least three years of clinical experience, with policy interpretation skills and familiarity with utilization review processes. This hybrid/remote position includes in-person training and adherence to travel/onsite requirements. #J-18808-Ljbffr Elevance Health
- Working Nurse in Los Angeles is seeking an experienced Utilization Management Nurse Specialist RN II for a full time role. You will coordinate and... ..., and collaborate with clinical staff to develop discharge... ...data transfer for medical reviews, in a #J-18808-Ljbffr Working...SuggestedFull time
- A leading staffing agency is looking for a Utilization Review Registered Nurse to work remotely with a major health insurance client. This role involves evaluating... ...of experience in utilization review and significant clinical experience in an acute setting. Strong written and...Remote work
- ...Carolina subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim... ...decisions and supports utilization review across multiple services. The position is remote, full-time, with standard hours... ...associate degree, and 2+ years of clinical RN experience required. #J-18...Remote jobFull time
- Mass General Brigham Incorporated is seeking a P2P Utilization Review Nurse to join the Central Utilization Management team. You will identify, prepare, and clinically review cases requiring payer peer-to-peer discussions, focusing on concurrent level-of-care denials and...Remote job
- ...Incorporated is seeking a Peer-to-Peer Utilization Review Nurse to join the central utilization... ...led peer-to-peer discussions through expert clinical analysis and standardized criteria. It... ...admitting teams, and care management, with remote work options and a 32-hour weekly #J...Remote job
$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant, we’re focused on helping our clients... ...and Commercial Payers. You will work remotely in a fast paced and dynamic... ...And Abilities Needed Experience with utilization management systems or clinical decision...Remote workFor contractorsWork at officeWork from homeHome officeShift work- WNS, a Capgemini subsidiary, seeks a licensed RN/LPN for utilization review in a remote U.S.-based role. You will determine medical necessity, support... ...RN/LPN license in the U.S. and at least 2 years in UR or clinical quality improvement; proficiency in MS Office is expected...Remote job
$20 - $36 per hour
Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading... ...meaning behind Caring. Connecting. Growing together. The Utilization Review LVN nurse will perform documentation review for medical necessity...Remote jobHourly payMinimum wageFull timeWork experience placementWork at officeLocal area$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 work- Centene Corporation is seeking a clinical professional on our Medical Management/Health Services team to review prior authorization requests and determine medical necessity... ...and cost-effective care, with flexible remote/hybrid/work options. #J-18808-Ljbffr Centene...Remote jobFlexible hours
- ...Brighton Health Plan Solutions is seeking an Utilization Management Nurse to perform medical necessity and benefit reviews remotely. The role requires current LPN licensure and expertise in CMS/MCG criteria with experience in inpatient/outpatient reviews. The successful...Remote work
$31.05 - $48.13 per hour
...Clinical Registered Nurse (RN) IIThe Clinical Registered Nurse (RN) II is responsible for managing individualized... ...educational workshops; reviews nursing professional... ...manner.Resource Utilization and StewardshipSupports... ...are) waived for 100% remote employees**Cath Lab/ElectrophysiologyOperating...Remote workWork experience placementImmediate startFlexible hours- BHPS, a remote Utilization Management provider, seeks an experienced UM Nurse (LPN) to review medical necessity and benefits according to national standards and policies. The role requires collaboration with healthcare partners, presenting cases to the Medical Director,...Remote job
$69.3k - $78k
...healthcare payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government... ...include auditing claims and documenting findings, all in a remote work environment. This role offers a competitive salary range...Remote job- ...Clinical Review Nurse II (US) Clinical Review Nurse II Sign on Bonus: $3500. Anticipated Job Posting End Date: 08/31/2026. Location... ...information strongly preferred. Medical management or Utilization Review experience is preferred. For candidates working...Full timeWork experience placementWork at officeLocal areaRelocation packageMonday to FridayDay shift
- ...Senior Clinical Nurse II - Virtual Heart Failure Transitional Care Bridge Clinic... ...evaluation, medication review, patient education, and ongoing monitoring through remote patient monitoring, virtual platforms... ...to treatment plans Utilize evidence-based practice and clinical...Remote work
$96.35 - $111.14 per hour
Category: Nursing Job Type: Full time Shift... ...Eligible: Yes Remote Eligible: No... ...of the job. The Clinical Nurse II is an RN that practices... ...effectiveness. Utilizes the EBP process:... ...evidence, considers expert clinical... ...Participates in the design, review, and evaluation...Remote workHourly payFull timeShift work- ...Job Description: Manager of Clinical Utilization Management - Denial ComplianceLocation... ...Type: Hybrid (85% remote, 15% onsite in Northridge,... ...managing daily tasks, performance reviews, and any necessary... ...from an accredited Registered Nursing Program; RN preferred.2. Minimum...Remote workPermanent employmentFull timeTemporary workFlexible hours
- Authority.inc is seeking an Energy Utilities Expert Commentary to deliver clear, accurate insights... ..., and related regulation. The role is remote and open to experts located anywhere in... ...about four hours per month. You will review Authority.inc research, datasets, and forecasts...Remote job
- ...DescriptionProSidian Seeks a Subject Matter Expert II - Subject Matter Specialist (NSS010) headquartered near CONUS - Washington, DC (Remote) to support requirements for Energy &... ...Industry (Nuclear | Oil & Gas | Power & Utilities | Distribution Engineering) Sector...Remote workFull timeTemporary workFor contractorsWork at officeFlexible hours
$30 - $34 per hour
A healthcare services company is seeking an experienced Utilization Review Nurse to work remotely. The ideal candidate must hold an active LVN license in California and have experience in outpatient utilization management. Responsibilities include approving or denying medical...Remote workHourly pay$127k - $152k
...for a Senior Software Engineer II to join our AI Enablement... ...within the Consulting & Embedded Experts team. In this role, you will operate... ...tools to assist in reviewing and evaluating job applications... ...data privacy rights.LinkedIn Remote Hashtag#LI-Remote LinkedIn Hashtag#LI...Remote workHourly payTemporary workWork experience placementWork at office- ...dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this role,... ...inpatient and outpatient utilization reviews, support transitions of care,... ...candidate will have strong clinical judgment, a valid RN license, and...Remote job
$87.32k - $142.17k
Arlington County Virginia is looking for an Electrical Plans Examiner I/II to review construction documents ensuring compliance with electrical design standards and regulations. This full-time position offers a salary range of $87,318.40 - $142,168.00 annually depending...Remote jobFull timeMonday to Friday- A healthcare staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates to reside in PA, DE, or NJ. Key duties involve applying criteria for medical necessity, collaborating...Remote job
- ...is seeking a Coding Reimbursement Specialist II to interpret and bill physician services... ...and modifiers. This is a full-time hybrid or remote role supporting the RCM team, typically Monday-Friday, 8 am-5 pm. You will review notes and reports, assign codes, enter data...Remote jobFull timeMonday to Friday
$40.12 - $62.19 per hour
...Utilization Review RNSinai Hospital's Utilization Review operates... ...physician advisors, nurses, and support staff who... ...ensure hospital stays are clinically appropriate and fully... ....This is a Full-time remote position.... ...center, a designated Level II Trauma Center, and the...Remote workFull time$34 - $40 per hour
...00/hr - $40.00/hr Remote (Compact Licensure Required... ...an experienced Utilization Review Nurse to support our... ...,000.00 1 day ago Clinical Review Nurse - Prior... ...Health Team Level I & II Remote Registered... ...knowledge in a new way. Experts add insights directly...Remote workFull time$34 - $35 per hour
...Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical... ...telephonic and concurrent review of hospitalizations and... ...Nurse- Prior Authorization Remote Registered Nurse (Remote... ...community knowledge in a new way. Experts add insights directly into...Remote workFull timeWork at officeWork from homeNight shift- Spectrum Healthcare Resources seeks a Utilization Manager Registered Nurse (UMRN) to work entirely from home in a fully remote role. The nurse will review cases, educate patients on appropriate care, and manage health care costs for dependents of active duty and eligible...Remote jobWork from homeMonday to Friday
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