Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Remote RN Utilization Review Specialist

CCF

Cleveland Clinic Health System is seeking an experienced Utilization Management RN Reviewer to work remotely with a focus on admission, concurrent and retrospective reviews. The role supports payer communications, data collection, and clinical decision-making to ensure appropriate resource use.

Ideal candidates are RNs with strong clinical judgment, knowledge of UM criteria, and proficiency with Microsoft Office.

#J-18808-Ljbffr
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Remote RN Utilization Review Specialist in New York, NY vacancy
  •  ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant...  ...team-oriented environment. Requirements include active RN or LVN licensure, a minimum of two years in utilization... 
    Remote work
    Work at office

    HealthHelp

    United States
    16 hours ago
  •  ...Allegheny Health Network seeks an RN Utilization Review professional to obtain pre-certifications, coordinate authorizations and manage denials...  ...appropriate levels of care and timely approvals. This remote role requires PA RN licensure (or multi-state eNLC), a care-... 
    Remote work

    Highmark Health

    United States
    16 hours ago
  •  ...Cleveland Clinic is seeking an Utilization Management RN Reviewer to support remote operations from home. The role covers admission and concurrent reviews, and ensures medical necessity criteria are applied to hospital stays and discharges. Qualifications include RN... 
    Remote work

    Cleveland Clinic

    New York, NY
    2 days ago
  • $65k - $85k

     ...Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning Potential At Concierge Home Care, we are growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team. This role is ideal for an RN with... 
    Remote work
    Monday to Friday
    Weekend work
    Weekday work

    Concierge Home Care

    United States
    1 day ago
  • CVS Health Corporation is seeking an RN Concurrent Review Nurse to join a remote team delivering inpatient clinical expertise to ensure medically necessary...  ...license, 5+ years inpatient nursing, and 2+ years in utilization management or discharge planning, with an Associate... 
    Remote job
    Work from home
    Monday to Friday
    Weekend work

    CVS Health Corporation

    Jackson, MS
    16 hours ago
  • HonorHealth is seeking an Utilization Review RN Specialist to review and monitor the utilization of health care services, ensuring medical necessity and appropriate levels of care. You will coordinate reviews for Medicare, AHCCCS, self-pay, and others from admission onward... 
    Remote job

    HonorHealth

    Phoenix, AZ
    16 hours ago
  • Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires... 
    Remote job

    Ampcus Inc

    Owings Mills, MD
    1 day ago
  •  ...Cohere Health seeks an experienced RN Reviewer to perform prospective, concurrent, and retrospective reviews ensuring medical necessity...  ...Commercial, Medicare, and Medicaid lines. The role is fully remote, requires strong communication, and entails 40 hours per week... 
    Remote work
    Flexible hours

    Cohere Health

    United States
    16 hours ago
  •  ...seeking experienced nursing professionals to review medical records and ensure appropriate...  .... Candidates must have a valid California RN license and at least two years of clinical...  ...degree in a related field. The position offers remote work with emphasis on critical thinking... 
    Remote work

    Santa Barbara Cottage Hospital

    United States
    1 day ago
  •  ...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 work
    Contract work
    Work from home

    Mass Digital Health

    Quincy, MA
    4 days ago
  •  ...Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This remote, part-time role focuses on obtaining and maintaining insurance authorizations, communicating with managed care organizations, and collaborating with clinical teams.... 
    Remote work
    Part time
    Weekend work

    Recovery Unplugged

    United States
    16 hours ago
  •  ...Northpoint Recovery Holdings, LLC is seeking a licensed Utilization Review Specialist to ensure clinically appropriate care, discharge planning, and cost-effective utilization across the treatment continuum. You will lead reviews of admissions, stays, discharges, and appeals... 
    Remote work

    Northpoint-Recovery-Holdings,-LL

    United States
    3 days ago
  •  ...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 Verify insurance benefits, eligibility,... 
    Remote work
    Full time

    Virtual Vocations Inc

    United States
    2 days ago
  •  ...treatment of addiction and mental health issues, the full-time Remote Utilization Review Specialist will manage pre-authorizations and concurrent reviews,...  ...School diploma or equivalent with a state license (e.g., RN, LPN, LCSW, LMHC) preferred Minimum of three years'... 
    Remote work
    Full time

    Virtual Vocations Inc

    United States
    3 days ago
  •  ...Utilization Review (UR) Specialist Location: Open to candidates near Wyomissing PA & Chadds Ford PA (Hybrid / Remote Eligible) Job Type: Full-Time Schedule: Monday - Friday Overview Diversified Treatment Alternative Centers (DTAC) is seeking a detail-oriented... 
    Remote work
    Full time
    Monday to Friday
    Flexible hours

    Diversified Treatment Alternative Centers

    Wyomissing, PA
    3 days ago
  • $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 work
    Hourly pay
    Contract work

    Pyramid Consulting

    Long Beach, CA
    4 days ago
  •  ...Minnesota Adult & Teen Challenge in Minneapolis is seeking a Utilization Review Coordinator to obtain and maintain insurance authorizations for...  ...and DHS requirements. Training is provided; initial in-person in Minneapolis with remote work thereafter. #J-18808-Ljbffr... 
    Remote work

    MnAdultTeenChallenge

    Minneapolis, MN
    21 hours ago
  •  ...and streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will utilize his...  ...a cohesive and rewarding environment. This is a fully remote or office/home hybrid position. Your Responsibilities:... 
    Remote work
    Work at office
    Flexible hours

    Spectrum Billing Solutions

    Skokie, IL
    1 day ago
  •  ...Bradford Health Services seeks an experienced Utilization Review Specialist to join our Birmingham-based team. You will evaluate patient records, treatment plans, and clinical data to determine medical necessity and appropriate level of care while ensuring regulatory compliance... 
    Remote work

    Addiction And Mental Health Services

    United States
    1 day ago
  • $24 - $26 per hour

     ...Utilization Review Specialist – Behavioral Health (Remote) PHP/IOP | Full-Time | Monday–Friday, 9 AM–5 PM ET | $24–$26/hour About the Role Principles Recovery Center (PRC) are hiring a Utilization Review (UR) Specialist to manage insurance authorizations for... 
    Remote work
    Full time
    Monday to Friday

    Principles Recovery Center

    Davie, FL
    21 hours ago
  •  ...Utilization Review Specialist – Join a Top 1% Workplace Are you looking for a fast-paced clinical role where your contributions are truly valued...  .... 2 days in office at our Olathe corporate office, 3 days remote. What You Will Do Act as the primary point of contact... 
    Remote work
    Work at office

    KVC Missouri

    Olathe, KS
    3 days ago
  • $40k - $50k

     ...Description Utilization Review Specialist Full-Time- must be able to work a few weekends per month Location: Remote Preferred Residence: Candidates residing in Florida, Tennessee, Texas, Virginia, South Carolina, or New Jersey are strongly encouraged to apply. Job Details... 
    Remote work
    Full time
    Part time
    Work at office
    Weekend work

    Recovery Unplugged

    Fort Lauderdale, FL
    2 days ago
  • Spectrum Billing Solutions is seeking an ABA Utilization Review Specialist to review clinical data and obtain authorized services for ABA and related treatments. This role offers either remote work or a home-office hybrid setup, with collaboration across clinical staff... 
    Remote job
    Work from home
    Home office

    Spectrum Billing Solutions

    New York, NY
    1 day ago
  • $30 - $35 per hour

     ...Location: Remote Schedule: Monday-Friday 8am-5pm MST Compensation: $30-35/hour Northpoint Recovery Holdings, LLC...  ...POSITION SUMMARY: As a key member of the Northpoint team, the Utilization Review Specialist is a licensed professional who is responsible for ensuring... 
    Remote work
    Full time
    Temporary work
    For contractors
    Work at office
    Monday to Friday

    Northpoint-Recovery-Holdings,-LL

    Meridian, ID
    3 days ago
  • $60k - $70k

     ...process. Full Time Office/Clerical Remote, Birmingham, AL, US Salary Range: $...  ...of the journey. We are seeking a Utilization Review Specialist to add to our dynamic team! The Utilization...  ...or relevant certification, such as RN, LPN/LVN, LMSW, LPC, CADC, LADAC, CCM,... 
    Remote work
    Full time
    Part time
    Work at office

    Addiction And Mental Health Services

    Birmingham, AL
    1 day ago
  • Kingman Healthcare Incorporated (KHI) seeks an experienced Utilization Review Nurse to support case management in Arizona. You will conduct medical...  .... Ideal candidates hold a BSN (MSN preferred), have 3+ years RN hospital experience, and UR or CM exposure. #J-18808-Ljbffr

    Kingman Healthcare

    Kingman, AZ
    3 days ago
  •  ...UofL Health in Louisville, KY is seeking a Utilization Review RN to support utilization management across inpatient and observation services. You will assess medical necessity, coordinate with physicians and case managers, and ensure payor approvals and appropriate discharge... 

    UofL Health

    Louisville, KY
    2 days ago
  • To support a growing behavioral healthcare team, the remote Licensed Utilization Review Specialist will ensure clinically appropriate care and cost-effective utilization of services, managing the review process from patient admission through discharge while collaborating... 
    Remote work

    Virtual Vocations Inc

    New York, NY
    6 hours ago
  •  ...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

    Gateway Regional Medical Center

    Granite City, IL
    4 days ago
  •  ...advanced care to our neighbors throughout the region. Organization Utilization Management Job Summary Facilitates optimal reimbursement...  ...is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for secondary review... 
    Remote job
    Temporary work
    Work experience placement
    Live out
    Flexible hours

    Vanderbilt University Medical Center

    New York, NY
    2 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote RN Utilization Review Specialist. Be the first to apply!