Remote Utilization Review Nurse - EMR & Criteria Expert
Netsmart
Netsmart is seeking a Remote Utilization Review Nurse to evaluate ED admissions using InterQual/MCG criteria and apply evidence-based guidelines to ensure proper resource utilization. You will discuss documentation and admission status with ED physicians and enter reviews for insurance authorization.
Ideal candidates have an active RN license, 3+ years in acute care (ER/ICU/medical-surgical), and 2+ years UM experience, plus EMR and MS Office proficiency in a fast-paced, remote setting.
#J-18808-LjbffrVacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Remote Utilization Review Nurse - EMR & Criteria Expert in United States vacancy
$22 per hour
Midi Health is hiring a Certified Medical Assistant to join their remote team in Austin, Texas. The ideal candidate should have a... ...extensive experience with the CoverMyMeds system and ATHENA ONE EMR. This role involves maintaining patient records, ensuring compliance...Remote jobHourly payFull 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 patient care cases and ensuring requested services align with medical necessity while adhering to confidentiality...Remote job
- ...Utilization Review Nurse We are seeking a detail-oriented and experienced Utilization... ...and medical necessity criteria. Key Responsibilities... ...electronic medical records (EMR/EHR). Strong clinical assessment... ...management department. Remote, hybrid, or on-site opportunities...Remote workWork at office
$78k - $88k
...Utilization Review Nurse- Remote It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges... ...and appropriateness of services, following clinical criteria, coverage policies, and contract guidelines. This involves...Remote workFull timeContract workWork at officeWork from homeFlexible hoursGainwell Technologies
United States4 days ago- ...Job Description Job Description Remote Utilization Review Registered Nurse (UR RN) Location: Remote (Texas RN License or Compact License Required... ...and appropriate level of care. Apply evidence-based criteria, including InterQual (or similar), to support clinical...Remote workFull timeWork at office
Nexus Health Systems Ltd
Houston, TX9 days ago - ...hours are 8:00 AM - 5:00 PM As a Utilization Review Registered Nurse for Johns Hopkins Health Plans, you... ...Evaluate member benefits and medical criteria to determine authorization of services... ...~ Work-life balance - This is a remote role! Candidates in the following approved...Remote workFull timeMonday to Friday
Johns Hopkins Medicine
Hanover, PA10 days ago $66.83k - $111.38k
...Days) Overview: Sentara Health Plans is hiring an Utilization Review Nurse/ RN for Medicaid - Remote! Status: Full-time, permanent position (40 hours)... ...setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits,...Remote workPermanent employmentFull timeTemporary workShift workDay shiftSentara Health
Nevada2 days ago$70 - $75 per hour
...ExpertLocation: Phoenix, AZ ( Onsite - Hybird) and remote is optionalDescription:We are seeking... ...Autodesk Fusion Manage Implementation Expert to lead the initial setup, and... ...disability, marital status, veteran status, or any other occupationally irrelevant criteria.Remote workHourly pay$170.6k - $250k
...establishing measurable success criteria and translating research... ...that evaluate synthetic data utility, controllability, coverage, and... ...you? You are a recognized expert in both deep learning and autonomous... ...of the AAP are available for review by applicants and employees...Remote work- ...Sustainability Reporting Expert For Industries And Companies We are looking for a sustainability reporting expert for industries... ...climate change fields. The ideal candidate should meet the following criteria: Age: Less than 35 B.E - Mechanical / Electrical /...Remote workFull timePart timeWork experience placementWork from home
Rcg Eecc
United States2 days ago $41 per hour
...Medical Review Nurse (RN) Remote position, however, candidates must reside in the State of TX or State of IL This position is a contract... ...insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the...Remote jobContract work- ...Utilization Review Nurse Position at Vassar Brothers Medical Center Northwell is the largest not... ...Review Nurse applies evidence-based criteria to evaluate medical necessity and collaborates... ...outlined in the Nuvance Health Remote Work Program Policy when utilizing a hybrid...Remote workNight shift
- Currently seeking a Utilization Management RN . Please see... ...below: Position is remote - candidate must reside... ...PA license or a Nurse Licensure Compact to include... ...medical record review to determine medical necessity... ...’ll apply InterQual criteria and other guidelines to...Remote workImmediate startDay shift
$78k - $88k
Gainwell Technologies is seeking a skilled Utilization Review Nurse to perform prior authorization across prospective, concurrent, and retrospective... ...home-based role supports providers, uses InterQual/MCG criteria, requires 3+ years inpatient experience and an active RN...Remote job- Brighton Health Plan Solutions, LLC is seeking an Utilization Management Nurse to perform medical necessity reviews remotely. Licensed LPN with strong MS Office skills will review clinical criteria, coordinate with care partners, and document determinations in compliance...Remote job
- Gainwell Technologies LLC is looking for a Utilization Review Nurse to work remotely in Maine. You will conduct reviews for medical necessity and appropriateness of services, utilizing clinical criteria and guidelines. Qualified candidates should have an active Maine RN...Remote jobFlexible hours
- ...a Mid Level Energy Programs Procurement Expert to support requirements that address the... ...DC | Houston, TX | Charlotte, NC | Other Remote) but services International Projects (OCONUS... ....COM. ONLY CANDIDATES WITH REQUIRED CRITERIA ARE CONSIDERED. Be sure to place the job...Remote workFull timeContract workTemporary workFor contractorsWork at officeFlexible hours
$1,966 per week
...first 25 applicants Nurses - are you looking... ...-life balance. Remote/hybrid setting (once... ...This individual will utilize clinical knowledge... ...meet acceptable criteria sets and... ...to a second level reviewer. This individual interfaces... ...knowledge in a new way. Experts add insights...Remote workFull timeTemporary workPart timeWork at officeWork from homeMonday to FridayFlexible hours- Location: Fully remote (PA RN License or Compact including PA Required), Must Reside... ...seeking a skilled and detail-oriented Utilization Review RN with a valid PA license (or Compact)... ...appropriateness of care Apply evidence-based criteria to assess patient treatment plans and...Remote workFull timeContract work
$120k - $180k
...Senior Safety Domain Expert – Falcon Veeva Systems is a mission-driven organization and... ...Ground-Truth Verification: Actively review and verify platform outputs across initial... ...complete case lifecycle, including validation criteria, database reconciliation, and global...Remote workWork at officeLocal areaWork from homeFlexible hoursVenturefizz Product Management Community
United States22 hours ago- ...DescriptionProSidian Seeks a Job Training and Education Expert (AER7) [Key Personnel | Program Manager -... ..., TX, Chicago, IL, Washington D.C. (Remote) to provide Education, And Academia... ...documented, and comply with established criteria. All employees, in the performance of...Remote workHourly payFull timeTemporary workFor contractorsH1bWork at officeFlexible hoursNight shift
- ...Seeks a Subject Matter Expert | Nuclear Energy Subject... ...Area or Telework (Remote) As Authorized to 0Seeking... ...independent technical reviews in various areas such as... ...compliance to regulatory criteria of the Lessee... ...oversight and transfer of utility, and transportation services...Remote workFull timeContract workFor contractorsH1bWork at officeFlexible hours
- ...Utilization Management Registered Nurse Duration: 6 Month Contract (Possibility of Extension... ...outpatient utilization review and prior authorization... ...and medical necessity criteria. Required Qualifications... ...work independently in a remote environment. Comfortable...Remote workContract work
- Overview Title: Clinical Review Nurse - Prior Authorization Review Location: Fully Remote (PST Time Zone - WA/OR Resident) Duration... ...Review to join our Utilization Management team. In this role,... ...with regulatory guidelines and criteria Works with healthcare providers...Remote workContract work
- ...Management Location: 100% Remote Schedule: M-F 9:00am... ...-based MCP/MCG criteria. Verify member benefits... ...Summary Works with the Utilization Management team primarily... ...necessity/utilization review and other utilization... ...IL State Registered Nursing (RN) license in good standing...Remote workContract work
- Job Title Utilization Review/Case Management - Nurse Department Case Management (Quality) Hours & Shift Requirements... ...(combination of in person and remote considered) General Summary The Utilization... ...reviews and discusses payer criteria and issues on a case-by-case basis...Remote workFull timeShift work
$35 - $45 per hour
...message the job poster from IntePros IntePros is seeking a Remote Utilization Review Nurse serves as a key clinical liaison, coordinating resources... ...Outlook, Excel, Word, Adobe) and capable of navigating multiple EMR and case management systems. Seniority level Mid‑Senior...Remote workContract workWeekend work$30 - $34 per hour
Overview Utilization Review Nurse - Remote at Astrana Health Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Compensation: $30.00 -... ...medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. This position will...Remote jobHourly payMonday to Friday- ...Health is seeking a Medical Billing & Collections Specialist for a remote, full-time position. The specialist will ensure the accuracy of... ...1+ year of experience in a medical setting, proficiency in EMR systems, and strong knowledge of billing and insurance guidelines...Remote workFull time
Logan Health
New York, NY3 days ago - ...Utilization Review Nurse American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional... .../necessary clinical data Apply clinical review criteria, guidelines, and screens in determining the medical necessity...Remote jobFull timeTemporary workLocal area
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Review Nurse - EMR & Criteria Expert. Be the first to apply!
Related searches
- utilization review nurse United States
- remote utilization review nurse part time United States
- utilization review nurse work from home United States
- remote utilization review nurse United States
- utilization review registered nurse United States
- fruit expert United States
- subject matter expert United States
- expert data analyst United States
- guest service support expert United States
- expert systems engineer United States