Remote Utilization Review Nurse
$85.99k - $105.34kUmpqua Health
A community-focused healthcare organization in Oregon is seeking a Utilization Review Nurse for a full-time remote position. The role involves evaluating clinical service requests, conducting prior authorization reviews, and collaborating with interdisciplinary teams. Applicants should have an active RN license and at least five years of direct patient care experience. The position offers a competitive salary from $85,990 to $105,344, along with a generous benefits package including healthcare and 401k options. #J-18808-Ljbffr
$78k - $88k
...Utilization Review Nurse- Remote It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast...Remote workFull timeContract workWork at officeWork from homeFlexible hours- ...Johns Hopkins Health Plans is seeking a Utilization Review Registered Nurse to apply clinical, managed care and utilization review expertise to improve member outcomes. This remote role supports the organization with standard hours; you will monitor care relevance, evaluate...Remote work
$90k - $107k
...Mass General Brigham Health Plan Holding Company, Inc. is seeking a Remote UM Nurse to support network adequacy review and authorization activities for members in ACO, HMO, and EPO products. The role requires clinical knowledge to review prior authorization requests,...Remote work- ...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 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 - $34.00 / hour Department: HS - UM This is a fully remote position. Description Astrana Health is looking...Remote workHourly payMonday to Friday- ...who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage... ...Employee Referral Bonus Program JOB SUMMARY: The Utilization Review Nurse is to assess the medical necessity and quality of healthcare...Remote workFull timeTemporary workLocal area
$78k - $88k
Gainwell Technologies is seeking a skilled Utilization Review Nurse to perform prior authorization across prospective, concurrent, and retrospective reviews for medical necessity, documenting findings and ensuring policy compliance. This home-based role supports providers...Remote job- ...Management Company LLC is seeking a registered nurse to perform concurrent reviews for the Missouri Medicaid population in a fully remote role. The incumbent will assess health... ..., and support discharge planning within utilization management guidelines. Requires MO RN...Remote job
- ...Job Description Job Description Remote Utilization Review Registered Nurse (UR RN) Location: Remote (Texas RN License or Compact License Required) Company: Nexus Health Systems Employment Type: Full-Time Make an Impact from Anywhere Nexus Health Systems...Remote workFull timeWork at office
$35 - $45.94 per hour
...Utilization Review Nurse Remote Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team. About the Role You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as...Remote workHourly payWork from homeHome officeWeekend work- ...leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the... ...insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and...Remote workFull time
- ...Comagine Health is seeking a remote clinical reviewer to evaluate medical necessity for behavioral health services across a national footprint. The role requires applying evidence-based criteria, managing high-volume reviews, and documenting outcomes within the EMR. You...Remote workFull time
- ...Management Location: 100% Remote Schedule: M-F 9:00am to 5... ...Summary Works with the Utilization Management team primarily responsible... ...necessity/utilization review and other utilization management... ...IL State Registered Nursing (RN) license in good standing...Remote workContract work
- ...Job Title This position is fully remote, however, you must reside in the State of Texas The position is a contract for about 6 months. RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and...Remote workContract work
- ...Overview Title: Clinical Review Nurse – Prior Authorization Review Location: Fully Remote (PST Time Zone - WA/OR Resident) Duration: 12-Month (Potential... ...for Prior Authorization Review to join our Utilization Management team. In this role, you will conduct...Remote workContract work
- ...Umpqua Health in Oregon is seeking a Utilization Review Clinician to perform clinical reviews and assess care related to mental health and substance use disorders. This full-time, exempt role requires evaluating medical necessity, level of care, and coverage decisions...Remote workFull time
- ...Utilizing clinical expertise, the full-time Licensed Medical Review Nurse (LVN/LPN) will conduct medical reviews of claims and documentation to ensure medical necessity... ...and compliance with regulations while working remotely on a MST/PST schedule. Key responsibilities...Remote workFull time
- ...Currently seeking a Utilization Management RN . Please see details... ...qualifications below: Position is remote - candidate must reside in... ...an active PA license or a Nurse Licensure Compact to include... ...conditions through medical record review to determine medical...Remote workImmediate startDay shift
$35 - $40 per hour
...Base Pay Range $35.00/hr - $40.00/hr Location Fully Remote Position Summary The Utilization Review Nurse serves as a key liaison in coordinating resources and services to meet patients’ needs, ensuring efficient, cost-effective, and compliant delivery of...Remote workContract workFlexible hoursWeekend work- ...first 25 applicants This is full-time remote, but candidates must reside in IL or TX... ...performing accurate and timely medical review of claims suspended for medical necessity... ...and prioritization skills. ~ Registered Nurse (RN) with unrestricted license in state...Remote workFull timeContract work
$35 - $43 per hour
...range $35.00/hr - $43.00/hr Job Title Clinical Review Nurse – Concurrent Review Location: Remote (California only – must reside in CA or hold an... ...Clinical Review Nurse – Concurrent Review will perform utilization management functions to ensure members receive the...Remote work$55 per hour
...from Akkodis Akkodis is hiring a Concurrent Review Nurse to support our client in the Healthcare space. Location: Remote (must be based in California) Employment type... ...setting. Preferred: Experience in case management, utilization management, or discharge planning. Experience...Remote workFull timeContract workTemporary workLocal area$30.64 - $45.8 per hour
...Utilization Review Nurse The Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective... ...of the Case Management department and of CorVel. This is a remote position. Essential Functions & Responsibilities:...Remote workHourly payFull timeWork at officeLocal areaFlexible hours$34 - $40 per hour
...recruiter to learn more. Base pay range $34.00/hr - $40.00/hr Remote (Compact Licensure Required) - Open to LPN's & RN's About the Role Medix is seeking an experienced Utilization Review Nurse to support our mission of improving patient care through home-...Remote workFull time- ...levels possible. Job summary: Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure... ...position with two days per week in the office and three days remote. Candidates must also have flexibility to periodically work...Remote workWork at officeImmediate startFlexible hours2 days per week
$30 - $40 per hour
...RN Clinical Review Nurse (Utilization Review Nurse)The Clinical Review Clinician for Appeals is responsible for performing clinical reviews to... ...PTO, Vacation or Sick Leave)Workplace Type:This is a fully remote position.Application Deadline:This position is anticipated...Remote workContract workTemporary work- ...to meet QM objectives Responsibilities: • Reviews documentation and evaluates Potential Quality of... ...inpatient hospital experience • Registered Nurse in state of residence • Must have prior authorization utilization experience • Able to work in multiple IT platforms...Remote work
$30.64 - $45.8 per hour
...The Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and... ...the Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES:...Remote workHourly payMinimum wageFull timeWork at officeLocal areaFlexible hours- ...leading healthcare solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services.... ...accredited nursing degree and experience in utilization review. Competitive pay and remote flexibility offered. #J-18808-LjbffrRemote work
$30 - $40 per hour
...Job Title: RN Clinical Review Nurse (Utilization Review Nurse) Job Description The Clinical Review Clinician for Appeals is responsible for... ...Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is...Remote workContract workTemporary work
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