Remote Utilization Management RN - Care Coordination
Humana Inc
Austin, TX
- Remote job
Humana Inc. is seeking a remote Utilization Management Registered Nurse to interpret clinical data and coordinate medical service determinations for home solutions and post‑acute care. You will review, document, and communicate with providers to ensure appropriate care levels and timely processing, reporting to the Manager of Utilization Management. The role emphasizes evidence-based criteria, collaboration with care teams, and adherence to HIPAA/privacy standards while supporting member #J-18808-Ljbffr Humana Inc
Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the Remote Utilization Management RN - Care Coordination in Austin, TX vacancy
- Highmark Health is seeking a remote Care Manager RN to support utilization management and care coordination. The role requires weekend availability (Saturday and Sunday) plus three weekdays, focusing on reviewing services, applying criteria, and improving member outcomes...Remote jobWeekend workWeekday work
- ...recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an... ...include evaluating healthcare services and coordinating care for members. Join a dynamic team and make a meaningful...Remote workContract work
The Judge Group
Chicago, IL3 hours ago - ...experienced Registered Nurse to join the Utilization Management team in a remote, full-time role focused on Medicare... ...information, apply criteria, and coordinate care plans to ensure members receive... ...Ideal candidates have an active RN license in their state, 3+ years of...Remote workFull timeWork at office
CVS Health
West Virginia3 hours ago $63.1k - $94.65k
...enabled revenue cycle management solutions for... ...have current compact RN license, or be... ...Information: Our Utilization Review team provides... ...of health care resources and assists... ...Denial Management Coordinates the P2P process with... ...: This is a remote role which requires...Remote workTemporary workPart timeWork at officeLocal areaFlexible hoursShift work$70k - $75k
...Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to... ...Description The Utilization Management Registered... ...services Quality of care concerns Interfacing... ...user‑friendly. Care Coordination & Quality Support Initiating...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from homeGuidehealth
Gary, IN3 hours ago$39.4 - $53 per hour
...enabled revenue cycle management solutions for health... ...healthcare. The Lead Utilization Review RN is a key contributor... ...-oriented, patient care delivery system, which... ...MANAGEMENT: Coordinates the appeal process with... ...required #LI-LS1 #LI-REMOTE Join an award-winning...Remote workWork at officeLocal area- ...in the United States seeks an RN Utilisation Management Nurse Consultant to support... ...Medicare joint procedures in a remote, full-time role. Remote work... ...apply evidence-based criteria, coordinate care with providers, and help optimise utilization while upholding safety and...Remote jobFull timeAfternoon shift
- Highmark Inc. is seeking a full-time REMOTE Care Management professional with weekend availability to coordinate utilization management and health coaching. You will review services... ...3 years of progressive clinical experience; RN licensure in PA or multi-state licensure,...Remote jobFull timeWeekend work
- ...Description: Home Care & Hospice Virtual Care Center Coordinator Registered Nurse (RN) Hiring for the following... ...critical moments. Utilizing virtual platforms,... ...Leadership - Accessible managers who understand the... ...patients' conditions remotely. Develop and...Remote workFull timeTemporary workPart timeReliefLocal areaImmediate startMonday to FridayShift workWeekend work
$47.03 - $63.48 per hour
...enabled revenue cycle management solutions for health... ...possible in healthcare. RN, Senior Utilization Review Quality will... ...management denials. Coordinate with service line... ...experience in an acute care environment required... ...experiences This is a remote position; however,...Remote workTemporary workWork at officeLocal area- Humana Inc. is seeking an Utilization Management Administration Coordinator to support non-clinical processes ensuring appropriate care for members. This fully remote role reports to the UM Manager within the Home Solutions organization, aligning with SNF services and...Remote job
$29.1 - $62.32 per hour
...passionate colleagues who care deeply, innovate with purpose... ...one community at a time. Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) Remote | Full-Time | Weekday Schedule... ...and care teams to coordinate appropriate treatment Apply...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work- ...highest quality patient care to residents... ...Transition of Care Coordinator to join our team.... ...TOC) Coordinator, RN supports high-risk... ...reducing avoidable utilization (reducing total... ...hybrid model with remote opportunities and... ...plans and symptom management strategies. Serve...Remote workContract workLocal areaFlexible hours
- Description Join our team as a remote (Oklahoma City) full time days and every other weekend RN Case Manager -Utilization Review at INTEGRIS Health,... ...available resources. Recommends and coordinates timely transfers to appropriate levels of care as indicated by clinical needs...Remote workFull timeWork at officeWeekend work
$42 - $45 per hour
...Care Management Coordinator/RN Location: 100% Remote Duration: 3+ Months (FT conversion) This is a Utilization Management RN part time position - working every other weekend (2 days a week in a 2 week cycle). Must be available M-F 8:30-4:30pm for 2-3 weeks of training...Remote jobHourly payFull timeTemporary workPart timeFlexible hoursWeekend work2 days per week- ...seeking a Registered Nurse Case Manager to handle an individual... ...communication with the health care team. The role emphasizes case... ...management, documentation, and payer coordination to ensure quality patient care. Required are an active RN license and a bachelor’s degree...Remote workWork from home
MedWatch, LLC
Florida3 hours ago - Centene is seeking a registered nurse care manager to develop, assess, and facilitate complex... ...care plans, educate families, and coordinate with providers to address unmet needs.... ...Macomb counties, with the option to work remotely from home the remaining time. Mon-Fri,...Remote jobLocal areaWork from home
$60.53k - $129.63k
...passionate colleagues who care deeply, innovate with purpose... ...one community at a time. Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) Remote | Full-Time | Monday-... ...healthcare quality, and care coordination to improve member outcomes...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shift- ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge... ...and claim denials/appeals.• Assesses and coordinates discharge planning needs with healthcare...Remote work
First Connect Health
Austin, TX3 days ago - ...Guidehealth, a data-powered healthcare company, seeks a Utilization Management Registered Nurse (RN) to perform utilization review remotely. The role supports compliance with federal and state regulations and URAC standards, applying medical necessity criteria to documentation...Remote work
Guide-Health
Gary, IN3 hours ago - Community Care is seeking a Registered Nurse to perform utilization review and coordinate care for members across the health care continuum. You will assess medical necessity, document decisions, and collaborate with physicians and care teams to optimize outcomes. In this...
$72.8k - $130k
...global organization that delivers care, aided by technology to help... ...an occasional opportunity for remote work based on business needs. As a Sr Utilization Management Nurse in the Springfield MA Regional... ...~ Must be a Registered Nurse (RN) with a current, active,...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal areaOptum
Amherst, MA3 hours ago- The Regional Care Coordinator (RCC) is assigned to a geographic region and is highly familiar with the region they service. The RCC is also... ...work from home and work in the physician's office position (remote). Succesful candidate will work autonomously in an exempt, Monday...Remote workWork at officeWork from homeMonday to Friday
- UnitedHealthcare is seeking an RN Clinical Care Coordinator to manage a panel of members with complex needs. The role focuses on medical, behavioral,... ...Residents in Plymouth County, MA or surrounding areas may work remotely part-time while visiting members in the community. #J-...Remote jobPart timeWork at officeWork from home
- ...Logan Health is hiring a Utilization Management Specialist to join the UM team. The role focuses on... ...case management and insurers to authorize care and ensure medical necessity. The... ...proficiency, with a four-day work week and remote options for Montana residents. #J-188...Remote work
Logan Health
Montana3 hours ago - ...Arkansas Blue Cross and Blue Shield is seeking an Utilization Management Nurse to perform clinical reviews for prior approvals... ...and evidence-based criteria to guide cost-effective care. Candidates should have an RN license in good standing, a Bachelor's degree in Nursing...Remote workHome office
Arkansas Blue Cross and Blue Shield
Arkansas3 hours ago - ...CVS Health is seeking a Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) to support treatment decisions remotely. You will collaborate with providers and apply clinical judgment for the right care at the right time. An active RN license...Remote workWork at office
CVS Health
Crystal Bay, NV3 hours ago - ...CVS Health is seeking an RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) for a remote, full-time role. You will review clinical... ...data, apply criteria, and coordinate plans to ensure members receive appropriate care in a timely manner. Ideal candidates...Remote workFull time
CVS Health
New Hampshire3 hours ago - ...Registered Nurse for the Medicare Utilisation Management Nurse Consultant role (Remote, Full-Time). You will help ensure members receive the right care at the right time within joint... ...while supporting care integration and utilization management. #J-18808-Ljbffr CVS HealthRemote jobFull time
- ...CVS Health is seeking a Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) for a remote, full-time role. You will review cases, coordinate care, and apply clinical judgment to support decisions, serving as a resource across stakeholders....Remote workFull timeWeekday work
CVS Health
North Dakota3 hours ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Management RN - Care Coordination. Be the first to apply!
