Remote Utilization Review Case Manager & Appeals (RN)
Jobgether
- Remote job
Partner Company is seeking a Case Manager – Utilization Review Specialist for a fully remote position based in the United States. You will oversee admission and concurrent utilization reviews, assess medical necessity, and coordinate appeals to support patient care and financial performance. You will apply clinical nursing expertise to evaluate records, identify denials, and work with physicians, directors, and payer representatives to resolve complex cases and improve review processes. #J-18808-Ljbffr Jobgether
- Jobgether is seeking a Case Manager - Utilization Review Specialist based in the United States. This fully remote role focuses on admission and concurrent reviews, medical necessity, and appeal coordination to improve reimbursement outcomes and compliance with clinical...Remote job
$76k
...DATA is seeking a BPO Clinical Review Specialist in the United States, with remote work available for Florida residents... .... The role requires an active RN license (Florida or Compact) and at least 3 years of appeals, utilization management, or clinical review experience....Remote work- ...Description Join our team as a remote (Oklahoma City) full time days and every other weekend RN Case Manager -Utilization Review at INTEGRIS Health, Oklahoma City, OK. Get to Know Your Team: INTEGRIS Health, Oklahoma's largest not-for-profit health system, is seeking a...Remote workFull timeWork at officeWeekend work
- Optum is seeking a Per Diem Utilization Management Nurse to review medical records and craft defensible appeal letters. You will extract pertinent case details, adhere to HIPAA, and follow OPAS/Optum guidelines while meeting time expectations. The role offers telecommuting...Remote jobDaily paidLocal area
- CorVel Corporation is seeking a Utilization Review Case Manager for a remote role. The ideal candidate holds an RN license and has 4+ years of clinical experience with utilization review, CPT/ICD coding knowledge, and strong communication skills. Responsibilities include...Remote job
- CorVel is seeking a Utilization Review Case Manager to gather demographic and clinical data for in-patient and outpatient reviews, certify... ...supporting the Case Management department’s goals. This remote role requires RN licensure and 4+ years of clinical experience. The...Remote job
$52 - $56 per hour
...Contract RN For New York Health Plan You'... ...done UM. You've worked appeals. Now find a role that... ...you built in utilization management. 100% remote (U.S.) | Contract | $... ...investigation, clinical review, decision and notification... ...health, DME and LTSS cases Prepare case files...Remote jobContract workAfternoon shift- ...partnership with a healthcare team, seeks a Case Manager – Utilization Review Specialist based in the United States. This fully remote role focuses on admission and concurrent... ...reviews, denials prevention, and coordinated appeals to support patient care and financial...Remote work
$36 per hour
...Case Manager / Utilization Review Nurse (RN)Working at Cibola General Hospital makes a big difference in our community! Cibola General Hospital Rooted... ...risks.Assist with preparation and submission of denial appeals, including supporting clinical rationale and documentation...Hourly payFull timeTemporary workRelocation package$32 - $48 per hour
...health. Position Overview The Utilization Review Specialist RN assumes responsibility and... ...payers, as well as coordination and management of appeals for accounts deemed appropriate for... ...Review Specialist RN Department: Case management Location: Gateway Regional...Hourly payFull time$32 - $48 per hour
...Utilization Review Specialist RNFull-Time | Case Management | Gateway Regional Medical Center | Granite City, IllinoisGateway... ...Review Specialist Registered Nurse (RN) to join our Case Management team... ...and coordinating appeals for denied or at-risk accountsCollaborating...Weekend workWeekday work- Case Manager - Utilization Review Specialist - RemoteFull-Time Position You must reside in one of these states... ...denials from all payers, as well as appeals of all accounts reviewed and deemed... ...TRAINING & EXPERIENCE Current state-issued RN license. Knowledge in areas such as...Remote job
- ...of a partner company, who manages all applications and next... ...partner is looking for a Case Manager - Utilization Review Specialist based in the United... ...requirements. In this remote role, you will oversee admission... ...denials, and coordinate appeals to support appropriate...Remote workFull timeLive in
- Description The Case Manager / Utilization Review Nurse (RN) is responsible for coordinating patient care progression, discharge planning, and utilization... .... Assist with preparation and submission of denial appeals, including supporting clinical rationale and documentation...Work at office
$32 - $48 per hour
Utilization Review Specialist RN Full-Time | Case Management | Gateway Regional Medical Center | Granite City, Illinois Gateway Regional Medical Center is hiring... ...and documentation Managing and coordinating appeals for denied or at‑risk accounts Collaborating with...Full timeWeekend workWeekday work- ...LTSS department. RN will be responsible for providing case management services and evaluating... .... May also manage appeals for services... ...authorization and concurrent review. Provides monthly... ...setting by utilizing the applicable... ...Info: *possible remote opportunity after...Remote workContract workMonday to FridayFlexible hours
$63k - $94k
...Remote Utilization Review Registered Nurse (UR RN) Are you an experienced RN looking to transition away from the bedside while still making a massive... ...timely physician advisor referrals. Denial Management & Appeals: Coordinate the Peer-to-Peer (P2P) process with physicians...Remote workWork at office10 hours per weekFlexible hoursShift workWeekend workAfternoon shift3 days per week$40.12 - $62.94 per hour
...Sinai Hospital's Utilization Review operates as a distinct... ...is a Full-time remote position.Responsibilities... ...Review RN reviews the medical... ...trends in utilization management. Monitors... ...opportunities for expedited appeals and collaborates... ...advisors to review case not met with...Remote workFull time$42 per hour
...Ascension Texas Utilization Management Department (Fully Remote) Provides health care services regarding admissions, case management, discharge planning and utilization review. Reviews admissions and service... ...reimbursement and claim denials/appeals. Assesses and...Remote job- HealthEdge Software, Inc. is seeking a motivated Utilization Review RN to perform prospective, concurrent, and retrospective review of inpatient... ...involves coordinating discharge planning and addressing appeals initiated by providers, facilities, and members. The position...Remote jobContract work
$65 per hour
...RN Case Manager / Utilization Review - Syracuse, NYLocation: Acute Care/Academic Medical Center, Syracuse, NYEmployment Type: Full-timeHourly Rate: $65/hourAbout Greenlife Healthcare Staffing:Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated...Private practiceMonday to FridayDay shift$30 - $38 per hour
A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment... ...reviews for pre-certification requests, processing appeals, and working collaboratively with hospital staff. Candidates...Remote jobHourly payPart time- Ensemble Health Partners is seeking a Lead Utilization Review RN to drive medical necessity reviews, discharge planning, and appeals coordination while collaborating with physicians... ...integrity and patient care quality in a remote US-based environment. You will evaluate...Remote job
$63.1k - $94.65k
...enabled revenue cycle management solutions for health systems... ...have current compact RN license, or be willing... ...are seeking Virtual Utilization Review Specialist with at... ...documentation relevant to the appeal process. Maintains... ...: ~ This is a remote role which requires...Remote workFull timeTemporary workWork at officeLocal areaMonday to FridayShift work$81.95k - $110.24k
...enabled revenue cycle management solutions for health... ...healthcare. The Lead Utilization Review RN is a key contributor... ...: Coordinates the appeal process with the... ...work queues assigned to case management for revenue... ...#LI-LS1 #LI-REMOTE Join an award-winning...Remote workFull timeWork at officeLocal area- The Utilization Review Case Manager gathers demographic and clinical information on prospective, concurrent... ...Management department and of CorVel. This is a remote position ESSENTIAL FUNCTIONS &... ...licensure in the state of operation required;RN is required unless local state...Remote workMinimum wageFull timeWork at officeLocal areaFlexible hours
- ...CVS Health Corporation is seeking an RN Concurrent Review Nurse to join a remote team delivering inpatient clinical expertise to ensure medically... ..., 5+ years inpatient nursing, and 2+ years in utilization management or discharge planning, with an Associate degree (BSN...Remote workWork from homeMonday to FridayWeekend work
$89.07k - $162.8k
...negotiates, procures, and manages care of our members/... ...for carrying a complex case management case load ownership... ...(s) pre-authorization reviews to provide Medically... ...the population served. Utilizes standards/guidelines to... ...and Certifications: RN - Registered Nurse -...Contract workWork at office- ...RN BLS Case Managers, Utilization Review A Few Words About Us Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity...
- ...Registered Nurse Non-Certified Case Manager The Registered Nurse Non-Certified Case Manager works with physicians and multidisciplinary... ...BLS ~ Minimum of 2 years of nursing experience MUST HAVE UTILIZATION REVIEW EXPERIENCE ~ Preferred Bachelor's Degree in Nursing ~2...Shift workDay shift
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