Remote LPN Utilization Review Specialist
Mass Digital Health
- Remote job
Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The role involves performing retrospective medical reviews based on patient eligibility and contract requirements, requiring clinical expertise and knowledge of Medicaid guidelines. Candidates must have an active LPN license, at least one year of experience in a relevant medical setting, and the ability to work in a remote environment. Comprehensive benefits are provided, including medical, dental, and 401(k) plans. #J-18808-Ljbffr Mass Digital Health
- ...Tennova Healthcare- Turkey Creek Medical Center is seeking a PRN Remote Clinical Utilization Review Specialist to evaluate the necessity and efficiency of hospital services and to support payer requirements. You will review admissions and continued stays, collaborate with...Remote workRelief
- ...Cincinnati Children's is seeking a Utilization Review professional to perform admission and continued stay reviews to determine medical necessity... ...requires RN licensure with relevant experience and works remotely in the United States. The position includes interactions...Remote work
- ...Optum is seeking a remote Behavioral Health Utilization Review Specialist to support case management and care coordination. This full-time, Monday–Friday role offers standard business hours with occasional on-call needs based on business requirement. The position requires...Remote workFull timeMonday to Friday
- ...Optum is seeking a Behavioral Health Utilization Review Specialist to support case management and care coordination remotely. You will review cases, determine levels of care, and coordinate transitions between inpatient and outpatient settings. You will collaborate...Remote workMonday to Friday
- ...excellence. Who We're Looking For We are seeking an experienced specialist who is passionate about making a difference in the lives of... ...Health or related field required preferred. 2-3 years of utilization review experience in behavioral health, addiction treatment, or managed...Remote workDaily paidFull time
$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 workHourly payContract work- ...Kent County Cmh Authority is seeking a Utilization Review Specialist to perform reviews for I/DD, mental health, and SUD services. You will assess... ...appropriate intensity settings. The role is full-time and remote with occasional local travel within the Kent County area....Remote workFull timeLocal area
- ...Camber Connect in Olathe, KS seeks a detail-oriented Utilization Review Specialist to bridge clinical teams and health plans, managing initial, concurrent... ...a 90-day review, with 2 days in the office and 3 days remote. The role demands accuracy, urgency, and advocacy, with...Remote workWork at office
- 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 jobWork from homeHome office
- ...Integra Partners seeks an experienced LPN/LVN to conduct pre-service and post-service utilization reviews and appeals within a NCQA-compliant UM program, collaborating... ...approvals, referrals, and handling appeals. Remote opportunities available and strong team culture....Remote work
- ...Integra Partners is seeking an LPN/LVN with managed care experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with... ...guidelines. The role supports a nationwide remote workforce with competitive compensation,...Remote work
$63.1k - $83.65k
...making a difference by helping others. We are seeking a Utilization Review Specialist to perform utilization review of intellectual and... ...holiday requirements for this position. While the position is remote, the individual in this position will have occasional travel...Remote workFull timeTemporary workMonday to Friday- ...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
$69.39k - $88.61k
...Cincinnati Children’s is seeking an experienced Utilization Review professional for a remote role in the United States. The position supports case management, authorization, compliance, and education within the Utilization Review department. The role requires a Bachelor...Remote workFull time- ...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...Remote workWork at office
$34.82k - $55.99k
...The Utilization Review (UR) Intake Specialist provides staff support services including typing reports and correspondence, file handling and forms completion... ...Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote...Remote workHourly payMinimum wageFull timeWork at officeLocal areaFlexible hours- ...Integra Partners is seeking an LPN/LVN experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to review benefit and medical necessity within an...Remote work
- ...Integra Partners is seeking an LPN/LVN with UM experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with the Medical... ...the Medical Director. The role supports a remote workforce across the United States and...Remote work
- ...Integra Partners seeks an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals for DMEPOS in a managed care environment. You will collaborate with the Medical Director to ensure medical necessity reviews align with NCQA-compliant...Remote work
- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant patient care. The role emphasizes adherence to HIPAA, state and federal regulations, and a strong team-oriented environment...Remote workWork at office
$63.1k - $83.65k
...Position : Utilization Review Specialist Req.# : 26-144 FTE : Full-time, exempt Unit : UAW Department/Location : Utilization Management... ...requirements for this position. While the position is remote, the individual in this position will have occasional travel...Remote workFull timeTemporary workMonday to Friday- ...Saint Joseph Health System is seeking an RN Utilization Review specialist for a part-time, remote PRN role that requires on-site training in Mishawaka, Indiana. The position emphasizes reviewing medical necessity, insurance requirements, and discharge planning in collaboration...Remote workPart timeRelief
- ...growing nonprofit home infusion provider serving Maine, New Hampshire, and Massachusetts. We are seeking a Remote Clinical Review Specialist to conduct utilization management reviews and provide clinical information to confirm coverage for patients. This remote role...Remote jobMonday to Friday
- ...Integra Partners is seeking an experienced LPN/LVN to conduct pre-service and post-service utilization reviews and appeals in a managed care environment. You will... ...InterQual and CMS guidelines is preferred, and we offer remote work options and a comprehensive #J-18808-...Remote work
- Diversified Treatment Alternative Centers (DTAC) is seeking a detail-oriented Utilization Review (UR) Specialist to support our behavioral health programs in a hybrid/remote setup in Chadds Ford, PA. You will manage authorizations and eligibility verification across clinical...Remote job
- Spectrum Billing Solutions is seeking an ABA Utilization Review Specialist. The role supports review of clinical data to determine medical necessity... ...for ABA and related services. It is a fully remote or office/home hybrid position with a collaborative, detail...Remote jobWork at office
- FHE Health in the United States seeks an experienced Utilization Review Specialist to manage clinical authorization processes, ensuring timely, accurate, and compliant communications with insurance payers. You will support patient access by securing initial and continued...Remote job
$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 workMonday to FridayWeekend workWeekday work- ...Corporation is seeking a licensed clinician to review ABA services and health status across... ...reviews, data analysis to improve utilization, and collaboration with BH providers. Time... ...MST, or CST is required, with flexible remote/hybrid options. #J-18808-Ljbffr Centene...Remote workFlexible hours
- ...most efficient and streamlined manner. We are seeking a ABA Utilization Review Specialist The ABA Utilization Review Specialist will utilize his or... ...in a cohesive and rewarding environment. This is a fully remote or office/home hybrid position. Your Responsibilities: Review...Remote workWork at officeFlexible hours
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