Remote Utilization Review Nurse - Home Health & Compliance
IntePros
A healthcare provider is seeking a Utilization Review Nurse to coordinate resources and ensure efficient delivery of home health care. This role involves monitoring patient admissions and ongoing care while ensuring adherence to guidelines. The ideal candidate will have a nursing license in Arizona and substantial experience in utilization review or case management. Strong communication skills and flexibility are essential. This is a contract position that offers a chance to make a direct impact on patient outcomes. #J-18808-Ljbffr
- ...healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities... ...and have experience in utilization review or home health. This contract role offers a chance to...Remote workContract work
$35 - $45 per hour
...from IntePros IntePros is seeking a Remote Utilization Review Nurse serves as a key clinical liaison,... ...meet patients’ needs while ensuring compliance with federal, state, and organizational... ...determine the need for continued home health services in alignment with Medicare...Remote workContract workWeekend work- ...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
$29 - $52 per hour
...Integrity Clinical Compliance AuditorOptum... ...the flow of health data and information... ...compliance reviews of medical and... ...position will utilize information from... ...This position is Remote in Massachusetts... ..., for example, nursing facility care... ...programs like Home HealthExperience...Remote workHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work- WNS, a Capgemini subsidiary, seeks a licensed RN/LPN for utilization review in a remote U.S.-based role. You will determine medical necessity, support case management, and ensure HIPAA compliance while collaborating with providers and clients. Regular CST schedule applies...Remote job
- ...Registered Nurse: Review and EvaluationAre you a registered nurse ready... ...program integrity through compliance management. Here, you'll champion... ...the freedom of working from home, the flexibility and... ...medical recordsExperience in utilization review, case management, quality...Remote workWork from home
- ...company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services.... ...authorization requests, ensuring compliance with Medicare guidelines, and collaborating... ...review. Competitive pay and remote flexibility offered. #J-18808-LjbffrRemote 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, assess...Remote 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
- ...American Specialty Health Incorporated seeks a Privacy Compliance Specialist to join the Regulatory Strategic Development (RSD) department... ...ensure compliance. The position is trained remotely and supports work-from-home operations with secure internet and video meetings...Remote workWork from homeWork at office
- ...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... ..., and document determinations in compliance with standards. Two or more years in...Remote work
- ...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
- ...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
$85.99k - $105.34k
...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....Remote workFull time$93k - $100k
...Integrity Systems seeks a Medical Review Supervisor (MCP) to lead the... ...with PI, and ensures ISO/compliance, reporting to the MR Project Manager. Remote from home OFFICE when not local in Grove... ...experience, and 4+ years in medical/utilization review or fraud investigation....Remote workLocal areaHome office- ...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
- A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing utilization management, reviewing medical records, and coordinating discharge planning. Candidates must have an active RN license...Remote workContract work
- ...Registered Nurse – Utilization Review (Remote) This is a fully remote Utilization Review RN role supporting multiple service lines and levels of... ...Utilization Review experience in a hospital setting (experience in health plans or medical groups is not applicable). InterQual...Remote work
- ...Overview Title: Clinical Review Nurse – Prior Authorization... ...Location: Fully Remote (PST Time Zone - WA/OR... ...Authorization Review to join our Utilization Management team. In... ...information in health management systems to ensure compliance with regulatory guidelines...Remote workContract work
- ...tuition assistance, 403(b), remote work United States,... ...: Johns Hopkins Health Plans, Hanover, MD 21076 Category: Nursing Schedule: Day Shift Employment... ...8:00 AM - 5:00 PM As a Utilization Review Registered Nurse for... ...JHHP is the place to call home. #J-18808-Ljbffr...Remote workFull timeMonday to FridayDay shift
- ...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
$1,600 - $1,800 per week
...Now Hiring: Registered Nurse – Utilization ManagementLocation: Buckley AFB... ...Peterson AFB, Colorado Military Health System Compensation: $1,600... ...no holidays, no telehealth/remote workMinimum QualificationsU.... ...Utilization Management, Utilization Review, or Case ManagementPreferred...Remote workContract workImmediate startMonday to Friday- ...Utilization Management Registered NurseDuration... ...Management (UM) Registered Nurse to support outpatient utilization review and prior... ...while maintaining compliance with regulatory standards... ...guidelines and health plan policies.... ...independently in a remote environment.Comfortable...Remote workContract work
- ...Currently seeking a Utilization Management RN . Please... ...below: Position is remote - candidate must reside... ...PA license or a Nurse Licensure Compact to include... ...medical record review to determine medical necessity... ...patients, and ensure compliance with federal, state,...Remote workImmediate startDay shift
$40 per hour
...reside in TXFull time remote Candidates must be based... ...performing initial, concurrent review activities; discharge... ...information regarding utilization management requirements... ...facilities. Registered Nurse (RN) with valid,... ...hospital/surgical setting or health care insurance company....Remote workContract workWork at office- ...time position entails administering assessments, ensuring compliance with regulations, and leading professional development.... ...South Carolina educator certification. Benefits include health care, work-from-home flexibility, and retirement options. All staff must reside...Remote workWork from homeFull time
- ...Location: 100% Remote Schedule: M-F... ...Works with the Utilization Management team primarily... .../utilization review and other utilization... ...effectiveness and compliance with all state and... ...State Registered Nursing (RN) license in good... ...Job function Health Care Provider Industries...Remote workContract work
- ...applicants This is full-time remote, but candidates must reside in... ...accurate and timely medical review of claims suspended for medical... ...URAC , NCQA standards and health insurance legislation . ~... ...prioritization skills. ~ Registered Nurse (RN) with unrestricted license...Remote workFull timeContract work
$35 - $43 per hour
....00/hr Job Title Clinical Review Nurse – Concurrent Review Location: Remote (California only – must reside in... ...Concurrent Review will perform utilization management functions to ensure members... ..., and medical determinations in health management systems. Educate...Remote work$40.12 - $62.19 per hour
...Utilization Review RNSinai Hospital's Utilization Review operates as a distinct... ...line of physician advisors, nurses, and support staff who... ...information.This is a Full-time remote position.Responsibilities:... ...wellness programs and mental health support403(b) retirement...Remote workFull time
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