Remote Utilization Management Nurse (RN)
Central California Alliance for Health
- Remote job
Central California Alliance for Health is seeking a full-time temporary Utilization Management RN in California. You will report to the UM Supervisor and conduct pre-authorization reviews, perform concurrent or retrospective reviews, and participate in UM Care Programs. The role requires a Bachelor's in Nursing, a current CA RN license, and knowledge of CMS guidelines, managed care, and Excel/PowerPoint. Hybrid work with remote interviews. #J-18808-Ljbffr Central California Alliance for Health
- CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home role in the EST time zone. The position supports... ...management and benefit coordination, requiring an active RN license and hospital experience. Responsibilities include...Remote jobWork from home
$70k - $75k
...analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build... ...Job Description The Utilization Management Registered Nurseis responsible... ...education consistent with current nursing practice standards and the...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home- CVS Health is seeking a Utilization Management (UM) Nurse Consultant for a fully remote, full-time role open to CST zone candidates. You will coordinate, document, and communicate all aspects of utilization and benefit management, ensuring appropriate care levels within...Remote jobFull time
$59.5k - $116.6k
UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services and requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate...Remote jobWeekend work$72.8k - $130k
...Sr Utilization Management Nurse Optum is a global organization that delivers care, aided by technology... ...there is an occasional opportunity for remote work based on business needs. As a... ...Qualifications: ~ Registered Nurse (RN) with a current, active, unrestricted...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- Humana is seeking an experienced Utilization Management Nurse 2 to support medical necessity reviews, care... ...providers and members. The role is remote/work-from-home with weekend shifts and... ...few times annually; requires Kentucky RN license, 2+ years clinical experience,...Remote jobWork at officeWork from homeShift work
- A leading healthcare organization is seeking a Care Manager RN for a remote role primarily serving the state of Washington. This per diem position involves crucial utilization management activities, ensuring compliance with payer requirements and regulations. Candidates...Remote workHourly payDaily paidDay shift
- ...Spectrum Healthcare Resources has a need for a Utilization Manager Registered Nurse (UMRN) . These will be completely remote positions, working entirely from the Nurse’s home. The Nurse will be reviewing cases, educating patients on appropriate care and managing health...Remote workFull timeContract workWork at officeWork from homeMonday to Friday
- CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home, full-time position open to MST/PST residents. You will coordinate and document utilization and benefit management activities, ensuring timely, safe, and appropriate...Remote jobFull timeWork from home
- ...Health is seeking a Medicare Precertification Utilization Management Nurse Consultant in a full‑time role. The position requires RN licensure, 3+ years of RN experience, and 1... .... Applicants should be able to work remotely from home within their state after training...Remote jobFull timeWork from homeShift work
$1,600 - $1,800 per week
...Now Hiring: Registered Nurse – Utilization Management Location: Buckley AFB & Peterson AFB, Colorado Military... ...weekends, no holidays, no telehealth/remote work Minimum Qualifications U... ..., full, active, and unrestricted RN license Certifications: BLS...Remote workContract workImmediate startMonday to Friday- Netsmart is seeking a Registered Nurse with solid utilization management experience to perform ED utilization reviews and admissions screening using established criteria. The role requires adept EMR review, strong clinical judgment, and collaboration with ED physicians...Remote job
- UnitedHealth Group's Optum is seeking an experienced RN for Utilization Management & Clinical Validation. You will review patient records, extract... ...using evidence-based literature and coding guidelines. This remote role supports telecommuting from anywhere in the U.S. with...Remote jobFlexible hours
- A healthcare management organization is seeking a Utilization Management Nurse to oversee health service utilization while collaborating... ...role requires an active LPN/RN license, and candidates should... ...comprehensive benefits package including remote work options. #J-18808-Ljbffr...Remote job
- Santa Barbara Cottage Hospital is seeking a licensed practical nurse to join BHPS Utilization Management as a remote reviewer of medical necessity and benefit determinations. You will assess cases using clinical guidelines and coordinate with providers and departments to...Remote job
- IntusCare is seeking a Utilization Management Nurse to ensure high-quality, cost-effective, and compliant care for PACE participants. You will review... ...with care plans and PACE regulations. This is a fully remote US-based position. #J-18808-Ljbffr Santa Barbara Cottage...Remote job
- Valenz Health is seeking a Utilization Management Nurse to oversee and manage the UM process, ensuring the delivery of high-quality, cost-effective... ...with CMS, URAC, and other regulators. This fully remote role requires a US-based location, strong nursing background...Remote job
- UCHealth in Colorado is seeking a Registered Nurse for a remote-capable role focused on utilization and case management. This fully remote opportunity requires residency in Colorado and adherence to payer guidelines and documentation standards. The role emphasizes medical...Remote job
- Appworkshub is seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this role, you will conduct inpatient and outpatient utilization reviews, support transitions of care, and ensure compliance with...Remote job
- ...people live healthier lives. The Utilization Management and Clinical Validation RN will review patient medical records... ...instructions and guidelines. This role is remote from anywhere in the U.S. with an... ...Care experience plus 2+ years in #J-18808-Ljbffr Registered NurseRemote job
$71.1k - $97.8k
...a part of our caring community The Utilization Management Nurse 2 utilizes clinical nursing skills to... ...Qualifications Licensed Registered Nurse (RN) with at least 3 years prior clinical... ...information.Travel: While this is a remote position, occasional travel to Humana'...Remote workFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayShift work- Johns Hopkins Health Plans (JHHP) is seeking a Utilization Review Registered Nurse to assess care appropriateness, authorize services, and coordinate discharge planning for plan members. This remote role prioritizes candidates in MD, DC, VA, PA, DE, and FL with strong clinical...Remote job
- CVS Health seeks a Utilization Management Nurse Consultant to support a 24/7 operation. In this role you will assess, plan, implement, coordinate,... ...and care teams to facilitate treatment decisions. Required RN experience and active license; Associates degree required with...Remote job
$42 per hour
IntusCare is seeking a Contract Utilization Management Nurse to ensure high-quality, cost-effective, and compliant care for PACE participants. The... ...transitions across care settings. The position is fully remote within the United States and offers a 1-year contract with...Remote jobHourly payContract work- Molina Healthcare seeks an experienced RN to support Arizona Plan clinical member services... ...active AZ RN license and experience with utilization management, prior authorization, and both inpatient and outpatient settings. Remote position, must reside in Arizona, with...Remote job
- A healthcare recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an active RN license and experience with health plan operations. Responsibilities include evaluating healthcare...Remote jobContract work
- Brighton Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate with partners, and ensure timely, compliant documentation and communications...Remote jobWork at office
- UnitedHealth Group is seeking an Utilization Management & Clinical Validation RN to accurately review medical records and extract case details, crafting defensible appeal letters using evidence-based literature and coding knowledge. You will work from anywhere in the U....Remote jobFlexible hours
- Brigham and Women's Hospital in Boston is seeking a Staff Nurse - Per Diem Rotating Day in Utilization Management. The role reviews denials, appeals, and ensures... ...and finance teams. A BSN is required with RN licensure in Massachusetts and prior utilization review...Remote jobDaily paid
- Humana Inc. is seeking an Utilization Management Nurse 2 to support coordination, documentation, and communication... ...medical service determinations. This remote role involves interpreting criteria... .... The position requires a Florida RN/LPN license with the stated experience...Remote job
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