Remote RN: Utilization Management Specialist
CVS Health
- Remote job
CVS Health is seeking a Utilization Management Nurse Consultant to coordinate, document and communicate all aspects of the utilization/benefit management program. You will ensure the member receives appropriate care at the right time and place, while adhering to federal and state turnaround times and reviewing clinical records. This full-time, remote role requires Monday–Friday 8:00am–4:30pm EST and offers comprehensive benefits, eligibility for bonus programs, and opportunities to support #J-18808-Ljbffr CVS Health
- Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires...Remote job
$51.77 per hour
...Job Title: Utilization Management Specialist (RN) Location: Baltimore, MD Type: Contract To Hire Compensation: Max BR $68 /hr, Mid-Range Pay (MRP) $100,500/yr Work Model: Remote – offsite Responsibilities Perform prospective, concurrent, and retrospective...Remote workContract workLocal area- ...Ascension Sacred Heart Hospital is seeking a nurse to join our Utilization Management team in a remote role. You will perform prospective, concurrent, and retrospective reviews to ensure medical necessity and alignment with reimbursement policies. Join a multidisciplinary...Remote work
- ...R1 RCM is seeking an experienced Utilization Review Author (RN) for our Physician Advisory Team. The role involves first-level admission and continued... .../MCG criteria and requires hospital-based UR or Case Management experience. The position offers a flexible schedule with...Remote workFlexible hours
- ...HealthHelp is seeking a remote Utilization Review clinician (RN/LPN/LVN) to support medical necessity determinations across client programs. You will... ...bring 2+ years in utilization review or case management, strong clinical knowledge, and proficiency with Microsoft...Remote workWork at office
- ...To support effective utilization management, the part-time Senior Utilization Review Specialist will conduct concurrent and retrospective... ...clinical teams in a fully remote capacity. Key Responsibilities... ...Qualifications Current, unrestricted RN license Five or more years of...Remote workPart time
- HonorHealth in Arizona seeks an Utilization Review RN Specialist to review and monitor utilization for cost... ...compact allowed), 1 year UR/UM or Case Management experience, and a strong collaboration with physicians and care teams. Remote work is available after training. #J...Remote job
- ...ABA Utilization Review SpecialistSpectrum Billing Solutions offers... ...industry-leading revenue cycle management services for healthcare... ...ABA Utilization Review (UR) Specialist to our growing team. The ABA... ...environment. This is a fully remote or office/home hybrid position...Remote workWork at officeFlexible hours
- ...Working remotely in a full-time capacity, the Utilization Management Support Specialist will conduct audits of authorization case work, provide technical support for authorization processing, and assist in resolving quality issues to ensure compliance with service level...Remote workFull timeSecond jobWork at office
- ...Excellus BCBS in New York seeks a Utilization Management professional to coordinate behavioral and physical health services for members. You will... ...required. Requirements include an associates degree with NYS RN license and at least three years of UM experience, plus proficiency...Work at office
- ...Utilization Management Specialist Under general supervision by management, and in collaboration with Medical Directors and other members of the clinical... .... Required License: LCSW, LCMFC, LMHC, LMFT, LCPC or RN. OR RN, then a Bachelor Degree is required. The Master Degree...Remote workContract workLocal area
$110k
...& Working Hours City/State: Nyack, New York Department: Care Management Work Shift: Day Work Days: MON-FRI Scheduled Hours: 9 AM-5:30... ...outcomes in the expected time frame and with the most efficient utilization of resources. Carries out activities related to utilization...Daily paidFull timePart timeFlexible hoursShift work$56.27k - $69.9k
...application process. Professionals Remote, Remote, US 2 Attachments 5 days ago... ...Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties... ...has a career opening for a Utilization Management Specialist II to join our team! The Utilization...Remote workWork at officeImmediate startWork from homeFlexible hours- ...Excellus BCBS in Utica, NY seeks an experienced RN to coordinate and monitor utilization management for behavioral and physical health services. You will ensure compliance with medical policies and standards, refer complex cases to the Medical Director, and collaborate...
$13 - $14 per hour
...Job Type : Contract Location- Remote Schedule and Shift: Monday-Thursday... ...contracted health plans requirements related to Utilization Management and authorizations. Acts as a... ...applies to direct care staff (Examples: RN, LPN, Nurse Aides, Therapists) referred...Remote workHourly payContract workWork at officeLocal areaShift work- Trillium Health Resources in North Carolina is hiring a Utilization Management Specialist II to validate service authorization requests and manage workflow from intake through determination. You will ensure completeness, route cases to clinical staff, and monitor timelines...Remote job
- ...Huntsville Hospital is seeking a nursing professional to perform utilization management tasks, assessing medical necessity, hospital admission... ...minimize denials after discharge. Ideal candidates hold an LPN/LVN/RN license with at least two years of nursing experience; a BSN...
- ...Utilization Management Specialist The Utilization Management Specialist demonstrates excellent customer service performance in that his/her attitude... ...Works to maximize positive outcomes. Qualifications RN with current license in State of Michigan required. 3...Contract workWork at officeLocal areaImmediate start
$46.76 - $51.76 per hour
...references. Follows NCQA Standards and departmental SOPS to manage member assignments. Conducts research and analysis of... ...internal stakeholders. Nice to Have: Prior experience in utilization management, care management, or payer-side review of ABA services...Remote jobWork at office$114k - $161k
...Job Title: Principal Consultant Utility Return on Equity & Cost of Capital Specialist Job Location : Marlborough... ...: Hybrid 3 days in office, 2 remote days per week 2025... ...Concentric") is an employee-owned leading management consulting and financial advisory...Remote workWork at officeWork from homeFlexible hours2 days per week- ...Utilization Manager Registered Nurse (UMRN) 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...Remote workFull timeContract workWork at officeWork from homeMonday to Friday
- Sentara Health Plans Community Care in Norfolk, VA seeks an Utilization Review Nurse to manage utilization management within licensure. You will handle... ...communicating decisions to members and providers. The role requires a RN license, 3 years of acute care experience, and familiarity...
- ...our service to our vegetation management clients. We’re transparent... ...plans necessary work to meet utility standards Collects data on unit... ...preferred ISA Utility Specialist certification preferred Must... ...patrol of utility power lines; remote locations as well as urban, city...Remote workFull time
- UF Health Central Florida is seeking an experienced registered nurse to support utilization management. The role evaluates medical records to confirm necessity and appropriateness of services, coordinates with care teams, and communicates authorization decisions to support...
- Meadville Medical Center in Meadville, PA is seeking a qualified RN to support Utilization Management and clinical documentation efforts on-site. The role focuses on evaluating medical necessity, coordinating care, and ensuring accurate documentation. External candidates...Relocation package
- A leading healthcare staffing agency is seeking an experienced Registered Nurse (RN) - Utilization Management to support clinical decision-making and ensure appropriate use of healthcare services. This role requires strong assessment skills and experience in utilization...Contract work
- Summa Health System is seeking a Full-Time Utilization Management Nurse to optimize cost-effective care across the hospital care continuum. The role involves performing initial and concurrent reviews, aligning with Medicare/ payer guidelines, and applying clinical criteria...Full time
- ...candidate will coordinate with healthcare providers, support discharge planning, and analyze utilization data for improved care coordination. Candidates must have an active RN license and 3+ years of relevant experience, showcasing strong communication and organizational...
- A leading staffing firm is seeking a Utilization Management professional who is responsible for inpatient medical necessity and utilization review. The ideal candidate will have an RN license, strong problem-solving skills, and at least 4 years of clinical nursing experience...
- Huntsville Hospital seeks a qualified nurse for utilization management to evaluate medical necessity and appropriateness of inpatient and continued stays. You will ensure payer authorizations where required and document care to minimize denials after discharge. The role...
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