Remote Utilization Review RN - Insurance Care Quality
IntePros
A healthcare staffing firm is seeking a skilled Utilization Review RN to join their team. This fully remote position requires a valid PA RN license and prior experience in insurance utilization review. Responsibilities include conducting clinical reviews, applying evidence-based criteria for patient treatment, and collaborating with healthcare providers. Strong clinical judgment and familiarity with review tools are essential for this role. The ideal candidate will have 2-5+ years of experience in the field. #J-18808-Ljbffr
- ...clinical member services review assessment... ...clinical guidelines, insurance policies, and... ...integrated delivery of care across the... ...strategy to provide quality and cost-effective... ...model. Adheres to utilization management (UM) policies... ...Registered Nurse (RN). License must be...Remote workQualityWork at office
$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX... ...and will include 80% travel. Remote role. Will require a driver’... ..., and need for services for care plan development. Monitor... ...travelers be an infectious agent of quality care wherever they go....Remote workQualityHourly payFull timeContract workImmediate startShift work3 days per week- ...organization is searching for Clinical Utilization Review Nurses (RN) based in Alabama. This full-time, remote position involves assessing the medical necessity and quality of healthcare services.... ...ensuring compliance with quality care. The organization values work-life...Remote workQualityFull time
- ...organization is seeking a remote RN to ensure appropriate administration... ...of hospital resources and quality care. Responsibilities include reviewing patient care levels and utilizing Interqual Criteria for... ...benefits including health insurance, retirement contributions,...Remote workQuality
- ...provider in Chicago is hiring a Clinical Care Manager to oversee high-quality, patient-centered care through Utilization Review. The role requires an active RN license in Illinois and significant... ...position offers the flexibility of remote work while supporting professional...Remote workQuality
- ...healthcare provider in Houston is seeking a Utilization Management Review Nurse. This role involves evaluating... ...based on necessity and promoting quality care outcomes. The candidate must have a... ...with care management and insurance payers. This position offers flexible...Remote workQualityFlexible hours
- ...Village Center for Care, Inc. is seeking a self-motivated RN for the role of Utilization Review Nurse in a full-time, hybrid position located in the New York Tri-State... ...for assessing member needs and ensuring high-quality health care services. Key qualifications include...Remote workQualityFull time
- ...Humana is offering a remote internship for a Utilization Management Behavioral Health Registered Nurse (RN) Intern. This role supports... ...team, focusing on clinical reviews and patient care. Candidates must be transitioning... ..., documentation, and quality assurance. The position...Remote workQualityInternshipWork at officeWeekday work
- ...is seeking a Clinical Review Supervisor to provide... ...clinical staff conducting utilization review activities. This fully remote position requires an RN license and relevant experience in patient care and medical management. The role focuses on quality oversight and staff...Remote workQuality
- ...MVP Health Care is seeking a Sub-Acute RN UM Reviewer-Medicare to join our Utilization Management team. In this remote role, you will conduct clinical reviews to ensure compliance with... ...Medicare guidelines and support high-quality patient outcomes. The ideal candidate...Remote workQuality
- ...Healthcare Solutions is seeking a Utilization Review Nurse to join their team in a fully remote role. The ideal candidate... ...LPN) or Registered Nurse (RN) with strong critical... ...reviews, assisting in quality improvement, and resolving patient care issues with providers. Candidates...Remote workQuality
$30.37 - $59.21 per hour
...clinical member services review assessment... ...clinical guidelines, insurance policies, and... ...integrated delivery of care across the... ...strategy to provide quality and cost-effective... ...model. Adheres to utilization management (UM) policies... ...Registered Nurse (RN). License must be...Remote workQualityHourly payWork experience placementWork at office- ...and e-referral case review and authorization of services utilizing established mental... ...criteria to provide quality care appropriate to... ...is full-time, fully remote (work from home) and... ...One (1) year health insurance plan experience or... ...clinical license (RN, LMSW, LP, LPC, or...Remote workQualityFull timeWork from homeShift workWeekend workAfternoon shift
- ...engaged in health care quality consulting and quality... .... Our talented remote workforce spans... ...dental and vision insurance Paid time off for... ...employee is an active RN and based in... ...Supervisor, Clinical Review plays a critical role... ...staff who conduct utilization review and/or...Remote workQualityContract work
- ...appropriate clinical review of all applicable... ...stated in system utilization management plan.... ...This role will be remote but regular meetings... ...in hospital or insurance related utilization... ...including critical care, for appropriateness... ..., and reporting quality issues. Reviews concurrently...Remote workQualityReliefShift workWeekend work3 days per week
$35 - $45 per hour
...Position: RN / Utilization Review Nurse Location: Sacramento, CA (ON-SITE)... ...timely, accurate, and compliant care decisions in accordance with... ...working independently in a remote or office-based setting.... ...same enthusiasm, we devote to quality and competency and using the...Remote workQualityWeekly payContract workWork at officeMonday to Friday$2,210 per week
...managed health care, focused on what... ...while ensuring quality care through... ...voluntary life insurance. Critical Illness... ...-life balance. Remote/hybrid setting... ...individual will utilize clinical knowledge... ...a second level reviewer. This... ...not limited to RN, LMSW, LMHC. Successful...Remote workQualityFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours- ...POSITION SUMMARY: The Utilization Review Registered Nurse (UR RN) is a key... ...-effective patient care. Working collaboratively... ...policies on Health Insurance Portability and... ...levels of care. • Quality Assurance and Compliance... ...based staff; optional for remote staff.Remote workQualityWork at office
$32 - $48 per hour
...RN-Utilization Review/Case Manage Nurse - RFT Hot Job Gibson City, IL 6... ...DEPARTMENT: CASE MANAGEMENT (QUALITY) HOURS & SHIFT REQUIREMENTS... ...of in person and remote considered) GENERAL SUMMARY... ...ensures safe transitions of care. GIBSON AREA HOSPITAL & HEALTH...Remote workQualityHourly payFull timeWork at officeRelocation packageShift work- ...OverviewDescription – This is a remote role. You MUST live... ...) to be considered. Care Manager RN, Per diem / On call, Day shift.The Utilization Review (UR) Nurse has a... ..., vision), life insurance, disability insurance... ...expanding access to quality health care for all.Providence...Remote workQualityDaily paidLive inShift workDay shift
$30 - $38 per hour
...solutions, and comprehensive care navigation together in one... ...Job Summary We are seeking Utilization Review Nurse RN to join our team on a part‑... ...to meet productivity, quality, and turnaround times daily... ...successfully perform in a remote healthcare environment. Ability...Remote workQualityHourly payFull timePart timeWork at officeMonday to FridayWeekend work- ...Registered Nurse (RN) – Case Manager & Utilization Review Nurse Wichita, United... ...setting while supporting quality member outcomes,... ...services, and effective care coordination. The... ...stop-loss carriers, insurance brokers, and health... ...however, this isnota remote position. Applicant...Remote workQualityMonday to FridayFlexible hours
- ...or behavioral health care services. Assesses... ...professionals regarding utilization management and quality requirements. Makes... .... Medical necessity reviews for designated... ...~ Registered Nurse (RN) - State of Michigan... ...protection, home and auto insurance Traditional and...Remote workQualityFull timeMonday to FridayShift workWeekend work
$49.14 per hour
...Dignity Health is seeking a Utilization Review Nurse to supervise clinical decision-making and ensure resource utilization compliance. Responsibilities... ...utilization review principles, and liaising with care coordinators and physicians. Ideal candidates will have a nursing...Remote workQualityHourly pay$77.91k
...USA, LLC is seeking an Inpatient Review Nurse to join its remote Utilization Management team. This position... ...inpatient admissions, coordinating care, and ensuring quality and cost-effective patient... ...management and licensing as an LVN or RN in California. The role offers a...Remote workQuality- ...Harris Health System is seeking a Utilization Management Review Nurse (UMRN) to assess the necessity and... ...utilizes clinical expertise to ensure care aligns with industry standards, works... ...resolve denials, and participates in quality improvement activities. Qualified...Remote workQualityFlexible hours
- ...Martin's Point Health Care Inc. is looking for a Utilization Review Nurse in New York. This role requires a strong... ...and utilization management to ensure quality, cost‑efficient medical outcomes. Responsibilities... .... Candidates must have a Compact RN License and at least 3 years of...Remote workQuality
- ...seeking a Registered Nurse (RN) Intern to conduct clinical reviews and support healthcare... ...providing key training in a remote work setting. Key responsibilities... ..., documentation, and quality assurance. Applicants must... ..., and a keen interest in managed care. #J-18808-Ljbffr...Remote workQualityInternship
- ...Quantum Corporation is seeking a Pre-Cert Pharmacy Review Nurse, RN for their healthcare navigation team. The role... ...with multidisciplinary teams to ensure quality care for members, either on-site in Dublin, OH, or remotely within the United States. The ideal candidate...Remote workQuality
- ...Advanced Health Coordinated Care Organization is hiring a part-time remote Utilization Review Nurse. The ideal candidate will be a licensed RN with experience in acute care and utilization... ...prior authorizations, ensuring quality care, and applying medical necessity...Remote workQualityPart time
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